老年血液透析患者血清甲状旁腺激素水平与远期心脑血管事件相关性的研究

Association between serum intact parathyroid hormone level and long-term cardiocerebrovascular events in elderly patients undergoing hemodialysis

目的探讨老年血液透析患者血清全段甲状旁腺激素(iPTH)水平与心脑血管事件(CCVE)相关性。方法选择2015年1~3月在我院规律血液透析的老年患者134例,根据血清iPTH水平分为低水平组(iPTH<150.00 ng/L);中水平组(iPTH 150.00~300.00ng/L);高水平组(iPTH>300.00 ng/L)。随访5年,观察各组CCVE发生情况,用Kaplan-Meier生存曲线及Cox回归模型评价血清iPTH水平与CCVE的关系。结果低水平组年龄、糖尿病比例高于中水平组和高水平组;血清白蛋白、血磷、服用活性维生素D比例低于中水平组和高水平组(P<0.05,P<0.01)。Kaplan-Meier生存分析显示,血清iPTH低水平组和高水平组CCVE发生率显著高于中水平组(80.00%和67.50%vs 46.15%,χ^(2)=13.897,P_(log-rank)=0.001)。多因素Cox回归分析显示,低水平组和高水平组患者CCVE发生风险是中水平组的1.992倍(95%CI:1.120~3.544,P=0.019)和2.216倍(95%CI:1.209~4.060,P=0.010)。结论血清iPTH降低或升高均是老年血液透析患者CCVE发生的独立危险因素。

Objective To study the association between serum intact parathyroid hormone(iPTH)levels and long-term cardiocerebrovascular events(CCVE)in elderly patients undergoing hemodialysis.Methods One hundred and thirty-four elderly patients who underwent regular hemodialysis in our hospital from January 2015 to March 2015 were divided into group A(iPTH<150 ng/L),group B(iPTH=150-300 ng/L),and C group(iPTH>300 ng/L).The patients were followed up for 5 years,during which the incidence of CCVE was recorded.The association between serum iPTH level and CCVE in elderly patients undergoing hemodialysis was analyzed by Kaplan-Meier survival curve analysis and multivariate Cox regression analysis respectively.Results The age was significantly older and the incidence of DM was significantly higher while the serum albumin and phosphorus levels and the ratio of taking active vitamin D were significantly lower in group A than in group B and group C(P<0.05,P<0.01).Kaplan-Meier survival curve analysis showed that the incidence of cardiocerebroovascular events in group C and group A were significantly higher than those in group B(80.00%,67.50%vs 46.15%,χ^(2)=13.897,P_(log-rank)=0.001).Multivariate Cox regression analysis displayed that the risk of CCVE was 1.992-fold higher and 2.216-fold higher respectively in group A and group C than in group B(95%CI:1.120-3.544,P=0.019;95%CI:1.209-4.060,P=0.010).Conclusion Reduced or elevated serum iPTH level is an independent risk factor for CCVE in elderly patients undergoing hemodialysis.