单中心维持性血液透析患者钙磷代谢情况及影响因素

Metabolism of calcium and phosphorus and its influencing factors in maintenance hemodialysis patients

目的:分析维持性血液透析患者钙、磷、钙磷乘积、全段甲状旁腺激素(iPTH)达标情况并对其影响因素进行分析。方法:应用横断面研究的方法,纳入武汉大学中南医院血透中心维持性血液透析患者并采集患者年龄、性别、体质量指数(BMI)、原发病、透析龄、血管通路、血常规、电解质、iPTH等资料,并对结果进行分析。结果:本研究入选患者176例,平均(60.88±14.35)岁,其中男性108例(61.36%),女性68例(38.64%)。原发病:糖尿病肾病57例(32.39%),高血压性肾病41例(23.30%),慢性肾小球肾炎55例(31.25%),多囊肾5例(2.84%),高尿酸性肾病4例(2.27%),狼疮性肾炎3例(1.70%),梗阻性肾病3例(1.70%),其他8例(4.55%)。以K/DOQI指南为标准,校正钙、血磷、钙磷乘积、iPTH达标率分别为59.66%、43.18%、62.5%、28.41%。多因素Logistic回归分析结果显示,透析龄是校正钙的影响因素;性别、血肌酐、BMI、血钾是血磷的影响因素;透析龄是iPTH的影响因素。结论:研究结果提示本中心校正钙、磷、钙磷乘积、iPTH控制并不理想,尤其是血磷、iPTH达标率较低。钙磷代谢紊乱是维持性血液透析患者常见并发症,严重影响患者生活质量及生存率,我们需积极寻找原因,以期提高达标率,改善患者生活质量。

Objective:To analyze the standard status of calcium,phosphorus,calcium⁃phosphorus product,and intact parathyroid hormone(iPTH)in maintenance hemodialysis patients and analyze the influenc⁃ing factors.Methods:Using the method of cross⁃sectional study,the patients with maintenance hemo⁃dialysis in the Hemodialysis Center of Zhongnan Hospital of Wuhan University were enrolled.The clinical data of age,gender,body mass index(BMI),primary diseases,dialysis age,vascular access,blood routine,electrolytes,iPTH,etc.,were collected and then the results were analyzed.Results:A total of 176 patients were enrolled in this study,with the average age of(60.88±14.35)years,in⁃cluding 108 males(61.36%)and 68 females(38.64%).Their primary diseases included diabetic ne⁃phropathy(57,32.39%),hypertensive nephropathy(41,23.30%),chronic glomerulonephritis(55,31.25%),polycystic kidney disease(5,2.84%),hyperuricemia nephropathy(4,2.27%),lupus ne⁃phritis(3,1.70%),obstructive nephropathy(3,1.70%),and others(8,4.55%).According to the K/DOQI guidelines,the compliance rates of corrected calcium,blood phosphorus,calcium⁃phospho⁃rus product,and iPTH were as follow:59.66%,43.18%,62.5%,and 28.41%.Multivariate logis⁃tic regression analysis showed that dialysis age was the influencing factor for corrected calcium;gen⁃der,serum creatinine,BMI,and serum potassium were the influencing factors for serum phosphorus;dialysis age was the influencing factor for iPTH.Conclusion:The results of the study suggest that the control of calcium,phosphorus,calcium⁃phosphorus product,and iPTH was not easy,and especial⁃ly,the compliance rates of blood phosphorus and iPTH were low.Disturbance of calcium and phos⁃phorus metabolism is a common complication in maintenance hemodialysis patients,which seriously affects the quality of life and survival rate of patients.So it's necessory to actively analyze the reasons in order to increase the compliance rate and improve the quality of life of patients.