尿毒症合并继发性甲状旁腺功能亢进患者发生转移性钙化的影响因素分析

Analysis of influencing factors of metastatic calcification in patients with uremia complicated with secondary hyperparathyroidism

目的分析尿毒症合并继发性甲状旁腺功能亢进(SHPT)患者发生转移性钙化的影响因素。方法以2017年12月至2021年1月汉中市中心医院收治的168例尿毒症合并SHPT患者为研究对象。收集患者的一般资料及实验室指标,并根据其是否发生转移性钙化分为钙化组和非钙化组。分析尿毒症合并SHPT患者发生转移性钙化的影响因素,比较钙化组和非钙化组的随访结果。结果168例尿毒症合并SHPT患者中,128例发生转移性钙化,40例未发生转移性钙化。单因素分析结果显示,两组的年龄、透析时间、甲状旁腺素(PTH)、血磷(Pi)、碱性磷酸酶(ALP)、高敏C反应蛋白(hs-CRP)、成纤维细胞生长因子23(FGF23)、25-羟维生素D_(3)(25-OH-VD_(3))及维生素K_(2)水平比较,差异具有统计学意义(P<0.05);两组的性别、既往病史、吸烟史、血钙(SCa)、白蛋白(ALB)及血红蛋白(Hb)水平比较,差异无统计学意义(P>0.05)。多因素Logistic回归分析结果显示,透析时间、PTH、hs-CRP及FGF23是尿毒症合并SHPT患者发生转移性钙化的独立危险因素,25-OH-VD_(3)、维生素K_(2)是保护因素(P<0.05)。钙化组的心肌缺血、心肌梗死、心功能不全发生率及死亡率高于非钙化组,差异具有统计学意义(P<0.05)。结论透析时间、PTH、hs-CRP、FGF23是尿毒症合并SHPT患者发生转移性钙化的独立危险因素,25-OH-VD_(3)、维生素K_(2)是保护因素。

Objective To analyze the influencing factors of metastatic calcification in patients with uremia complicated with secondary hyperparathyroidism(SHPT).Methods A total of 168 patients with uremia complicated with SHPT admitted in Hanzhong Central Hospital from December 2017 to January 2021 were enrolled in the study.The general data and laboratory indicators of the patients were collected and the patients were divided into calcification group and non-calcification group according to whether metastatic calcification occurred.The influencing factors of metastatic calcification in uremia patients with SHPT were analyzed,and the follow-up results of the calcification group and the non-calcification group were compared.Results Of the 168 patients with uremia complicated with SHPT,128 cases had metastatic calcification and 40 cases didn't occur metastatic calcification.Univariate analysis showed that there were statistically significant differences in age,dialysis time,parathyroid hormone(PTH),serum phosphorus(Pi),alkaline phosphatase(ALP),high-sensitivity C-reactive protein(hs-CRP),fibroblast growth factor 23(FGF23),25-hydroxyvitamin D_(3)(25-OH-VD_(3))and vitamin K_(2)levels between the two groups(P<0.05);there were no significant differences in gender,past medical history,smoking history,serum calcium(SCa),albumin(ALB)and hemoglobin(Hb)levels between the two groups(P>0.05).Multivariate Logistic regression analysis showed that dialysis time,PTH,hs-CRP and FGF23 were independent risk factors for metastatic calcification in uremic patients with SHPT,and 25-OH-VD_(3)and vitamin K_(2)were protective factors(P<0.05).The incidences of myocardial ischemia,myocardial infarction,cardiac insufficiency and mortality in the calcification group were higher than those in the non-calcification group,and the differences were statistically significant(P<0.05).Conclusion Dialysis time,PTH,hs-CRP and FGF23 were independent risk factors for metastatic calcification in uremic patients with SHPT,while 25-OH-VD_(3)and vitamin K_(2)were protective factors.