血液透析患者钙磷代谢和血管钙化及其危险因素

Study of calcium-phosphorus metabolism and vascular calcification in maintenance hemodialysis patients and its risk factors

目的 研究维持性血液透析患者钙磷代谢及血管钙化情况,并分析血管钙化的相关危险因素.方法 选择在上海市第七人民医院肾病科血液透析中心行维持性血液透析(MHD)患者150例,横断面调查所有患者透析前血浆钙、磷、全段甲状旁腺激素(iPTH)、25羟维生素D水平和颈动脉钙化状况,并进一步分析其危险因素.结果(1)150例MHD患者普遍存在矿物质代谢异常,各项指标的达标率分别为校正血钙57.33％,血磷48.67％,钙磷乘积65.33％,iPTH36.67％,25羟维生素D 2.00％.(2)血管钙化发生率达74％.(3)血管钙化患者年龄(F=11.263)、透析龄(F=8.541)、长期吸烟史(x2=6.351)和高血压(x2 =8.462)、糖尿病(x2 =5.371)、冠心病(x2=3.371)、脑卒中(x2 =3.658)发病率以及校正血钙(F=6.253)、血磷(F=3.247)、钙磷乘积(F=5.638)显著高于无钙化患者,且随着钙化程度的进展逐步增加;25羟维生素D逐步下降(F =3.642),均有统计学意义(P均＜0.05).(4)多因素Logistic回归分析显示年龄、糖尿病史、校正血钙、钙磷乘积为颈动脉钙化独立危险因素,OR(95％CI)分别为1.564(1.056～1.847)、1.476(1.158～1.736)、1.625(1.223 ～2.045)、1.315(1.078～1.836)(P均＜0.05).结论 MHD患者普遍存在钙磷代谢异常及血管钙化;血管钙化可使多种慢性病的发病率增高;年龄、糖尿病史、校正血钙、钙磷乘积为颈动脉钙化独立危险因素.

Objective To investigate the change of calcium-phosphorus metabolism and vascular calcification in maintenance hemodialysis (MHD) patients,and its related risk factors for vascular calcification.Methods One hundred and fifty MHD patients were selected as our subjects at the hemodialysis center of nephrology in the 7th People's Hospital of Shanghai.A cross-sectional survey was performed.The concentration of plasma calcium,phosphorus,parathyroid hormone (iPTH),25 hydroxy vitamin D levels were measured.Carotid artery calcification was evaluated.Results (1) The mineral metabolic abnormalities in the MHD patients were at high frequency.The rate of reaching the stand of serum calcium,phosphorus,calciumphosphorus product,iPTH,25-hydroxyl VD were 57.33％,48.67％,65.33％,36.67％,2.00％ respectively.(2) The incidence of vascular calcification was 74％.(3) The Age (F =11.263),duration of dialysis (F =8.541),long-term smoking history (x2 =6.351),the incidence of hypertension (x2 =8.462),diabetes (x2 =5.371),coronary heart disease(x2 =3.371),stroke(x2 =3.658),the standardized serum calcium level(F =6.253),serum phosphorus level(F =3.247) and calcium-phosphorus (F =5.638) in patients with vascular calcification were significantly higher than that in patients without calcification,and all of those gradually increased with the progress of calcification,while 25-hydroxyl VD (F =3.642) gradually decreased (P ＜ 0.05).(4) Multi-factor Logistic regression analysis showed that age,history of diabetes,serum calcium and calcium-phosphorus product were independent risk factors for carotid artery calcification.OR values and 95％ CI were 1.564 (1.056-1.847),1.476 (1.158-1.736),1.625 (1.223-2.045),1.315 (1.078-1.836)respectively (all P ＜ 0.05).Conclusion The calcium phosphate metabolic abnormalities and vascular calcification were at high frequency in the MHD patients.Vascular calcification can increase the incidence of variety of chronic diseases.Age,history of diabetes,serum calcium and calcium-phosphorus were independent risk factors for carotid artery calcification.