摘要
目的分析尿毒症患者高甲状旁腺激素水平的影响因素,并观察甲状旁腺激素水平对骨代谢的影响。方法选择2016年5月—2017年12月哈尔滨医科大学附属第一医院肾内科收治的尿毒症患者105例作为研究对象,根据PTH值分为2组,正常PTH组39例(150~300 pg/ml),高PTH组66例(>300 pg/ml),收集患者的一般临床资料、生化指标及骨代谢相关指标,肾功能指标等,比较2组患者各项指标的差异,分析影响PTH水平的相关因素及其对骨代谢的影响。结果 2组患者性别、透析龄、二氧化碳结合力(CO_2CP)、C反应蛋白(CRP)、血红蛋白(Hb)、白蛋白(Alb)、三酰甘油(TG)和总胆固醇(TC)比较,差异均有统计学意义(P均<0.05)。影响尿毒症患者PTH水平的因素有透析龄、血肌酐、CO_2CP、Hb、CRP。其中PTH水平与透析龄、SCr、CRP呈正相关(r/P=0.876/<0.001,0.660/<0.001,0.624/<0.001),与CO_2CP、Hb呈负相关(r/P=-0.527/<0.001,-0.471/<0.001)。PTH水平对骨代谢指标的影响包括使血钙水平降低,血磷和碱性磷酸酶水平升高(t/P=2.250/0.035,-5.706/<0.001,-10.469/<0.001)。结论尿毒症患者PTH过高与性别和CO_2CP、Hb、CRP、血脂等多种因素密切相关,深入对其分析并有针对性的治疗,是未来治疗中的重要任务。
Objective To analyze the influencing factors of high parathyroid hormone levels in uremic patients, and to observe the effect of parathyroid hormone levels on bone metabolism. Methods One hundred and five uremic patients admitted to the Department of Nephrology, First Affiliated Hospital of Harbin Medical University from May 2016 to December 2017 were selected as the research objects. According to PTH value, they were divided into two groups: 39 cases in normal PTH group(150-300 pg/ml) and 66 cases in high PTH group(>300 pg/ml). General clinical data, biochemical indexes, bone metabolism related indexes and renal function indexes were collected and compared between the two groups. Difference, analysis of the related factors affecting PTH level and its impact on bone metabolism. Results There were significant differences in gender, dialysis age, carbon dioxide binding capacity(CO_2CP), C-reactive protein(CRP), hemoglobin(Hb), albumin(Alb), triglyceride(TG) and total cholesterol(TC) between the two groups(P< 0.05). The influencing factors of PTH level in uremic patients were dialysis age, serum creatinine, CO_2CP, Hb and CRP. PTH level was positively correlated with dialysis age, SCr and CRP(r/P=0.876/<0.001,r/P=0.660/<0.001,r/P=0.624/<0.001), negatively correlated with CO_2CP and Hb(r/P=-0.527/<0.001,r/P=-0.471/<0.001). The effects of PTH level on bone metabolic indexes included decreasing blood calcium level and increasing blood phosphorus and alkaline phosphatase(t/P=2.250/0.035,r/P=-5.706/<0.001,r/P=-10.469/<0.001). Conclusion The high PTH in patients with uremia is closely related to gender and CO_2CP, Hb, CRP, blood lipids and other factors. In-depth analysis and targeted treatment are important tasks in future treatment.
引文
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