尿毒症患者高甲状旁腺激素水平的影响因素及其对骨代谢的作用
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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.
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
[1] 段思宇.血液透析滤过联合血液灌流治疗尿毒症继发甲状旁腺功能亢进患者的疗效[J].中国药物经济学,2016,11 (9):107-109.DOI: 10.12010/j.issn.1673-5846.2016.09.041.
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[6] 万丽娟,李楠,李春霖,等.性激素及性激素结合球蛋白与老年男性骨转换标志物的相关性[J].中华骨质疏松和骨矿盐疾病杂志,2016,8(2):112-117. DOI: 10.3969/j.issn.1674-2591.2015.02.003.
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[11] 鲁嘉越, 朱旻霞, 张伟明,等.维持性血液透析患者透析前碳酸氢盐浓度与临床特征的关系[J]. 中国血液净化,2017,16(2):104-107. DOI: 10.3969/j.issn.1671-4091.2017.02.009.
[12] Shigematsu T, Fukagawa M, Yokoyama K, et al. Long term effects of etelcalcetide as intra venous calcimimetictherapy in hemodialysis patients with secondary hyperparathyroidism [J].Clinical & Experimental Nephrology,2017,22(2):1-11.DOI: 10.1007/s10157-017-1442-5.
[13] 李玉平,徐海燕,刘翻利,等.甲状旁腺切除术治疗终末期血液透析患者SHPT疗效及对肿瘤样钙质沉着、血清FGF23水平的影响[J].疑难病杂志,2018,17(11):1229-1232,1237.DOI:10.3969/j.issn.1671-6450.2018.11.011.
[14] 何志婷,刘琼,梁维,等.尿激酶联合阿加曲班对维持性血液透析患者长期血管通路急性血栓形成后溶栓治疗及预防的效果[J].疑难病杂志,2018,17(9):909-913.DOI:10.3969/j.issn.1671-6450.2018.09.011.
[15] 李欣,杨洁,丁致民.维持性血液透析患者应用活性维生素D的临床效果观察[J].中国医药,2017,12(3):375-378.DOI:10.3760/cma.j.issn.1673-4777.2017.03.013.
[16] 张李刚,张春天,王丽芳,等.西那卡塞辅治血液透析继发性甲状旁腺功能亢进患者效果观察[J].疑难病杂志,2016,15(12):1242-1245.DOI: 10.3969/j.issn.1671-6450.2016.12.008.
[17] 张宏,李新伦,高卓,等.血液灌流对血液透析患者体内蛋白结合类毒素的清除效果[J].中国血液净化, 2016, 15(2): 77-81. DOI: 10.3969/j.issn.1671-4091.2016.02.005.
[18] 张豪,孟彦, 金小冬,等.高磷联合腺嘌呤饮食诱导大鼠高转化型肾性骨病模型的建立与分析[J].中国骨质疏松杂志,2014,20(5):485-489. DOI: 10.3969/j.issn.1006-7108.2014.05.006.
[2] Mizobuchi M, Ogata H, Koiwa F. Secondary Hyperparathyroidism: Pathogenesis and Latest Treatment[J]. Ther Apher Dial,2018,8(1):1-7. DOI: 10.1111/1744-9987.12772.
[3] 袁芳,陈星,王畅,等.西那卡塞联合小剂量骨化三醇治疗重度继发性甲状旁腺功能亢进的效果及其对骨代谢的影响[J].中南大学学报:医学版,2017,42(10):1169-1173. DOI: 10.11817/j.issn.1672-7347.2017.10.007.
[4] 吴小清. 甲状旁腺激素升高程度对慢性肾功能衰竭血透患者残余肾功能的影响[J]. 中国实用医刊,2015,42(23):79-81. DOI:10.3760/cma.j.issn.1674-4756.2015.23.044.
[5] Wu GY, Xu BD,Wu T, et al. Correlation between serum parathyroid hormone levels and coronary artery calcification in patients without renal failure[J].Biomed Rep,2016,5(5): 601-606.DOI: 10.3892/br.2016.761.
[6] 万丽娟,李楠,李春霖,等.性激素及性激素结合球蛋白与老年男性骨转换标志物的相关性[J].中华骨质疏松和骨矿盐疾病杂志,2016,8(2):112-117. DOI: 10.3969/j.issn.1674-2591.2015.02.003.
[7] Vanderschueren D, Pye SR, Venken K, et al.Gonadal sex steroid status and bone health in middle-aged and elderly European men[J].Osteoporos Int,2010,21(4):1331-1339. DOI: 10.1007/s00198-009-1144-2.
[8] 罗君华. 糖尿病肾病患者血清甲状旁腺激素和骨密度检测的临床意义[J].宁夏医科大学学报,2015, 37(9): 1074-1077. DOI: 10.16050/j.cnki.issn1674-6309.2015.09.023
[9] Ma TL,Hung PH,Jong IC, et al. Parathyroidectomy is associated with reduced mortality in hemodialysis patients with secondary hyperparathyroidism[J]. Biomed Res Int,2015,2015:639-647. DOI: 10.1155/2015/639587.
[10] Guillaume Jean,Jean-Claude Souberbielle,Eric Zaoui, et al. Analysis of the kinetics of the parathyroid hormone, and of associated patient outcomes, in a cohort of haemodialysis patients[J]. BMC Nephrol.2016,17:153.DOI: 10.1186/s12882-016-0365-9.
[11] 鲁嘉越, 朱旻霞, 张伟明,等.维持性血液透析患者透析前碳酸氢盐浓度与临床特征的关系[J]. 中国血液净化,2017,16(2):104-107. DOI: 10.3969/j.issn.1671-4091.2017.02.009.
[12] Shigematsu T, Fukagawa M, Yokoyama K, et al. Long term effects of etelcalcetide as intra venous calcimimetictherapy in hemodialysis patients with secondary hyperparathyroidism [J].Clinical & Experimental Nephrology,2017,22(2):1-11.DOI: 10.1007/s10157-017-1442-5.
[13] 李玉平,徐海燕,刘翻利,等.甲状旁腺切除术治疗终末期血液透析患者SHPT疗效及对肿瘤样钙质沉着、血清FGF23水平的影响[J].疑难病杂志,2018,17(11):1229-1232,1237.DOI:10.3969/j.issn.1671-6450.2018.11.011.
[14] 何志婷,刘琼,梁维,等.尿激酶联合阿加曲班对维持性血液透析患者长期血管通路急性血栓形成后溶栓治疗及预防的效果[J].疑难病杂志,2018,17(9):909-913.DOI:10.3969/j.issn.1671-6450.2018.09.011.
[15] 李欣,杨洁,丁致民.维持性血液透析患者应用活性维生素D的临床效果观察[J].中国医药,2017,12(3):375-378.DOI:10.3760/cma.j.issn.1673-4777.2017.03.013.
[16] 张李刚,张春天,王丽芳,等.西那卡塞辅治血液透析继发性甲状旁腺功能亢进患者效果观察[J].疑难病杂志,2016,15(12):1242-1245.DOI: 10.3969/j.issn.1671-6450.2016.12.008.
[17] 张宏,李新伦,高卓,等.血液灌流对血液透析患者体内蛋白结合类毒素的清除效果[J].中国血液净化, 2016, 15(2): 77-81. DOI: 10.3969/j.issn.1671-4091.2016.02.005.
[18] 张豪,孟彦, 金小冬,等.高磷联合腺嘌呤饮食诱导大鼠高转化型肾性骨病模型的建立与分析[J].中国骨质疏松杂志,2014,20(5):485-489. DOI: 10.3969/j.issn.1006-7108.2014.05.006.