维持性血液透析继发甲状旁腺功能亢进症患者肺功能特征及其影响因素分析
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摘要
目的探讨继发甲状旁腺功能亢进症对维持性血液透析患者肺功能的影响,旨在为临床预防和治疗提供科学依据。方法纳入维持性血液透析伴继发性甲状旁腺功能亢进症患者254例。根据血清全段甲状旁腺激素(i PTH)水平,将患者分为A组229例(i PTH>800 pg/ml)、B组25例(i PTH<800 pg/ml)。检测血红蛋白(Hb)、血清白蛋白(Alb)、尿素氮(BUN)、肌酐(Scr)、血钙、血磷、碱性磷酸酶(ALP)、i PTH、C-反应蛋白(CRP)等。同时测定:(1)肺容量:包括肺活量(VC)、肺总量(TLC)、残气量(RV)及残气量与肺总量之比值(RV/TLC);(2)通气功能:包括用力肺活量(FVC)、呼气峰流速(PEF)、第1秒用力呼气容积(FEV1);(3)小气道功能:包括25%及50%用力肺活量的呼气流量(V25及V50);(4)弥散功能:一氧化碳弥散量(DLCO)。比较两组间肺功能差异并分析其影响因素。结果 A组血钙、磷、ALP显著高于B组(P<0.05)。A组VC、FVC、FEV1、PEF、V25、V50、DLCO均显著低于B组(P<0.05)。相关性分析显示:(1)肺通气功能中FEV1、PEF与透析龄呈负相关性(P<0.05);(2)肺容量、通气功能、小气道功能、弥散功能与血清i PTH具有相关性,其中RV/TLC与i PTH呈正相关性(P<0.05),其余各项与i PTH均呈负相关性(P<0.05,P<0.001);(3)DLCO与Hb呈正相关性(P<0.05);(4)VC、FVC、FEV1与CRP呈负相关性(P<0.05);(5)FEV1与Alb呈正相关性(P<0.05)。结论维持性血液透析伴严重继发性甲状旁腺功能亢进患者的肺功能明显受损,主要表现为通气功能、弥散功能的下降,小气道功能减退;维持性血液透析继发甲状旁腺功能亢进症患者的肺功能多项指标与i PTH、CRP、透析龄呈负相关性,与Alb、Hb水平呈正相关性。
Objective To explore the effect of secondary hyperparathyroidism on pulmonary function in maintenance hemodialysis patients,and to provide a scientific basis for clinical prevention and treatment. Methods 254 hemodialysis patients with secondary hyperparathyroidism were divided into group A i PTH > 800 pg/ml( n = 229)and group B i PTH < 800 pg/ml group( n = 25) according to the different i PTH levels. Hemoglobin( Hb),albumin( Alb),urea nitrogen( BUN),creatinine( Scr),serum calcium,phosphorus,alkaline phosphatase( ALP),serum total parathyroid hormone( i PTH),and C-reactive protein( CRP) were determined. Simultaneous determinnaton:(1) Pulmonary volume: including vital capacity( VC),total lung capacity( TLC),residual volume( RV),residual volume/total lung capacity( RV/TLC);(2) Ventilation function: including forced vital capacity( FVC),expiratory flow velocity( PEF),forced expiratory volume in 1 s( FEV1);(3) Small airway function: including expiratory flow volume of forced vital capacity at 25% and 50%;(4) Dispersion function: diffusing capacity of in the lung( DLCO). The difference of lung function between the two groups was compared and the influencing factors were analyzed. Results Compared with group B,serum calcium,phosphorusand ALP were significantly increased in group A( all P < 0. 05). VC,FVC,FEV1,PEF,V25,V50 and DLCO of the group A were significantly lower than those in the B group( P < 0. 05). Correlation analysis showed that the lung ventilation function of the FEV1 and PEF was negatively correlated with dialysis age( P < 0. 05). The correlation between pulmonary volume,ventilation function,small airway function,diffusion function and i PTH,there was a positive correlation between RV/TLC and i PTH( P < 0. 05),the rest were negatively related with i PTH( P < 0. 05,P < 0. 001); DLCO was positively correlated with Hb( P < 0. 05); There was negative correlation between VC,FVC,FEV1 and CRP( P < 0. 05),and there was a positive correlation between FEV1 and Hb( P < 0. 05). Conclusion The pulmonary function of maintenance hemodialysis patients with severe secondary hyperparathyroidism is significantly impaired,mainly for the decline of ventilation function,diffusion function,small airway dysfunction. Pulmonary function indexes in hemodialysis patients with secondary hyperparathyroidism are negatively correlated with i PTH,CRP and dialysis age,and they are positively correlated with Alb and Hb.
Objective To explore the effect of secondary hyperparathyroidism on pulmonary function in maintenance hemodialysis patients,and to provide a scientific basis for clinical prevention and treatment. Methods 254 hemodialysis patients with secondary hyperparathyroidism were divided into group A i PTH > 800 pg/ml( n = 229)and group B i PTH < 800 pg/ml group( n = 25) according to the different i PTH levels. Hemoglobin( Hb),albumin( Alb),urea nitrogen( BUN),creatinine( Scr),serum calcium,phosphorus,alkaline phosphatase( ALP),serum total parathyroid hormone( i PTH),and C-reactive protein( CRP) were determined. Simultaneous determinnaton:(1) Pulmonary volume: including vital capacity( VC),total lung capacity( TLC),residual volume( RV),residual volume/total lung capacity( RV/TLC);(2) Ventilation function: including forced vital capacity( FVC),expiratory flow velocity( PEF),forced expiratory volume in 1 s( FEV1);(3) Small airway function: including expiratory flow volume of forced vital capacity at 25% and 50%;(4) Dispersion function: diffusing capacity of in the lung( DLCO). The difference of lung function between the two groups was compared and the influencing factors were analyzed. Results Compared with group B,serum calcium,phosphorusand ALP were significantly increased in group A( all P < 0. 05). VC,FVC,FEV1,PEF,V25,V50 and DLCO of the group A were significantly lower than those in the B group( P < 0. 05). Correlation analysis showed that the lung ventilation function of the FEV1 and PEF was negatively correlated with dialysis age( P < 0. 05). The correlation between pulmonary volume,ventilation function,small airway function,diffusion function and i PTH,there was a positive correlation between RV/TLC and i PTH( P < 0. 05),the rest were negatively related with i PTH( P < 0. 05,P < 0. 001); DLCO was positively correlated with Hb( P < 0. 05); There was negative correlation between VC,FVC,FEV1 and CRP( P < 0. 05),and there was a positive correlation between FEV1 and Hb( P < 0. 05). Conclusion The pulmonary function of maintenance hemodialysis patients with severe secondary hyperparathyroidism is significantly impaired,mainly for the decline of ventilation function,diffusion function,small airway dysfunction. Pulmonary function indexes in hemodialysis patients with secondary hyperparathyroidism are negatively correlated with i PTH,CRP and dialysis age,and they are positively correlated with Alb and Hb.
引文
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[10]王艺萍,宋玉环,覃莲香,等.难治性继发性甲状旁腺功能亢进症患者心脏结构与功能特点及相关因素分析[J].中国血液净化,2013,12(10):543-6.
[11]Trillini M,Cortinovis M,Ruggenenti P,et al.Paricalcitol for secondary hyperparathyroidism in renal transplantation[J].J Am Soc Nephrol,2015,26(5):1205-14.
[12]付渊洁,杨松涛,肖跃飞.难治性继发性甲状旁腺功能亢进症患者肺功能临床分析[J].中国血液净化,2015,16(4):206-9.
[13]陈锐娟,梁萌.尿毒症患者肺功能损害的研究进展[J].中国中西医结合肾病杂志,2011,13(5):112-5.
[14]Soler J J,Snchez L,Romn P,et al.Prevalence of malnutrition outpatients with stable chronic obstructive pulmonary disease[J].Arch Bronconeumol,2004,40(6):250-8.
[15]Tbahriti H F,Meknassi D,Moussaoui R,et al.Inflammatory status in chronic renal failure:the role of homocysteinemia and pro-inflammatory cytokines[J].World J Nephrol,2013,2(2):31-7.
[2]Akizawa T,Kurita N,Mizobuchi M,et al.PTH-dependence of the effectiveness of cinacalcet in hemodialysis patients with secondary hyperparathyroidism[J].Sci Rep,2016,6:6-10.
[3]宋玉环,王艺萍,覃莲香,等.尿毒症继发重症甲状旁腺功能亢进症患者肺功能特征分析[J].军事医学,2014,38(10):819-22.
[4]卢元,胡晓舟,张瑾,等.维持性血液透析患者继发性甲状旁腺功能亢进相关因素分析[J].实用医学杂志,2015,31(16):2684-7.
[5]肖庆璇,秦耀荣,胡洁萍,等.维持性血液透析患者继发性甲状旁腺功能亢进相关因素分析及护理对策[J].实用临床医药杂志,2014,18(2):4-5.
[6]Chen C L,Chen N C,Liang H L,et al.Effects of denosumab and calcitriol on severe secondary hyperparathyroidism in dialysis patients with low bone mass[J].J Clin Endocrinol Metab,2015,100(7):2784-92.
[7]匡彬,方倩瑜,陈少敬,等.不同钙离子浓度透析液预防继发性甲状旁腺功能亢进效果比较[J].山东医药,2016,56(2):76-7.
[8]刁宗礼,郭维康,刘莎,等.继发性甲状旁腺功能亢进的药物治疗进展[J].中国全科医学,2015,18(26):3245-7.
[9]李铎,宋韩明,李文歌,等.难治性继发性甲状旁腺功能亢进的相关因素分析[J].肾脏病与透析肾移植杂志,2012,21(2):115-9.
[10]王艺萍,宋玉环,覃莲香,等.难治性继发性甲状旁腺功能亢进症患者心脏结构与功能特点及相关因素分析[J].中国血液净化,2013,12(10):543-6.
[11]Trillini M,Cortinovis M,Ruggenenti P,et al.Paricalcitol for secondary hyperparathyroidism in renal transplantation[J].J Am Soc Nephrol,2015,26(5):1205-14.
[12]付渊洁,杨松涛,肖跃飞.难治性继发性甲状旁腺功能亢进症患者肺功能临床分析[J].中国血液净化,2015,16(4):206-9.
[13]陈锐娟,梁萌.尿毒症患者肺功能损害的研究进展[J].中国中西医结合肾病杂志,2011,13(5):112-5.
[14]Soler J J,Snchez L,Romn P,et al.Prevalence of malnutrition outpatients with stable chronic obstructive pulmonary disease[J].Arch Bronconeumol,2004,40(6):250-8.
[15]Tbahriti H F,Meknassi D,Moussaoui R,et al.Inflammatory status in chronic renal failure:the role of homocysteinemia and pro-inflammatory cytokines[J].World J Nephrol,2013,2(2):31-7.