不同透析方式对终末期肾病患者钙磷代谢的影响
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摘要
目的:探讨终末期肾病患者血钙、血磷、全段甲状旁腺激素(PTH)达标情况及不同透析方式对钙磷代谢的影响。方法:回顾性分析收治的101例终末期肾病患者的临床资料,根据透析方式的不同,将其分为血透组、腹透组及非透析组,三组分别为43例、14例、44例,比较三组患者血钙、血磷及PTH水平及达标情况。结果:①血透组血钙、血磷、PTH达标率分别为:69.77%、30.23%、53.49%;腹透组血钙、血磷、PTH达标率分别为:50.00%、35.71%、57.14%;非透析组血钙、血磷、PTH达标率分别为:54.55%、2.27%、75.00%。三组在血钙、PTH达标率方面比较,差异无统计学意义(P>0.05),腹透组血磷达标率最高,差异有统计学意义(P<0.05)。②三组患者在血钙、血磷、PTH、白蛋白、25羟维生素D测定(25-OH-VD)、血红蛋白水平比较,差异有统计学意义(P<0.05),血透组血磷水平低于腹透组及非透析组,血红蛋白、血白蛋白、25-OH-VD水平高于腹透组及非透析组。结论:终末期肾病患者血钙、血磷及PTH水平达标率较低,尤其血磷水平达标率最低,腹透患者血磷达标高于血透患者。
Objective To investigate the standard of blood calcium,blood phosphorus and total parathyroid hormone(PTH) in patients with end-stage renal disease and the effect of different dialysis methods on calcium and phosphorus metabolism.Method The clinical datas of 101 patients with end-stage renal disease were analyzed retrospectively.According to the different dialysis methods,the patients were divided into the hemodialysis group,the peritoneal dialysis group and the non dialysis group.The three groups were 43 cases,14 cases and 44 cases respectively.The blood calcium,blood phosphorus and PTH leveling were compared in the three groups.Results ①The standard rate of blood calcium,blood phosphorus and PTH in the hemodialysis group were 69.77%,30.23% and 53.49%,respectively,and the rate of blood calcium,phosphorus and PTH in the peritoneal dialysis group were 50.00%,35.71% and 57.14%,respectively,and the rate of the blood calcium,phosphorus and PTH in the non dialysis group were 54.55%,2.27% and 75.00% respectively.There was no significant difference in blood calcium and PTH compliance rate between the three groups(P>0.05),and the blood phosphorus attainment rate was the highest in the peritoneal dialysis group(P<0.05). ②the levels of blood calcium,phosphorus,PTH,PTH,albumin,25 hydroxyvitamin D(25-OH-VD) and hemoglobin level were statistically different(P<0.05).The level of blood phosphorus in the hemodialysis group was lower than that of the peritoneal dialysis group and the non dialysis group.The level of hemoglobin,serum albumin and 25-OH-VD was higher than that of the peritoneal dialysis group and the non dialysis group.Conclusion The attainment rate of calcium,phosphorus and PTH in patients with end-stage renal disease is low,especially the level of blood phosphorus is lowest,and the level of blood phosphorus in patients with peritoneal dialysis is higher than that in hemodialysis patients.
Objective To investigate the standard of blood calcium,blood phosphorus and total parathyroid hormone(PTH) in patients with end-stage renal disease and the effect of different dialysis methods on calcium and phosphorus metabolism.Method The clinical datas of 101 patients with end-stage renal disease were analyzed retrospectively.According to the different dialysis methods,the patients were divided into the hemodialysis group,the peritoneal dialysis group and the non dialysis group.The three groups were 43 cases,14 cases and 44 cases respectively.The blood calcium,blood phosphorus and PTH leveling were compared in the three groups.Results ①The standard rate of blood calcium,blood phosphorus and PTH in the hemodialysis group were 69.77%,30.23% and 53.49%,respectively,and the rate of blood calcium,phosphorus and PTH in the peritoneal dialysis group were 50.00%,35.71% and 57.14%,respectively,and the rate of the blood calcium,phosphorus and PTH in the non dialysis group were 54.55%,2.27% and 75.00% respectively.There was no significant difference in blood calcium and PTH compliance rate between the three groups(P>0.05),and the blood phosphorus attainment rate was the highest in the peritoneal dialysis group(P<0.05). ②the levels of blood calcium,phosphorus,PTH,PTH,albumin,25 hydroxyvitamin D(25-OH-VD) and hemoglobin level were statistically different(P<0.05).The level of blood phosphorus in the hemodialysis group was lower than that of the peritoneal dialysis group and the non dialysis group.The level of hemoglobin,serum albumin and 25-OH-VD was higher than that of the peritoneal dialysis group and the non dialysis group.Conclusion The attainment rate of calcium,phosphorus and PTH in patients with end-stage renal disease is low,especially the level of blood phosphorus is lowest,and the level of blood phosphorus in patients with peritoneal dialysis is higher than that in hemodialysis patients.
引文
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[11] 薛志强,曾石养,李小利.血液透析与腹膜透析患者钙磷代谢紊乱治疗的随访对照研究[J].中国医药导报,2011,8(30):53.
[12] 徐春萍,余碧影,杨毅,等.浙江省维持性透析患者钙磷甲状旁腺激素水平调查[J].中国血液净化,2012,11(8):457.
[2] Block GA,Klassen PS,Lazarus JM,et al.Mineral metabolism,mortality,and morbidity in maintenance hemodialysis[J].J Am Soc Nephrol,2004,15(8):2208.
[3] 刘东瑜,马磊.血液透析早期干预钙磷代谢对肾性骨病患者的影响[J].吉林医学,2013,12(33):7231.
[4] Cusumano AM,Eckardt KU. KDIGO clinical practice guidelines for the diagnosis,evaluation,prevention,and treatment of chronic kidney disease-mineral and bone disorder (CKD-MBD)[J].Revista Der Nephrologe,2009,4(5):437.
[5] Ketteler M,Block GA,Evenepoel P,et al.Executive summary of the 2017 KDIGO Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD) Guideline Update:what′s changed and why it matters[J].Kidney Int.2017.92(1):26.
[6] Stevens LA,Djurdjev O,Cardew S,Cameron EC,Levin A.Calcium,phosphate,and parathyroid hormone levels in combination and as a function of dialysis duration predict mortality:evidence for the complexity of the association between mineral metabolism and outcomes[J].J Am Soc Nephrol,2004,15(3):770.
[7] Naves-Díaz M,Passlick-Deetjen J,Guinsburg A,et al.Calcium,phosphorus,PTH and death rates in a large sample of dialysis patients from Latin America.The CORES Study[J].Nephrol Dial Transplant,2011,26(6):1938.
[8] Moldovan D,Rusu C,Kacso IM,Potra A,Patiu IM,Gherman-Caprioara M.Mineral and bone disorders,morbidity and mortality in end-stage renal failure patients on chronic dialysis[J].Clujul Med,2016,89(1):94.
[9] Suki WN,Zabaneh R,Cangiano JL,et al.Effects of sevelamer and calcium-based phosphate binders on mortality in hemodialysis patients[J].Kidney Int,2007,72(9):1130.
[10] 林明增,陈霄峰,范佳妮,等.腹膜透析和血液透析对尿毒症患者钙磷代谢影响的临床研究[J].中国血液净化,2013,12(9):487.
[11] 薛志强,曾石养,李小利.血液透析与腹膜透析患者钙磷代谢紊乱治疗的随访对照研究[J].中国医药导报,2011,8(30):53.
[12] 徐春萍,余碧影,杨毅,等.浙江省维持性透析患者钙磷甲状旁腺激素水平调查[J].中国血液净化,2012,11(8):457.