| 摘要: |
| 目的 调查维持性血液透析(maintenance hemodialysis, MHD)患者继发性相对性甲状旁腺功能减退(secondary relative hypoparathyroidism, SRHOP)的发生率,探讨可能的影响因素。方法 选择2012年1月至2012年12月在上海市第七人民医院血液净化中心行常规血液透析3个月以上、病情稳定的慢性肾衰患者182例,参照改善全球肾脏病预后组织(KDIGO)指南,统计和分析全段甲状旁腺激素(intact parathyroid hormone, iPTH)达标情况。根据血浆iPTH浓度将患者分为SRHOP组(iPTH<150 pg/mL,n=73)和非SRHOP组(iPTH≥150 pg/mL,n=109),通过Spearman相关分析和Logistic多元回归分析探讨MHD患者发生SRHOP的可能影响因素。 结果 182例MHD患者血iPTH平均浓度为(173.5±114.3) pg/mL,随着患者年龄的增长,血iPTH浓度逐渐下降。参照KDIGO指南,达标者为83例(45.6%),低于标准者为73例(40.1%),高于标准者为26例(14.3%)。达标率在不同性别间差异无统计学意义。SRHOP组患者的年龄、糖尿病发生率、血浆校正钙浓度高于非SRHOP组,而血磷、白蛋白(Alb)水平和标准蛋白氮呈现率低于非SRHOP组(P<0.05)。两组患者的性别构成、透析时间、血压、尿素氮、肌酐、尿素清除指数(Kt/V)、口服钙剂和维生素D的病例数、血红蛋白等指标差异无统计学意义。Spearman相关分析结果显示,患者年龄、是否合并糖尿病、血浆校正钙浓度、血磷水平、Alb水平均与SRHOP有关;Logistic回归分析结果显示,年龄和血磷水平是MHD患者发生SRHOP的独立危险因素。结论 MHD患者更常发生SRHOP而不是继发性甲状旁腺功能亢进,年龄和血磷水平是MHD患者发生SRHOP的独立危险因素。 |
| 关键词: 慢性肾功能衰竭 肾透析 甲状旁腺激素 甲状旁腺功能减退症 |
| DOI： |
| 投稿时间：2013-07-03修订日期：2013-09-17 |
| 基金项目:上海市卫生局科研基金(2010109),上海市浦东新区科委科研基金(PKJ2012-105). |
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| Clinical study of secondary relative hypoparathyroidism in the patients with maintenance hemodialysis |
| LU Jian-rao*,WANG Xin-hua,HAN Hai-yan,HU Jing,XIONG Chong-xiang,CHEN Xiu-feng,CAO Bei-li,CHEN Jie,LIAO Lin,ZHANG Chuan-fu,LI Wu-feng |
(Department of Nephrology, The 7th People’s Hospital of Shanghai, Shanghai 200357, China
*Corresponding author.) |
| Abstract: |
| Objective To investigate the incidence and possible influencing factors of secondary relative hypoparathyroidism (SRHOP) in the patients with maintenance hemodialysis (MHD). Methods Totally 182 stable chronic renal failure patients with MHD for more than 3 months were selected from the Blood Purification Center of Shanghai 7th People’s Hospital from January 2012 to December 2012. The status of plasma intact parathyroid hormone (iPTH) was analyzed according to the KDIGO (Kidney Disease: Improving Global Outcomes) guidelines. The patients were divided into two groups according to plasma iPTH concentrations: SRHOP group (iPTH<150 pg/mL, n=73) and non-SRHOP group (iPTH ≥ 150 pg/mL, n=109). The influencing factors for the SRHOP of MHD patients were investigated by Spearman correlation analysis and Logistic regression analysis. Results The average concentration of plasma iPTH of 182 MHD patients was (173.5±114.3) pg/mL, and the concentration decreased gradually with age. According to KDIGO guidelines, the concentrations of plasma iPTH reached the standard in 83 cases (45.6%), lower than the standard in 73 cases (40.1%), and higher than the standard in 26 cases (14.3%). The concentrations of plasma iPTH were not significantly different between the genders. The age, incidence of diabetes, and plasma corrected calcium concentration of the SRHOP patients were significantly higher, while the plasma phosphorus, albumin and normalized protein equivalent of nitrogen appearance (nPNA) levels were significantly lower than those of the non-SRHOP patients (P<0.05). There were no significant differences in gender composition, duration of dialysis, blood pressure, plasma urea nitrogen, plasma creatinine, urea clearance index (Kt/V), numbers of patients with oral calcium or vitamin D, and hemoglobin between the two groups. Spearman analysis showed that age, diabetes, plasma corrected calcium, and phosphorus and albumin levels were associated with SRHOP, and Logistic regression analysis indicated that the age and plasma phosphorus level of MHD patients were independent risk factors for SRHOP. Conclusion SRHOP, rather than secondary hyperparathyroidism, often occurs in MHD patients. The patient age and plasma phosphorus level are the independent risk factors for SRHOP. |
| Key words: chronic kidney failure renal dialysis parathyroid hormone hypoparathyroidism |
