贵州医科大学学报

2016, v.41;No.194(11) 1330-1333

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维持性血液透析患者继发性甲状旁腺功能亢进的危险因素
Risk factors Associated with Secondary Hyperparathyroidism in Maintenance Hemodialysis Patients

高小芳;常欢;陈航;
GAO Xiaofang;CHANG Huan;CHEN Hang;Heibei University;Department of Renal Medicine,the Affiliated Hospital of Hebei University;

摘要(Abstract):

目的:探讨维持性血液透析患者继发性甲状旁腺功能亢进(SHPT)的相关危险因素。方法:选择行维持性血液透析治疗时间≥3月且病情稳定的尿毒症患者42例,统计患者透析前血钙(Ca)、血磷(P)、钙磷乘积及甲状旁腺激素(PTH)的达标率;根据患者透析前血清PTH水平分为低PTH组(PTH<300 ng/L)和高PTH组(PTH≥300 ng/L),比较两组患者性别、年龄、透析时间、是否患糖尿病及透析前血红蛋白(Hb)、血清铁蛋白(SF)、总胆固醇(TC)、甘油三脂(TG)、脂蛋白a、血清白蛋白(Alb)、前白蛋白(PA)、尿素氮(BUN)、血肌酐(Cr)、尿酸(UA)、二氧化碳结合力(CO2CP)、β2-微球蛋白(β2-MG)、胱抑素C(Cys C)、血Ca、血P以及钙磷乘积水平,对有差异的指标进行Logistic回归分析,探讨透析患者发生SHPT的危险因素。结果:42例患者中,血Ca、血P、钙磷乘积及PTH水平达标率分别为33.3%、19.0%、42.9%及33.3%,两组患者中糖尿病、年龄、Alb、Cr、血P以及钙磷乘积比较,差异有统计学意义(P<0.05),其余指标比较差异无统计学意义(P>0.05);Logistic回归分析显示糖尿病、Alb、血P是影响维持性血液透析患者SHPT的独立危险因素,其中糖尿病与SHPT负相关(B=-2.611,P<0.05)。结论:糖尿病、Alb和血P是维持性血液透析患者SHPT的独立危险因素。
Objective: To explore the risk factors of secondary hyperparathyroidism(SHPT) in maintenance hemodialysis patients with uremia. Methods: 42 patients with uremia undergoing more than 3months of maintenance hemodialysis whose condition was stable were selected for this study. The compliance rate of predialysis serum calcium(Ca),serum phosphorus(P),calcium- phosphorus product and parathyroid hormone(PTH) in these patients were recorded. According to the predialysis serum PTH levels,the patients were divided into low PTH group(PTH < 300 ng / L) and high PTH group(PTH≥300,ng /L). The comparison was conducted between the two groups in terms of gender,age,duration of dialysis,diabetic symptoms,predialysis hemoglobin(HB),serum ferritin(SF),total cholesterol(TC),triglyceride(TG),apolipoprotein A,serum albumin(ALB),prealbumin(PA),urea nitrogen(BUN), serum creatinine(Cr), uric acid(UA), carbon dioxide combining power(CO_2CP),β2-microglobulin(β2-MG),Cystatin C(Cys C),serum calcium(Ca),serum phosphorus(P),and the level of calcium-phosphorus product. Logistic regression analysis was conducted to investigate the risk factors of SHPT in uremic patients. Logistic regression analysis was conducted to investigate the risk factors of SHPT occurring in the patients with uremia. Results: The compliance rate of serum calcium,serum phosphorus,calcium-phosphorus product and PTH were 33. 3%,19. 0%,42. 9% and 33. 3% in the 42 patients. The differences in diabetes,age,ALB,Cr,serum phosphorus,calcium-phosphorus product between the two groups of patients were statistically significant(P <0. 05),and the differences in other indicators between the two groups of patients were not statistically significant(P > 0. 05). Logistic regression analysis showed that diabetes,ALB,serum phosphorus were independent risk factors of SHPT in uremic patients with maintenance hemodialysis,in which diabetes and SHPT were negatively correlated with SHPT. Conclusion: Diabetes mellitus,serum albumin and serum phosphorus are independent risk factors of SHPT in uremic patients of maintenance hemodialysis.

关键词(KeyWords): 血液透析,滤过;甲状旁腺功能亢进,继发性;甲状旁腺素;血磷;危险因素
hemodialysis,filtration;hyperparathyroidism,secondary;parathyroid hormone;serum phosphorus;risk factors

Abstract:

Keywords:

基金项目(Foundation): 河北大学医学学科专项资金建设项目(2012B3001)

作者(Author): 高小芳;常欢;陈航;
GAO Xiaofang;CHANG Huan;CHEN Hang;Heibei University;Department of Renal Medicine,the Affiliated Hospital of Hebei University;

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DOI: 10.19367/j.cnki.1000-2707.2016.11.021

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