腹膜透析患者下肢动脉病变与钙磷代谢紊乱的相关性

目的 观察应用不同钙离子浓度透析液治疗的腹膜透析患者下肢动脉病变与钙磷代谢紊乱的关系,探讨持续性非卧床腹膜透析（continuous ambulatory peritoneal dialysis,CAPD）患者下肢动脉病变的危险因素.方法 根据使用不同钙离子浓度腹膜透析液,将54例CAPD患者分组,A组27例使用PD-2标准钙腹透液（Ca2＋ 1.75 mmol/L）;B组27例使用PD-4低钙透析液（Ca2＋ 1.25 mmol/L）.两组均持续透析1年以上,观察组间下肢动脉狭窄与血钙、血磷等各生化指标的关系.结果 54例不同钙离子浓度透析患者,1年后下肢动脉狭窄者数量均有升高,A组高于B组,组间差异有统计学意义（P＜0.05）.治疗1年后两组间：血色素、胆固醇值差异无统计学意义（P＞0.05）;血钙值、血磷值、甲状旁腺素值及下肢动脉内中膜厚度值间差异有统计学意义（P＜0.05）.下肢动脉病变程度与血磷水平正相关（P＜0.05）,与血清iPTH水平、Hb水平负相关（P＜0.05）,与血钙、血脂、肌酐值不存在相关性（P＞0.05）.结论 下肢动脉狭窄程度在不同钙离子浓度腹膜透析患者中不相同,其动脉狭窄程度与钙磷代谢紊乱相关,是下肢动脉狭窄的重要危险因素.

Analysis of lower extremity arterial diseases and calcium-phosphorus metabolism in peritoneal dialysis patients

Objective To study the effects of relevant factor of different dialysate calcium concentrations on the calcium-phosphorus metabolism and lower extremity arterial diseases in peritoneal dialysis patients , and investigate the risk factors of calcium-phosphorus metabolism to lower extremity arterial calcification in patients undergoing peritoneal dialysis. Methods The peritoneal dialysis patients were divided into different groups according the different dialysate calcium concentrations. 27 peritoneal dialysis patients ill group A used PD-2 high calcium dialysate concentration （ Ca^2 ＋ 1.75mmol/L） ,while 27 patients in group B used PD-4 low calcium dialysate concentration （Ca^2＋ 1.25mmol/L）. We analyzed the relationship between lower extremity arterial stenosis and calcium-phosphorus metabolism after one year. Results Lower extremity arterial stenosis was confirmed in 54 CAPD patients receiving different dialysate calcium concentrations . The high calcium dialysate group had the larger amount of lower extremity arterial diseases than low calcium dialysate group （ P 〈 0.05 ） , After one year of dialysis, the levels of serum calcium ,phosphorous ,iPTH and intimal plus medial thickness were deferent significantly between the two groups （ P 〈 0.05 ） , The levels of serum Hb and chol esterol showed no significant difference between the two groups （ P 〉 0.05 ）. The changes in intimal plus medial thickness was variable correlating with the changes in serum phosphorous, serum iPTH and the level of serum Hb （ P 〈 0.05 ）. The levels of serum calcium, cholesterol and creatinine showed no correlation with the intimal plus medial thickness （ P 〉 0.05 ）. Conclusions Lower extremity arterial stenosis with different levels exists in CAPD patients undergoing CAPD of different dialysate calcium concentrations. Calcium-phosphorus metabolism is corre- lated with lower extremity arterial stenosis closely. They are the important dangerous factors of lower extremity arterial stenosis.