对血液透析患者钙磷代谢异常改进治疗的研究

目的改进对血液透析患者钙磷代谢异常的治疗，观察患者生活质量的改善。方法按照美国肾脏基金会（NKF）制定的“慢性肾脏病，透析病人生存质量指南（K/DOQI）”改进对血液透析患者钙磷代谢异常的治疗，观察1年后患者的血清钙、磷、钙磷乘积、全段甲状旁腺素（iPTH）等水平及治疗达标率的变化。应用肾脏病调查表（KDQ）评估患者生活质量的改善。结果改进治疗后患者的血清钙、磷、钙磷乘积及iPTH水平均较改进治疗前有明显下降（P〈0．01或〈0．05）。改进治疗后治疗达标率分别为：血清钙74．42％（32／43）、血清磷62．79％（27／43）、钙磷乘积55．81％（24／43）、iPTH60．47％（26／43）、四项达标25．58％（11／43），均较改进治疗前有明显上升（P〈0．01或〈0．05）。改进治疗后KDQ评分的总分及各方面得分均较改进治疗前有明显增中（P〈0．01）。结论改进治疗后患者钙磷代谢隋况较改进治疗前改善，生活质量提高。

Improvement of abnormal calcium-phosphorus metabolism in hemodialysis patients

Objective To improve the treatment of abnormal calcium-phosphorus metabolism in hemodialysis patients, and observe its influence on the quality of life. Methods Implemented the kidney Disease Outcomes Quality Initiative （K/DOQI） clinical practice guidelines for bone metabolism and disease in hemodialysis patients, improved the treatment of abnormal calcium-phosphorus metabolism in hemodialysis patients. After 1 year, the values were compared between before and after application of K/DOQI guidelines, including albumin-adjusted serum calcium, phosphorus, calcium x phosphorus （Ca x P） product, and intact parathyroid hormone （iPTH） and their achieved target range rates. The quality of life were evaluated by using the kidney disease questionnaire （KDQ）. Results One year later, the levels of serum calcium, phosphorus, Ca x P product, and iPTH were all decreased （P 〈 0.01 or 〈 0.05 ） compared with before the application of K/DOQI guidelines. The percentage of patients fell within the guideline range were as follows： 74.42% （32/43）, calcium; 62.79% （27/43）, phosphorus; 55.81% （24/43）, Ca x P product; 60.47% （26/43）, iPTH; 25.58% （11/43）, all four criteria, higher than before （P 〈 0.01 or 〈 0.05）. The scores of KDQ in global indices and symptom scores of physical symptoms, fatigue, depression, relationships with others and frustration dimension were also all increased （P 〈 0.01 ）. Conclusion The state of calcium-phosphorus metabolism in hemodialysis patients is improved, the quality of life is also enhanced.