不同钙浓度腹膜透析液对长期CAPD患者矿物质和骨代谢影响的分析

目的观察腹膜透析液钙离子浓度对持续性不卧床腹膜透析(CAPD)患者矿物质和骨代谢的影响。 方法回顾性分析我院腹膜透析中心行CAPD治疗2年以上的123例患者,根据腹膜透析液钙离子浓度分为低钙腹膜透析液组(LCD组,钙离子浓度为1.25 mmol/L)和标准钙腹膜透析液组(SCD组,钙离子浓度为1.75 mmol/L),观察不同钙浓度腹膜透析液对患者血清钙、磷、全段甲状旁腺激素(iPTH)、颈动脉厚度、心脏瓣膜钙化及骨痛、皮肤瘙痒等情况的影响。使用SPSS 18.0统计软件包进行数据处理。 结果2组患者治疗前人口学特征、腹膜转运特性、钙磷代谢等指标的基线水平差异无统计学意义(P>0.05)。治疗2年后,2组患者血钙浓度及达标率较治疗前均显著增高(P<0.05),SCD组血钙浓度增幅高于LCD组,但差异无统计学意义(0.26±0.31 mmol/L与0.17±0.29 mmol/L, t＝1.621,P＝0.108);2组间治疗后血清钙、磷、iPTH平均水平及其达标率、颈动脉厚度、心脏瓣膜钙化比例、骨痛及皮肤瘙痒累计发生率差异均无统计学意义(P>0.05);LCD组活性维生素D使用比例显著高于SCD组(χ² ＝6.373,P<0.05)。 结论采用低钙与标准钙腹透液治疗2年,对CAPD患者矿物质和骨代谢的影响无显著性差异。     

不同腹膜转运特性对血钙、血磷及PTH的影响

目的研究无尿持续非卧床腹膜透析（CAPD）患者腹膜转运功能对骨矿物质代谢的影响。方法选择159例无尿CAPD患者,根据腹膜平衡试验将患者分为2组：低转运特性组87例,高转运特性组72例。检测两组患者血钙、血磷、甲状旁腺激素等生化指标,测定腹膜尿素清除指数（KT／V）及肌酐清除率（CCr）。结果与低转运特性患者相比,高转运特性患者血钙、血磷和甲状旁腺激素水平明显偏低,而KT／V、CCr偏高,差异有统计学意义（P〈0．05）。多元逐步回归分析显示,CCr与血钙、血磷呈负相关（P〈0．05）,Kt／V与血钙呈负相关关系（P〈0．05）,而D／Pcr与血钙、血磷、甲状旁腺激素无明显相关性。结论低腹膜转运特性患者易出现高磷血症和高甲状旁腺激素;腹摸转运特性能影响血钙、血磷、甲状旁腺激素水平,但之间未见显著相关性。     

不同腹膜透析治疗模式对透析患者钙磷代谢及PTH的影响

目的 比较采用日间非卧床腹膜透析(DAPD)与经典持续非卧床腹膜透析(CAPD)对钙磷代谢及PTH的影响.方法 从新疆维吾尔自治区人民医院肾病科160例行腹膜透析患者中选取符合条件的83例,年龄在20～80岁,平均年龄为(45.26±16.14)岁,根据不同透析方式分为两组:CAPD组:共54例,男33例,女21例;DAPD组:共29例,男16例,女13例.CAPD组每次的透析剂量为6～8L、3～4次交换、夜间留腹(留腹的透析液浓度为1.5％);DAPD组日间采用6～8L的透析剂量,每袋透析液交换时间为3～4h,夜间干腹.观察这些患者相关临床指标包括患者的一般资料、血钙(Ca2+)、血磷(P3-)、甲状旁腺激素(PTH)以及残余肾功能.结果 两组在一般资料比较中差异无统计学意义(P＞0.05),两组在血钙(Ca2+)、血磷(P3-)、甲状旁腺激素(PTH)等方面差异均有统计学意义(P＜0.05),比较两组的超滤量以及比较透前残余肾功能与透后一年后残余肾功能差异均有统计学意义(P＜0.05).结论 行DAPD治疗的患者比经典的CAPD患者能更有效的控制钙磷代谢,并能更好的保护残余肾功能.     

CAPD的内分泌激素与rHuEPO疗效的相关性

目的：探讨在连续性非卧床腹膜透析(CAPD)干预治疗下慢性肾衰竭尿毒症内分泌激素与人类重组促红细胞生成素(rHuEPO)疗效的关系。方法：对经CAPD治疗的慢性肾衰竭尿毒症患内分泌激素等多重因素及血红蛋白进行多元回归分析。结果：非CAPD组贫血改善程度显低于CAPD组，内生肌酐清除率、甲状旁腺素、甲状腺激素、血皮质酵及透析治疗均与Hb显相关。结论：单用rHuEPO对改善肾衰竭尿毒症的贫血状态存在较大的局限，主要和包括PTH等在内的尿毒症红细胞生长抑制因子(inhibitors of erythropoiesis，IE)有关。rHuEPO配合CAPD是清除IE、改善贫血状态、提高生活质量的很好的组合治疗方法。     

慢性肾脏病患者血清全段甲状旁腺激素与钙、磷乘积的变化

目的：观察各期慢性肾脏病（CKD）患者血清全段甲状旁腺激素（iPTH）与钙、磷乘积的变化。方法：测定97例CKD患者、血液透析（HD）、腹膜透析（PD）患者及20例对照组血清iPTH、钙、磷等指标。结果：CKD3期、CKD4期、HD及PD患者血磷水平高于对照组及CKD1、CKD2期患者（P〈0.01）,iPTH也明显升高（P〈0.05）。CKD3、CKD4期、HD患者血清钙水平明显低于对照组及CKD1、CKD2期（P〈0.01）。结论：CKD后期起iPTH明显升高。CKD患者钙、磷代谢紊乱。     

尿素动力学模式评价CAPD充分性的新进展

连续性非卧床腹膜透析（ＣＡＰＤ）作为尿毒症病人的替代治疗近年来得到长足的发展。随着腹膜炎的发生率逐渐下降，透析充分性的问题越来越突出。尿素动力学模式（ＵＫＭ）作为广泛应用于评价血液透析（ＨＤ）病人透析充分性的指标在ＣＡＰＤ中的应用也受到重视。本文综述了ＵＫＭ的定量指标ＫＴ／Ｖ在评价ＣＡＰＤ充分性的目标值及其影响因素，并论述了ＫＴ／Ｖ与标化肌酐清除率（Ｃｃｒ）和营养评估指标之间的关系     

持续质量改进对老年腹膜透析患者钙磷代谢紊乱的作用

目的:探讨应用持续质量改进(CQI)的方法纠正老年腹膜透析患者钙磷代谢紊乱的效果。方法:运用PDCA四步法,即设计、实施、检验和应用,设计并实施改善老年腹膜透析患者钙磷代谢紊乱的治疗措施。结果:45例腹膜透析时间>3个月的老年患者参与了此项研究。经9个月CQI,各种钙磷代谢紊乱总发生率由82.22%降至42.22%(P<0.05)。其中高钙血症组血钙由(2.71±0.25)mmol/L降至(2.52±0.31)mmol/L(P<0.05),低钙血症组血钙由(1.78±0.42)mmol/L升至(2.11±0.24)mmol/L(P<0.05),血磷水平由(2.13±0.62)mmol/L降至(1.67±0.53)mmol/L(P<0.05),钙磷乘积由(80.22±16.61)mg2/dl2降至(54.58±15.93)mg2/dl2(P<0.05),继发性甲状旁腺功能亢进患者的血清全段甲状旁腺素(iPTH)由(488.12±227.31)pg/ml降至(290.3±171.15)pg/ml(P<0.01),血清碱性磷酸酶水平由(108.75±35.31)U/L降至(88.75±38.14)U/L(P<0.05)。有残肾功能较无残肾功能组,虽KT/V差异不大,在CQI后纠正高磷血症、高钙血症、甲状旁腺功能亢进上差异均有统计学意义(P<0.05)。结论:持续质量改进措施显著改善了老年腹膜透析患者的钙磷代谢紊乱。     

重视提高中国腹膜透析的临床和科研水平

腹膜透析以其简单便捷、安全有效、居家治疗,成为终末期肾脏疾病适宜的替代治疗方式之一。中国作为人口大国,近年来随着城乡基本医疗保险制度的普及和国家卫生政策的调控,腹膜透析患者持续增长,中国的腹膜透析事业正面临新的机遇和挑战,因此重视中国腹膜透析的临床技术改进和科学研究探索,势在必行。现就中国腹膜透析的现状及挑战;优化国人特点的个体化腹膜透析治疗方案,以循证医学促进治疗质量的提高;强化质量控制管理,努力构建腹膜透析治疗同质化;夯实腹膜透析研究基础,拓展腹膜透析相关自主知识产权产品领域等做一述评,以期为腹膜透析临床和基础研究提供新的思路,获得更大的社会经济效益。     

长期应用低钙透析对甲状旁腺激素的影响

目的：研究长期应用低钙透析液进行透析对患者甲状旁腺激素（parathyroidhormone,iPTH）的影响。方法：维持性血液透析患者16例,均使用钙浓度1.25 mmol/L的透析液透析3个月,比较血iPTH变化及透析前后的血钙磷水平的变化。结果：使用钙1.25 mmol/L的透析液3个月后,iPTH水平明显上升,透前血钙略有下降,透后血钙明显下降,血磷无明显变化。对于单次透析透后血iPTH较透前明显升高,下次透析前iPTH基本恢复,但略有上升。结论：长期应用（3个月）钙离子浓度1.25 mmol/L的透析液进行透析,会导致血iPTH的升高,但在可控制范围内。长期使用低钙透析时,应定期检查血的iPTH水平,以防发生继发性甲状旁腺机能亢进。     

Acute Effects of Different Phosphorus Sources on Calcium and Bone Metabolism in Young Women: A Whole-Foods Approach

The recommended dietary phosphorus intake is exceeded in the typical Western diet. However, few studies have been conducted on the bioavailability and metabolic consequences of dietary phosphorus from different food sources. In this study, acute effects of dietary phosphorus from three different food sources and a phosphate supplement on calcium and bone metabolism were investigated. Sixteen healthy women aged 20–30 years were randomized to five controlled 24-hour study sessions, each subject serving as her own control. At the control session, calcium intake was ca. 250 mg and phosphorus intake ca. 500 mg. During the other four sessions, phosphorus intake was about 1,500 mg, 1,000 mg of which was obtained from meat, cheese, whole grains, or a phosphate supplement, respectively. The foods served were exactly the same during the phosphorus sessions and the control session; only phosphorus sources varied. Markers of calcium and bone metabolism were followed. Analysis of variance with repeated measures was used to compare the study sessions. Only the phosphate supplement increased serum parathyroid hormone (S-PTH) concentration compared with the control session (P = 0.031). Relative to the control session, meat increased markers of both bone formation (P = 0.045) and bone resorption (P = 0.049). Cheese decreased S-PTH (P = 0.0001) and bone resorption (P = 0.008). These data suggest that the metabolic response was different for different foods.     

维持性血液透析和持续性不卧床腹膜透析患者生命质量及其影响因素分析

目的:探讨透析治疗患者的生命质量及其影响因素,为提高患者生命质量提供依据.方法:对31例持续性不卧床腹膜透析(CAPD)患者和29例维持性血液透析(MHD)患者,应用生命质量量表(MOS SF-36)、自评抑郁量表(SDS)、家庭功能问卷(Family APGAR)和社会支持评定量表(SSRS)进行测评调查,分析评价维持性透析患者生命质量及其影响因素.结果:60例维持性透析患者生命质量8个维度分值,均显著低于一般人群,CAPD患者躯体功能(PF)、情感角色(RE)2个维度分值以及主观支持得分均显著低于MHD患者;本组研究对象抑郁指数0.519±0.097,45%患者自评轻至中度抑郁状态;维持性透析患者生命质量影响因素主要有年龄、透析持续时间、费用来源、抑郁、主观支持和支持利用等.结论:抑郁在维持性透析患者中常见,CAPD和MHD患者生命质量明显下降,其影响因素除疾病本身外,还包括社会角色的转变和心理压抑.根据透析患者实际情况,采取个体化干预措施,可改善患者生命质量.     

Efficacy of calcium carbonate and low-dose vitamin D/1,25(OH)2D3 in reducing the risk of developing renal osteodystrophy in children on continuous ambulatory peritoneal dialysis

Eight children with terminal renal insufficiency on continuous ambulatory peritoneal dialysis were followed for 12 months to evaluate laboratory parameters of mineral ion and bone metabolism. Calcium carbonate (range 47–295 mg/kg body weight per day) was given in combination with low doses of either vitamin D or 1,25(OH₂D₃. Blood urea nitrogen and serum phosphate concentrations remained well controlled throughout the observation period. A significant increase in serum calcium levels from 2.35±0.18 to 2.61±0.22 mmol/l (mean ± SD) was observed during the first 6 months. Alkaline phosphatase activity and mid-C-regional parathyroid hormone, both indirect parameters of bone metabolism, revealed no evidence of severe secondary hyperparathyroidism. Our data indicate that calcium carbonate may be sufficient to induce relative hypercalcaemia in uraemic children, and thus reduce the risk of developing renal osteodystrophy. Unwanted side-effects of vitamin D preparations, i. e. increased intestinal phosphate absorption and hypercalcaemia after successful renal transplantation, may thus be avoided.     

Effect of age on protein catabolic rate, morbidity, and mortality in uraemic patients with adequate dialysis

To test the validity of the assumption that the protein catabolicrate (PCRn g/kg/day) is dependent on the normalized dose ofdialysis (Kt/V urea), and to try to define the charactensticsof the patients in the undefined domain A of the mechanisticmap of the National Cooperative Dialysis Study (NCDS), whichshould include patients with adequate amount of dialysis butinadequate PCRn, urea kinetic model ling was performed over12 months on 85 patients undergoing haemodialysis All the patientswere man aged to maintain a Kt/V urea 0.9. During the entireperiod of study the total number of hospitalizations and thenumber of days of hospitalization were recorded. Total serumproteins and serum albumin concentrations were measured at thestart and at the end of the study. The results of the studyshow that there was no correlation between Kt/V and PCRn norbetween Kt/V and patient's age, but there was a strong inversecorrelation between age and PCRn (r=0.578; P <0.0001). Furtherdivision of the patients into four groups according to age showedthat the lowest values of PCRn were for the group of patients75 years old. Twelve patients with PCRn0.8 and Kt/V0.9 wereincluded in domain A of the mechanistic map. Eleven (92%) ofthese 12 patients were years old. No correlations were foundbetween the total number of hospitalizations, the total daysof hospitalization, Kt/V, time on HD, body weight and PCRn bymultiple regression analysis, while the inverse correlationbetween PCRn and age was confirmed. Body weight, total serumproteins and serum albumin concentration remained stable throughoutthe study. However, the basal serum albumin was less in thegroup of patients 75 years old. We conclude that if an adequateamount of dialysis is delivered, the protein intake becomesindependent of the quantity of dialysis and dependent on otherfactors not yet known. In this situation, the age of the patientsexerts a great negative influence on PCRn, particularly in patients75 years old. In the 12 patients from the whole group with Kt/V0.9 and PCRn 0.8g/kg/day (domain A of the mechanistic map),we could find no differences in death, hospitalization rate,or duration of hospitaliza flon compared to the others. Thereduced PCRn in the oldest patients does not affect body weight,total serum protein, and serum albumin concentrations over time.This suggests that these patients might do well even with lessprotein intake.     

新型纳米骨关节修复重建材料的生物活性及近期对机体钙磷代谢的影响

目的 研究新型骨关节修复重建材料纳米羟基磷灰石/聚酰胺66（n-HA/PA66）植入兔肌和骨内后材料表面的生物学变化及近期对兔机体钙磷代谢的影响,为临床应用提供参考资料.方法 参照GB/T16886.5-1997-ISO 10993-5：1992对医用植入材料的评价规定标准,将n-HA/PA66植入新西兰大白兔骶棘肌及股骨髁内,在术前1 d及术后4 d,1周,2周和4周等不同时相点抽血化验血清钙磷含量,并设置空白对照;术后1周,2周,3周,4周,8周取出植入材料,以扫描电镜（SEM）对材料表面及材料/受体骨的界面进行形貌分析;对植入骨内标本再进行组织学切片观察材料/受体骨界面新骨形成情况.所得数据以SPSS10.0软件包进行统计学分析.结果 n-HA/PA66植入兔体内4 d后血清磷含量较植入前显著增高（P＜0.05）;余各时相点材料植入组植入后、前两两比较及分别与假手术对照组两两比较,血清钙磷含量均无显著性差异（P＞0.05）;SEM检测显示n-HA/PA66植入体内能够在其表面形成新的磷灰石晶体,能与受体骨发生牢固键合.结论 n-HA/PA66在动物体内具有良好的生物活性;植入体内近期对兔血清钙磷代谢未发生明显影响.