单中心腹膜透析患者钙磷代谢不达标的影响因素分析

目的回顾性分析山西医科大学第二医院腹膜透析中心近5年腹膜透析(peritoneal dialysis,PD)患者钙磷及全段甲状旁腺素(intact parathyroid hormone,iPTH)等相关生化指标,分析矿物质及骨代谢异常产生的原因,进一步提高PD患者的生活质量和改善预后。方法选取山西医科大学第二医院2014年1月至2018年12月间进行长期维持性腹膜透析患者102例,随访3个月以上,回顾性分析患者的基线和最后一次回院随访资料。了解其钙磷代谢紊乱情况,并按血钙、血磷及iPTH水平分为达标组、不达标组,比较两组临床资料差异,探讨山西省部分地区PD患者钙磷代谢不达标的影响因素。结果 PD患者中,男女比0.79∶1,年龄(51.2±13.9)岁,基线血钙、血磷、iPTH及碱性磷酸酶(alkaline phosphatase,ALP)水平分别为(2.07±0.26)mmol/L、(1.8±0.5)mmol/L、(387.8±40.3)pg/mL、(103.9±10.3)U/L,最后一次随访时平均血钙、血磷、iPTH及ALP水平分别为(2.16±0.27)mmol/L、(2.0±0.8)mmol/L、(497.8±39.6)pg/mL、(101.4±10.0)U/L。血钙、血磷及iPTH达标率分别为37.25%、48.04%、19.61%,最后一次随访时血钙、血磷及iPTH达标率分别为48.04%、34.31%、13.73%。钙磷代谢指标控制不达标因素分析结果显示:基线血肌酐(Scr)是血钙不达标的影响因素;基线钙磷乘积是血磷不达标的影响因素;透析时间是iPTH不达标的影响因素;透析时间、基线ALP是ALP不达标的影响因素。结论山西地区PD患者钙磷代谢紊乱问题突出,血钙、磷及iPTH达标率不理想,影响钙磷代谢不达标的因素有Scr、透析时间、钙磷乘积。     

维持性血液透析患者钙磷代谢及甲状旁腺素水平横断面调查

目的根据透析病人生存质量指南标准调查大理大学第一附属医院维持性血液透析(MHD)患者钙磷代谢及甲状旁腺素的达标率,评价其危险因素,为临床治疗提供依据。方法对我院128例MHD患者的血钙、血磷、血清白蛋白、血清碱性磷酸酶、甲状旁腺素(i PTH)等进行检验,并根据透析病人生存质量指南标准进行达标率统计;对患者年龄(≤45岁组和4 5岁组)、残余尿量(尿量1 0 0 m l/d的无尿组和尿量≥1 0 0 m l/d的有尿组)、透析时间(3年组和≥3年组)、透析充分性(eKt/V≥1.2和e Kt/V1.2)分别分组,并对组间血钙、血磷、钙磷乘积、ALP、i PTH、URR%、e Kt/V等指标进行比较;采用多元逐步回归分析i PTH与年龄、透析时间、血钙、血磷、钙磷乘积、血清白蛋白、碱性磷酸酶、尿素氮、血肌酐、残余尿量等的关系。结果1 2 8例患者中血钙、血磷、钙磷乘积、i PTH达标率分别为4 8.4%、4 2.2%、5 8.6%、2 5%,四项指标均达标的患者12例,占9.38%。≤45岁组和45岁组组间血磷、钙磷乘积、无尿组和有尿组组间i PTH,透析充分组和透析不充分组组间URR%差异有统计学意义(P0.05)。i PTH与透析时间、血钙呈负相关,与血磷、碱性磷酸酶、血肌酐呈正相关。结论本院MHD患者钙磷代谢及甲状旁腺素水平达标率较低,临床上需加强患者宣教,在合理使用磷结合剂、充分透析同时,注意监测总结治疗效果及不良反应,以改善MHD患者的预后。     

不同钙离子浓度透析液对单次血液透析钙平衡的影响

目的观察三种不同钙离子浓度透析液对维持性血液透析患者单次透析过程中血钙的影响,为透析液钙离子浓度的个体化选择提供理论参考。方法选择2014年1月在哈尔滨医科大学附属第一医院血液净化中心接受维持性血液透析治疗的患者80例为研究对象,随机分为3组,根据使用不同钙离子浓度分别为1.25 mmol/L(DCa 1.25组)、1.5 mmol/L(DCa 1.50组)和1.75 mmol/L(DCa 1.75组)的透析液进行单次血液透析治疗,每次透析4 h,3组所用透析液除钙离子浓度不同外,其他透析液主要成分组间无差别。分别检测每组透析前、后及下一次透析前的血肌酐(SCr)、尿素氮(BUN)、血白蛋白(albumin,Alb)、血钙、血磷等生化指标,同时监测单次透析前后患者的血压变化。结果对患者透析前基线数据初步分析结果表明,透析前iPTH水平为(458.7±408.2)ng/L、血钙(2.2±0.2)mmol/L、血磷(2.1±0.6)mmol/L、钙磷乘积(57.4±18.9)。iPTH、血钙、血磷达标率分别为53.8%、46.3%,25.0%;透析患者普遍伴有低钙血症(占48.8%)、高磷血症(占71.3%)和高甲状旁腺素血症(占23.8%)。单次透析治疗结束后的血钙水平分别为DCa 1.25组(2.27±0.20)mmol/L、DCa 1.50组(2.53±0.21)mmol/L、DCa 1.75组(2.51±0.20)mmol/L,组间比较差异有统计学意义(F=12.52,P0.01)。与透析前相比较,3组透析后血钙浓度较透析前均有所增加;协方差分析结果表明,在扣除透析前血钙浓度的影响因素后,DCa 1.25组血钙平均增加量最小。单次透析结束后血钙达标率分别为65.4%(DCa 1.25组)、48.1%(DCa 1.50组)、58.8%(DCa1.75组);透析结束后高钙血症的发生率DCa 1.75组(占41.2%)与DCa 1.50组(占51.9%)明显高于DCa 1.25组(占19.2%)。三种透析液对透析患者的血磷、血压影响差异均无统计学意义(P0.05)。结论单次使用钙离子浓度为1.25 mmol/L的透析液治疗,对透析后血钙浓度的影响最小、血钙达标率最高、高钙血症的发生率最低;与钙离子浓度分别为1.50 mmol/L和1.75 mmol/L透析液比较,钙离子浓度1.25 mmol/L更接近人体生理离子钙浓度。     

维持性血液透析患者血磷达标情况分析

目的通过分析昆明市第一人民医院血液净化中心维持性血液透析(maintenance hemodialysis,MHD)患者的临床数据,了解本中心的钙磷等达标情况及不同血磷水平的MHD患者营养状况和短期预后,以选择恰当的血磷干预方法。方法选取本中心MHD患者173例,每例患者每3个月测定血磷、血钙、全段甲状旁腺素(immunoreactive parathyroid hormone,iPTH)、白蛋白(albumin,Alb)、总胆固醇(total cholesterol,TC)、体质量指数(body mass index,BMI),至少测量6次,取其平均值。根据血磷测定值将MHD患者分为低磷组、标磷组、高磷组、超高磷组,使用T检验、卡方检验、秩和检验分析各组的病死率、部分营养指标、血总钙和iPTH、年龄、透析时间及透析频率,并用Logistic分析相关危险因素。结果本中心173例MHD患者相关指标的总体达标率分别为血磷42.2%、血钙67.6%、iPTH52.6%,钙磷乘积67.6%,Alb 43.4%,TC64.7%,BMI 60.7%;血磷、血钙、iPTH同时达标仅15.6%(27/173)。四组的病死率分析,标磷组最低(10.9%),低磷组最高(32.6%),但差异无统计学意义(P0.05)。四组的血清Alb达标率:高磷组最高(55.6%),低磷组最低(15.8%),仅低磷组与标磷组(41.1%)比较差异有统计学意义(P0.05)。高磷血症、营养不良和死亡相关因素分析:单因素Logistic分析年龄、血钙、血磷、iPTH、TC与病死率相关,有统计学意义(P0.05)。多因素Logistic回归分析提示年龄、TC与病死率有统计学关联。结论 MHD患者钙磷代谢紊乱及营养不良发生率较高;单纯从营养状况和钙磷代谢情况观察,血磷控制在达标者并不是最好的,低磷者最差,提示控制血磷的方法,应强调药物降磷及充分透析,低磷的饮食应兼顾营养状况,钙磷代谢和营养状况同时达标对患者更有益。     

单中心腹膜透析患者血红蛋白达标率及相关因素分析

目的通过调查腹膜透析(peritoneal dialysis, PD)患者贫血状况,分析影响血红蛋白(hemoglobin, Hb)达标的因素。方法收集2019年5月1日至9月30日间在安徽医科大学第一附属医院腹膜透析中心规律随访的所有年龄≥18岁且透析龄≥3个月的随访资料完整的PD患者280例,以Hb≥110 g/L为血红蛋白达标标准,分析Hb达标率及影响Hb达标因素。结果 (1)PD患者Hb浓度为(106.08±20.42) g/L,Hb达标率为40.36%,转铁蛋白饱和度、铁蛋白达标率分别为76.78%、38.95%;(2)Hb达标组与未达标组相比,透析龄、每周重组人促红细胞生成素使用剂量、营养评估体质指数(subjective global assessment, SGA)、血磷水平显著低于未达标组(P0.05);达标组血清白蛋白、胆固醇、血钙、血清铁、转铁蛋白饱和度、总肌酐清除率(creatinine clearance rate, Ccr)、残肾Kt/V、残肾Ccr显著高于未达标组(P0.05);(3)高转运组与低平均转运组、高平均转运组相比血红蛋白水平差异具有统计学意义;(4)单因素logistic回归分析显示透析龄1年、高SGA评分、血清白蛋白35 g/L、全段甲状旁腺素(intact parathyroid hormone, iPTH)300 ng/L、血钙2.5 mmol/L、血清铁10.6μmol/L、转铁蛋白饱和度20%、无残余肾功能是PD患者Hb不达标的影响因素;(5)多因素Logistic回归分析结果显示透析龄5年、血清白蛋白35 g/L、iPTH800 ng/L、血清铁10.6μmol/L、转铁蛋白饱和度20%为PD患者贫血的独立危险因素。结论高透析龄、低白蛋白水平、甲状旁腺功能亢进、铁缺乏为PD患者贫血的独立危险因素。     

高通量透析对维持性血液透析患者钙磷代谢的影响

目的探讨高通量血液透析对维持性血液透析患者钙磷代谢的影响,为临床维持性血液透析合并有钙磷代谢紊乱的患者提供新的血液透析治疗思路。方法纳入2013年1月至2015年1月于我院门诊行维持性透析治疗且合并有高磷血症及继发性甲状旁腺功能亢进的患者80例,将其随机分为高通量血液透析组(甲组)和普通血液透析组(乙组);比较透析前及透析后3个月、6个月患者血磷、血钙、骨密度、全段甲状旁腺素(immunoreactive parathyroid hormone,iPTH)、血红蛋白(hemoglobin,Hb)、C反应蛋白(C-reactive protein,CRP)透析充分性及患者的生活质量(如皮肤瘙痒、骨痛、关节痛)的变化。采用SPSS 20.0软件进行数据分析,P0.05表示差异有统计学意义。结果治疗3个月后甲组患者的血磷、iPTH、CRP水平较治疗前有降低,血钙及Hb较治疗前有升高,但治疗前后差异无统计学意义(P0.05);乙组患者治疗3个月后患者的血磷、iPTH、CRP水平较治疗前升高,血钙及Hb较治疗前有降低,差异无统计学意义(P0.05);治疗3个月后2组间比较,血磷、血钙、iPTH和CRP无差异(P0.05)。治疗6个月后甲组患者的血磷、iPTH、CRP水平较治疗前明显降低,血钙及Hb较治疗前明显升高,治疗前后差异有统计学意义(P0.05);乙组患者治疗6个月后患者的血磷、iPTH水平较治疗前明显升高,差异有统计学意义(P0.05);血钙及Hb较治疗前有升高,差异无统计学意义(P0.05);治疗6个月后2组间比较,甲组血磷、iPTH、CRP较乙组降低(P0.05),血钙较乙组升高(P0.05)。随着治疗时间的延长,甲组患者皮肤瘙痒、骨痛、关节痛的症状逐渐减轻,乙组患者的上述症状无明显改善;2组间比较,甲组关节痛和皮肤瘙痒较乙组明显缓解(P0.05)。2组患者治疗前后骨密度检测、透析充分性无明显差异(P0.05)。结论高通量血液透析对于维持性血液透析患者钙磷代谢紊乱、继发性甲状旁腺功能亢进、减轻皮肤瘙痒程度、贫血及生活质量有较好的改善作用。     

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。     

单中心维持性血液透析患者的钙磷代谢调查

目的 探讨维持性血液透析(maintenance hemodialysis,MHD)患者钙磷代谢异常及继发性甲状旁腺功能亢进的患病情况,并分析其相关危险因素.方法 选择2013年4月至2014年3月滁州市第一人民医院血液净化中心行MHD的203例患者进行调查,收集其一般资料,测定血钙、血磷、血全段甲状旁腺素(immunoreactive parathyroid hormone,iPTH),分析终末期肾脏疾病患者的患病率、达标率以及相关危险因素.结果 203例患者中,高钙血症50例,患病率为24.63％;低钙血症11例,患病率为5.42％;高磷血症88例,患病率为43.35％;低磷血症19例,患病率为9.36％;高iPTH86例,患病率为42.36％;低iPTH52例,患病率为25.62％.符合KDI-GO关于慢性肾脏病-矿物质和骨代谢异常诊断的患者比例高达97.54％.本组MHD患者血钙、血磷、iPTH达标率分别为69.95％、48.77％、32.02％.血钙、血磷、iPTH均达标仅17例(占8.37％).血钙和血磷的达标率低于透析预后与实践模式研究4 (the dialysis outcomes and practice patients sutdy 4,DOPPS4).多因素Logistic回归分析显示,高iPTH的危险因素为高磷血症、低钙血症、碱性磷酸酶;低iPTH的危险因素为透析时间、年龄、碳酸钙服用史、活性维生素D服用史.结论 MHD患者慢性肾脏病-矿物质和骨代谢异常的发病率较高,与DOPPS4比较,慢性肾脏病-矿物质和骨代谢异常各项指标达标率较低,其并发症危害值得注意.重视血钙、血磷、血iPTH 的检测,及时纠正血钙、血磷、血iPTH的紊乱可减少透析相关慢性肾脏病-矿物质和骨代谢异常的发生.     

降低透析液钙浓度对慢性肾脏病-矿物质骨代谢异常的影响

目的探讨降低透析液钙浓度对维持性血液透析患者慢性肾脏病-矿物质骨代谢异常(CKD-MBD)各项评估指标和相关药物使用的影响,初步了解1.25 mmol/L钙浓度透析液的适用人群。方法回顾性分析四川大学华西医院血液透析中心门诊透析患者在透析液钙浓度由1.5 mmol/L调低为1.25 mmol/L后的1年中的临床资料,比较透析液钙浓度调整前后血清钙、磷、甲状旁腺素(PTH)、碱性磷酸酶等CKD-MBD评估指标的检测值和达标情况以及钙剂和骨化三醇的使用剂量。依据基线PTH值对CKD-MBD患者进行分组分析,评价低钙透析液对各组患者继发性甲状旁腺功能亢进的影响。结果共纳入281例透析患者,透析液钙浓度降低后血钙和血磷水平无明显变化(P0.05),PTH和碱性磷酸酶水平明显增高(P0.05)。1.25 mmol/L钙浓度透析液使用1年后和使用前比较,血钙和血磷的达标率差异无统计学意义(P0.05),而PTH达标率由56.1%下降至49.8%,差异有统计学意义(P0.05)。透析液钙浓度调整后患者每周的碳酸钙使用剂量无明显变化(P0.05),而骨化三醇的使用量由(1.87±1.09)μg/周明显增加为(2.62±1.26)μg/周(P0.05)。不同PTH基线值分组的患者对1.25 mmol/L钙浓度透析液的反应不同,基线PTH300 ng/L的分组在药物调控后有59.5%患者PTH值高于目标值上限,较基线情况明显增加(P0.05)。结论 1.25 mmol/L钙浓度的透析液相较于1.5 mmol/L钙浓度的透析液对血清钙和磷的水平无明显影响,但可引起PTH的升高,诱发或加重继发性甲状旁腺功能亢进和高转运性骨病;基线PTH值较低的患者使用低钙透析液后可能获益更多,为更适宜人群。     

低钙透析液对血液透析伴继发性甲状旁腺功能减退患者的临床研究

目的：探讨应用含钙1.25mmol／L浓度透析液进行血液透析对维持性血液透析（MHD）伴相继发性甲状旁腺功能减退患者的钙磷代谢和甲状旁腺功能的影响。方法：选择MHD6个月以上、病情稳定、连续2次血iPTH〈100pg／ml的患者60例,随机分为对照组（含钙1.5mmol／L透析液）和治疗组（含钙1.25mmol／L透析液）,每组各30例,观察时间6个月。观察并记录研究前、研究后l、3、6个月等不同时期患者血iPTH、血清校正钙、磷、钙磷乘积等指标的变化以及相关不良反应。另外,选择使用含钙浓度1.5mmol／L和1.25mmol／L透析液进行MHD的患者各20例,检测单次透析前、透析结束时以及下次透析前的血清校正钙、磷和iPTH浓度。结果：（1）治疗组单次透析后血清校正钙、磷和钙磷乘积均较透析前明显下降,iPTH浓度较透前明显升高,P〈0.01;而对照组上述血钙和iPTH浓度无明显变化;（2）透析后治疗组血清校正钙和钙磷乘积较对照组明显下降,血iPTH浓度较对照组明显升高,P〈0.01;两组血磷浓度差异无统计学意义。（3）治疗组1个月后血清校正钙、磷和钙磷乘积较治疗前开始下降,3个月后进一步下降,P〈0.05,6个月后各项指标趋于稳定;iPTH水平1个月后较治疗前明显升高,并随着治疗时间的延长,逐渐升高,P〈0.01。（4）对照组治疗后1、3、6个月上述指标与治疗前比较差异无统计学意义。（5）两组透析过程中出现的不良反应差异无统计学意义。结论：对于血iPTH〈100pg／ml MHD患者应用含钙1.25mmol／L透析液进行血液透析能较好地控制其血清校正钙、磷、钙磷乘积水平,有效地改善被过度抑制的甲状旁腺功能,并且安全性良好。     

Intestinal calcium absorption,serum phosphate,and parathyroid hormone in patients with chronic renal failure and osteodystrophy before and during hemodialysis

Summary In 34 patients with chronic renal failure (CRF), fractional⁴⁷calcium absorption (Fa⁴⁷Ca) was measured by an external counting method. A significant correlation was found with impairment of renal function, as expressed by the creatinine clearance. There was also a significant correlation of Fa⁴⁷Ca with the serum phosphate (SeP) level and of immunoreactive parathyroid hormone (iPTH) with renal function. When the relationship of both SeP and Fa⁴⁷Ca with creatinine clearance was excluded, no partial correlation between SeP and Fa⁴⁷Ca appeared to exist. A significant increase of Fa⁴⁷Ca and serum Ca and a significant decrease of SeP and iPTH were found in 12 patients 2 to 15 months after they were put on intermittent hemodialysis. The possible influence of SeP on intestinal calcium absorption is discussed, and it is suggested that impairment of intestinal absorption of calcium is not a main factor in development of renal osteodystrophy.     

On-line血液透析滤过对维持性血液透析患者矿物质代谢的影响

目的 探讨On-line血液透析滤过技术对维持性血液透析患者矿物质代谢的影响.方法 选取尿毒症维持性血液透析患者110例,采用数字表法随机分为常规血液透析治疗组(HD组)和On-line血液透析滤过治疗组(HDF组),每组各55例.HD组患者每周行3次血液透析治疗,HDF组患者每周行2次常规血液透析治疗,1次血液透析滤过,时间均为4h.监测治疗当天和治疗3个月后患者外周血中血清钙离子、磷、全段甲状旁腺激素(iPTH)及碱性磷酸酶(ALP)等矿物质代谢的评估指标.结果 治疗前两组患者血钙、磷、iPTH及ALP水平差异无统计学意义(均P＞0.05).治疗3个月后,HD组血钙、iPTH和ALP与治疗前比较差异无统计学意义(均P＞0.05),血磷低于治疗前水平,与治疗前比较差异有统计学意义(P＜0.05).HDP组治疗后血磷、iPTH和ALP较治疗前下降明显(均P＜0.01).治疗后,HDF组血磷和ALP较HD组显著降低,差异有统计学意义(P＜0.05),iPTH降低更为显著(P＜0.01).结论 与普通血液透析比较,On-line血液透析滤过治疗能有效清除血磷,降低iPTH和ALP水平,从而改善维持性血液透析患者的矿物质代谢异常.     

维持剂量活性维生素D3联合组合型人工肾对维持性透析者钙磷代谢紊乱及微炎症的影响

目的 探讨组合型人工肾血液灌流串联血液透析对维持性透析者服用活性维生素D3时高血磷和高血清甲状旁腺激素的影响.方法 随机选择42例接受维持性血液净化治疗者,按血液净化方法不同分为血液透析组（n=20）和血液灌流串联血液透析组（n=22）,分别治疗4周.在治疗前后检测两组受试者血钙、血磷、血清甲状旁腺激素和C反应蛋白水平.采用t检验进行数据统计.结果 血液透析组血磷水平较治疗前有所升高[（2.2±0.4）vs（2.3±0.5）mrnol/L],但差异无统计学意义;甲状旁腺激素较治疗前明显下降[（340±36） vs（310±25） ng/L],差异有统计学意义（P＜0.05）.治疗后,血液灌流串联血液透析组血磷[（2.2±0.6）vs（1.7±0.4） mmol/L]、甲状旁腺激素水平[（355±38） vs （285±29） ng/L]和血清C反应蛋白水平[（3.3±4.8）vs（1.5±3.8）mg/L]均有所下降,差异有统计学意义（P＜0.05）.两组血钙水平未见明显改变.结论 组合型人工肾血液灌流串联血液透析可减轻维持性血透者磷负荷,改善钙磷代谢紊乱和微炎症状态,有效避免使用活性维生素D3时诱发的高磷血症.     

Intensified treatment of hyperphosphatemia associated with reduction in parathyroid hormone in patients on maintenance hemodialysis

Background: This study investigated the therapeutic effect of intensive phosphorus-lowering therapy on intact-parathyroid hormone (iPTH) levels in hemodialysis patients.

Methods: Ninety-five hemodialysis patients with serum phosphorus ≥1.78?mmol/L and iPTH ≥300?pg/dL were apportioned to either the treatment or control group (n?=?43 and 52, respectively) based on patient commitment to treatment. The treatment group was given phosphorus-lowering therapies with phosphate binders (lanthanum, sevelamer or/and calcium reagent) combined with dietary phosphate restriction and intensified hemodialysis. The control individuals were given low doses of calcium agents, if serum calcium was <2.54?mmol/L. Percent changes in serum phosphorus and iPTH levels were compared between the two groups. In addition, based on the time required to achieve >20% decrease in serum phosphorus, the patients in the treatment group were further stratified as rapid responders (≤2?months; 27 patients) or slow responders (>2?months; 16 patients) and percent changes in iPTH were compared.

Results: Serum phosphorus and iPTH levels decreased from baseline in the treatment group (?24.08?±?1.93% and ?9.92?±?3.70%, respectively) but increased in the control group (22.00?±?3.63% and 104.21?±?23.89%; both p?p?Conclusions: For these patients on maintenance hemodialysis, intensive treatment of hyperphosphatemia was associated with a decrease in iPTH levels, especially for those who had achieved substantial reduction in serum phosphorus within 2?months.     

Effect of menopause and aging on serum total and ionized calcium and protein concentrations

Summary The effects of menopause and aging on serum total and ionized calcium concentrations were evaluated in 402 healthy women (aged 18–71 years), of whom 83 were premenopausal and 319 postmenopausal. Serum albumin and globulin concentrations and serum pH were also measured in most of these women. Serum total but not ionized calcium concentration increased significantly at menopause. This increase in the protein-bound component of total calcium in postmenopausal women was associated with increases in mean serum globulin concentration (P=0.03) and in serum pH (P=0.03). Serum total calcium declined with age within the pre- and postmenopausal groups (r=−0.225,P=0.04 and r=−0.121,P=0.03, respectively). This was associated with an age-related decrease in serum albumin concentration in all women (r=−0.47,P<0.0001). Neither serum globulin concentration or pH varied with age. Thus, menopause and aging affect serum total, but not ionized calcium concentration.     

血清铁蛋白与血清铁调素在老年原发性高血压合并骨质疏松中作用的研究

目的探讨血清铁蛋白(serum ferritin,SF)与血清铁调素(hepcidin,Hep)的表达在老年原发性高血压(senile essential hypertension,SEH)合并骨质疏松(osteoporosis,OP)的意义。方法以SEH患者255例为研究对象,按照双能X线检测骨密度(bone mineral densily BMD)的检查结果分为骨质疏松组83例,骨量减少组91例,骨量正常组81例。ELISA法检测SF、Hep,进行各组间比较并分析相关因素与骨量的关系。结果 1.与骨量正常组比较,骨量减少组与OP组中的SF高于骨量正常组(P0.05);与骨量减少组相比,OP组中的SF高于减少组,差异有统计学意义(P0.05)。与骨量正常组比较,骨量减少组与OP组中的Hep低于骨量正常组(P0.05);与骨量减少组相比,OP组中的Hep低于减少组,差异有统计学意义(P0.05)。2.相关分析显示:股骨颈BMD与碱性磷酸酶、铁调素成正相关(P0.05);BMD与铁蛋白成负相关(P0.05)。结论 SEH患者SF、Hep的水平与OP密切相关,监测SF、Hep,有助于指导SEH合并OP患者的预防和治疗。     

Comparison between NK cell activity and prostate cancer stage and grade in untreated patients: correlation with tumor markers and hormonal serotest data

Summary NK cell activity was measured in 24 patients with untreated prostate cancer (11 subjects with localized disease, D0, and 13 patients with stage D tumor) and 10 healthy controls. In these same subjects serum prostate-specific antigen (PSA), prostatic acid phosphatase (PAP), testosterone, prolactin and cortisol concentrations were assessed. The data obtained were correlated with both tumor spread (localized vs disseminated disease) and grade (well-differentiated cancer, G1, vs moderately and poorly differentiated carcinoma, G2 and G3). In patients with stage D0 cancer mean NK activity (33.0±10.6) was virtually identical with the mean value recorded in healthy men (34.5±7.1), while in subjects with stage D1–D2 disease NK activity was significantly reduced (11.9±7.1). These findings correspond with our data on treated subjects, in whom NK activity level was found to correlate well with the presence of tumor cells in the circulation. In subjects free of malignant tumors but with a chronic disease (diabetes, arthritis, severe rheumatic disorders) mean NK activity was clearly reduced (5.7±1.5). The use of NK activity data as probe for tumor metastases was found to be statistically as reliable as was the application of the PSA serotest (but not serum PAP concentrations). None of the measured hormonal parameters correlated well with tumor stage. Both testosterone and prolactin serum concentrations were found to be lower in the G2 and G3 cancer group than in well-differentiated (G1) tumors, in accordance with the published literature. In conclusion, NK lytic activity measured in untreated prostate cancer patients has been found to be insensitive to differences in prostate cancer grades (P=0.86) but readily differentiates tumor dissemination from localized disease (P<0.01). From the results of this preliminary study we advocate the assessment of NK activity as potentially useful supplement to prostate cancer staging protocols.     

The impact of serum albumin and serum protein levels on POSSUM score of patients with proximal femur fractures

BackgroundPOSSUM was developed to predict risk-adjusted mortality and morbidity rates for surgical procedures. We evaluated the impact of serum albumin and serum protein levels on POSSUM scores.MethodsMedical files of 2269 patients operated for proximal femur fractures were reviewed. Preoperative serum albumin levels were available for 387 patients (mean 35.1 g/l, range 22–49) and serum protein levels for 279 patients (mean 61.6 g/l, range 40–86).ResultsSerum albumin and protein levels were inversely associated with mortality in multivariate models (albumin, OR = 0.89, p = 0.009; protein, OR = 0.92, p = 0.009) and in composite outcome models as well (albumin, OR = 0.955, p = 0.219, protein, OR = 0.94, p = 0.014). The area under the curve (AUC) for POSSUM prediction of mortality (n = 1770) was 0.632 (95% CI: 0.580–0.684, p < 0.001). The AUC for a model including serum protein levels was 0.742 (95% CI: 0.649–0.834, p < 0.001). Hospitalisation time was longer for patients with lower serum proteins levels (p = 0.045), with an inverse correlation (Pearson correlation −0.164, p = 0.011).ConclusionsLower preoperative serum albumin and serum protein levels were associated with increased risk for mortality, increased hospitalisation time and poorer outcomes in patients operated for proximal femoral fractures. Including those values to POSSUM scores would increase their predictive power.