血液透析滤过串联血液灌流联合骨化三醇冲击治疗对血透患者继发性甲状旁腺功能亢进的临床疗效

目的探讨血液透析滤过串联血液灌流联合骨化三醇冲击治疗对维持性血液透析患者并发继发性甲状旁腺功能亢进的临床疗效。 方法选取2019年01月至2019年06月60例维持性血液透析并发继发性甲状旁腺功能亢进的患者作为研究对象，其中男性42例，女性18例；年龄20～68岁，平均(52±17.2)岁。对照组30例，每周常规血液透析3次，联合骨化三醇冲击治疗；研究组30例，每周常规血液透析1次，血液透析滤过1次，血液透析滤过＋血液灌流1次，联合骨化三醇冲击治疗。观察两组患者血钙、血磷、血甲状旁腺素、碱性磷酸酶(ALP)等各项指标变化，并对两组患者的临床症状进行比较分析。 结果两组患者血甲状旁腺素均降低(P<0.05)；研究组患者的血甲状旁腺素、血磷、碱性磷酸酶明显低于对照组(P<0.05)；对照组治疗后血钙水平上升，较治疗前差异有统计学意义(P<0.05)；研究组治疗前后血钙水平差异无统计学意义(P>0.05)。 结论对维持性血液透析继发甲状旁腺功能亢进患者应用血液透析滤过串联血液灌流联合骨化三醇冲击治疗不仅能有效降低血甲状旁腺素、血磷、碱性磷酸酶水平，不影响血钙水平，且更能改善患者临床症状，提高生活质量。     

Effect of oral calcitriol pulse therapy on the lipid, calcium, and glucose homeostasis of hemodialysis-patients: its safety in a combination with oral calcium carbonate.

OBJECTIVE: To more clearly elucidate the conflicting results that have been obtained after oral calcitriol pulse therapy on lipid, glucose, and calcium levels in hemodialysis (HD) patients, and to determine safety of oral calcitriol pulse therapy in a combination with calcium carbonate. DESIGN: A randomized, crossover, placebo-controlled study. SETTING: HD centers in 3 teaching university hospitals. PATIENTS: Forty-eight chronic HD patients. METHODS: HD patients were randomized into 2 groups. Each group (n = 24), in addition to 4.5 g calcium carbonate daily, received either oral calcitriol pulse therapy or placebo twice weekly at the end of HD, sessions for 3 months, after which the 2 therapeutic groups were crossed-over, and for an additional 3 months, the calcitriol group received placebo, and the placebo group was put on calcitriol. Serum triglyceride, total cholesterol, low-density lipoprotein cholesterol (LDL-c), high-density lipoprotein cholesterol (HDL-c), total calcium, alkaline phosphatase, proteins, phosphorus, parathyroid hormone (PTH), blood pH, and glucose were measured at random and at the end of 3 and 6 months of the trial. RESULTS: After calcitriol therapy, triglyceride, serum PTH, total alkaline phosphatase, and fasting blood sugar significantly decreased, but total serum calcium significantly increased, whereas other examined parameters remained unchanged compared with the other groups. Calcium, phosphorus, calcium x phosphorus product, PTH levels, and all of these parameters were optimized in 18 (37.5%), 22 (45.8%), 34 (70.8%), 30 (62.5%), and 12 (%25) cases, respectively, in the calcitriol groups. No significant side effect was seen during the trial. CONCLUSION: Our findings indicate that short-term oral calcitriol pulse therapy in combination with calcium carbonate is safe and beneficial for metabolic abnormalities of HD patients; however, its safety for prolonged therapy is yet to be proved.     

Bone histomorphometrical analysis in patients on long-term dialysis treatment for more than ten years

In Japan there is a steady increase in patients who have been on dialysis therapy for more than 10 years. Bone lesions could emerge as a serious problem during this dialysis period. From 1986 to 1993, bone lesions were examined by histomorphometry of the bone tissues (40 biopsis, 17 autopsies) in fifty seven patients who have undergone a long-term hemodialysis treatment (37 males, 20 females) at Toranomon hospital. Mean age of the patients was 56 +/- 11 (SD) years (range; 22 to 74) and mean dialysis period, 14.5 +/- 11 (SD) years (range; 10 to 28). The results were compared with biochemical and endocrinological data. The subjects were classified into osteitis fibrosa group (33%), osteomalacia group (12%), mixed group (7%) and mild group (48%). Intact parathyroid hormone (PTH) and alkaline phosphatase (Al-P) value were significantly higher in osteitis fibrosa and mixed groups, all cases showing intact-PTH values greater than 500 pg/ml (normal value; 20-53), but not in osteomalcia and mild groups. The analysis of 32 cases with intact-PTH higher than 500 pg/ml showed osteitis fibrosa in 59.4% mixed in 12.5%, osteomalacia in 3.1% and mild in 25%. Aluminum was positive in 41% for osteitis fibrosa, 25% for mixed, 60% for osteomalacia and 52% for mild group. In summary, cases having undergone hemodialysis more than 10 years showed higher frequency of osteitis fibrosa when intact-PTH exceeded 500 pg/ml. Al-P values in such cases were high in association with the intact-PTH values. There was no significant correlation between aluminum deposition and respective bone tissue types.     

骨化三醇联合长时血液透析对维持性血液透析继发性甲状旁腺功能亢进患者的影响

目的探讨骨化三醇联合长时血液透析对维持性血液透析继发性甲状旁腺功能亢进患者血甲状旁腺激素（PTH）、钙、磷水平的影响。方法将22例维持性血液透析继发性甲状旁腺功能亢进患者进行长时血液透析治疗,3次／周,每次6h。同时口服骨化三醇1I,zg／次,3次／周,共治疗3个月。分别于治疗前和治疗后检测血PTH、钙及磷水平。结果患者治疗后血PTH和血磷较治疗前明显下降[（484．21±230．18）nmol／L比（750．53±327．41）nmol／L、（1．49±0．27）mmol/L比（2．37±0．76）mmol／L],血钙较治疗前明显上升[（2．35±0．32）mmol／L比（1．81±0．53）mmol／L],差异均有统计学意义（P〈0．05）。结论骨化三醇联合长时血液透析可以降低维持性血液透析继发性甲状旁腺功能亢进患者血磷及血PTH,升高血钙,对治疗维持性血液透析继发性甲状旁腺功能亢进有一定的疗效。     

复方α-酮酸对慢性肾脏病钙磷代谢的影响

目的通过极低蛋白饮食联合复方α-酮酸(开同)和常规低蛋白饮食在慢性肾脏病(chronic kidney disease,CKD)IV期中的作用,评估其对钙磷代谢和PTH的影响。方法采用前瞻、随机、对照临床研究,对24例CKD患者,肌酐清除率低于30ml/min,随机分为两组,极低蛋白饮食+开同组(VLPD+Ket组)和低蛋白饮食组(LPD组),每组12例患者,观察4个月。结果所有患者营养状态均得到充分维持,游离钙在VLPD+Ket组无明显变化,LPD组趋于下降;血磷在VLPD+Ket组下降[(1.48±0.16)mmol/L和(1.29±0.36)mmol/L,P<0.05],LPD组无变化。LPD组甲状旁腺激素明显升高[(241±138)pg/ml和(494±390)pg/ml,P<0.01],该参数与钙呈负相关(r=-0.75,P=0.02),而与磷呈正相关(r=0.71,P=0.03)。结论 VLPD+Ket能维持CKD IV期患者正常的营养状况,同时还具有改善钙磷代谢、降低尿素氮和稳定PTH的作用,进一步预防和降低肾性骨病的发生,有明显底预防和降低肾性骨病发生的作用。     

603名青春期儿童维生素D水平状况相关研究

目的 了解青春期儿童维生素D(VD)水平状况及其影响因素,分析导致VD不足的原因,为后续研究和防治提供科学依据。方法 2015-2016年随机抽取哈尔滨市某城区某中学603名6~8年级11~17岁青春期儿童进行体格检查、问卷调查及实验室检测血清25(OH)D、甲状旁腺素(PTH)、钙(Ca)、磷(P)和碱性磷酸酶(ALP)的水平。结果 603名青春期儿童血清25(OH)D的中位数和四分间距位数为14.16 (10.68, 18.46)ng/ml,VD不足和缺乏占81.1%。血清PTH、Ca、P、ALP水平分别为42.7(31.90, 60.70)pg/ml、(2.47±0.13) mmol/L、(1.57±0.21) mmol/L、(275.23±127.60) U/L。血清25(OH)D与PTH水平和ALP水平之间呈负相关(r=-0.039、-0.141,P<0.001),与Ca呈正相关(r=0.312,P<0.001),与P无明显相关性。PTH和25(OH)D为对数关系,当PTH达到最大抑制状态时无25(OH)D拐点值。户外活动时间、补充VD制剂与血清25(OH)D水平呈正相关(P_趋势<0.001),户外活动时间、VD制剂的补充是青春期儿童VD水平的重要影响因素。结论 11~17岁青春期儿童VD缺乏情况普遍存在。血清PTH、ALP和Ca,这些指标的测定有助于评价青春期儿童VD水平状况,建议通过鼓励青春期儿童增加户外活动,补充VD制剂等手段,可以提高血清25(OH)D水平。     

Sevelamer with and without calcium and vitamin D: observations from a long-term open-label clinical trial.

OBJECTIVE: To determine the effects of sevelamer hydrochloride on serum phosphorus, calcium, calcium x phosphate product, and parathyroid hormone (PTH) in patients treated with and without vitamin D metabolites and calcium supplementation. DESIGN: Long-term, open-label clinical trial. SETTING: Hemodialysis units. PATIENTS: One hundred ninety-two adult patients with end-stage renal disease on hemodialysis. INTERVENTION: An extended treatment period of sevelamer hydrochloride, preceded and followed by phosphate binder washout periods. MAIN OUTCOME MEASURES: Treatment-related changes in serum phosphorus, calcium, calcium x phosphate product, and PTH. RESULTS: Subjects treated with sevelamer alone, sevelamer with vitamin D metabolites (with or without calcium), and sevelamer with calcium without vitamin D experienced significant reductions in mean serum phosphorus (range, 2.1 to -2.9 mg/dL) and the calcium x phosphate product (range, -16.3 to -23.4 mg2/dL2). The mean serum calcium concentration increased in all subgroups except those treated with sevelamer alone (range, +0.3 to +0.5 mg/dL). In contrast, only subjects treated concurrently with vitamin D metabolites experienced a reduction in PTH. Subjects treated with sevelamer alone or sevelamer with calcium without vitamin D experienced an increase in PTH with treatment. CONCLUSION: Sevelamer hydrochloride is a safe and effective phosphate binder in hemodialysis patients. Sevelamer should be used in combination with vitamin D metabolites to jointly control hyperphosphatemia and hyperparathyroidism. Randomized clinical trials will be required to determine the optimal management strategies for metabolic bone disease in end-stage renal disease, as well as less advanced stages of chronic renal insufficiency.     

High phosphorus intake only slightly affects serum minerals, urinary pyridinium crosslinks and renal function in young women

OBJECTIVE: Assessment of the physiological effects of a diet rich in phosphorus in young women. DESIGN: Control period I--commercial basic diet containing 1700 mg P and 1500 mg Ca/day for 4 weeks. Supplementation period--a 6 week high-phosphorus period of 3008 mg P and 1995 mg Ca/day. Control period II--4 weeks washout with basic diet as in period I. SETTING: Institute of Nutritional Science, Friedrich Schiller University, Jena. SUBJECTS: Ten healthy women, aged 20-30y. INTERVENTIONS: Orange juice and tablets, containing supplements of Ca5(PO4)3OH and NaH2PO4, totalling 1436 mg elemental phosphorus per day. RESULTS: There was an increase of 10.7+/-13.7 pg/ml in serum PTH, a decrease of 0.6+/-0.6 ng/ml in serum osteocalcin, an increase of 73.6+/-136.6 nmol/mmol creatinine in urinary pyridinoline and of 19.3+/-36.0 nmol/ mmol creatinine in urinary deoxypyridinoline, and a decrease of 2.6+/-9.3 mg/l in urinary microalbumin. All changes were insignificant. There were no changes in serum levels of Ca, PO4 or Zn, in serum concentration of 1,25-(OH)2D3, and in urinary beta-2-microglobulin excretion. Phosphorus supplementation caused intestinal distress, soft stools or mild diarrhoea. CONCLUSIONS: In spite of a high phosphorus supplementation no significant changes in bone-related hormones, pyridinium crosslinks as markers of bone resorption and parameters of renal function in young women were found.     

甲状旁腺功能亢进症患者血清生化指标与99Tcm-MIBI SPECT/CT显像的相关性研究

目的 探讨甲状旁腺功能亢进症患者血清钙、磷、甲状旁腺激素（PTH）水平与⁹⁹Tc^m-MIBI显像的相关性,计算血清钙、磷和PTH的Cut-off值。方法 回顾性分析2017年9月—2019年9月经手术病理学确诊的甲状旁腺功能亢进患者234例,所有患者均于术前行甲氧基异丁基异腈（MIBI）显像和血清PTH、钙、磷等生化检查。结果 原发性（PHPT）和继发性（SHPT）甲状旁腺功能亢进者PTH水平中位数分别为210.93（122.60～529.20） pg/mL和1842.50（1342.50～2345.00） pg/mL,两组间差异有统计学意义（Z = -10.83,P = 0.000）,SHPT组显著高于PHPT组。PHPT组和SHPT组血清钙水平中位数分别为2.86（2.65～3.15） mmoL/L和2.43（2.32～2.58） mmoL/L,两组间差异有统计学意义（Z = -7.52,P = 0.000）,PHPT组显著高于SHPT组。PHPT组和SHPT组血清磷水平中位数分别为0.80（0.64～1.03） mmoL/L和2.26（1.97～2.63） mmoL/L,两组间差异有统计学意义（Z = -10.15,P = 0.000）,PHPT组显著低于SHPT组。将年龄、性别、PTH值、钙值、磷值作为自变量,MIBI显像结果作为应变量,Logistic回归分析得出PTH值为PHPT组的影响因素（OR: 1.012,95%CI：1.002～1.023）,相关性分析得出r = 0.60（P = 0.000）;SHPT组无相关因素。绘制PHPT组⁹⁹Tc^m-MIBI影像显像结果ROC曲线,对应最大曲线下面积0.91,计算Cut-off值为113.1 pg/mL。绘制PHPT组和SHPT组钙值、磷值与PTH值散点图,相关性分析得出PHPT组：钙值与PTH值具有中度相关（r = 0.64,P = 0.000）,磷值与PTH值具有低度相关（r = -0.28,P = 0.032）;SHPT组：钙值与PTH值具有低度相关（r = 0.17,P = 0.03）,磷值与PTH值无相关性（P = 0.15）。结论 PHPT组血清PTH水平与MIBI显像结果具有中度相关性,血清PTH水平越高MIBI显像阳性率越高,MIBI显像对应的分界值为113.1 pg/ml。PHPT组血清Ca水平与血清PTH水平具有中度相关性,而SHPT组血清Ca水平与血清PTH水平具有低度相关性。     

Effect of one year residence in Antarctica on bone mineral metabolism and body composition

OBJECTIVE: To evaluate the changes of the biochemical parameters of mineral metabolism and to assess the effect of these changes on the bone mass of young healthy men who voluntarily lived in the Antarctic Continent for one year. DESIGN: Lumbar spine and whole body bone mineral density (BMD) were measured pre- and post-campaign (14 months later). Serum and urinary biochemical parameters were measured every two months. Serum levels of calcium, phosphate, total alkaline phosphatase, parathormone (PTH) and 25-hydroxyvitamin D (250HD) were determined in blood fasting samples; and hydroxyproline, calcium and creatinine in 2 h fasting urine. The subjects received a dose of 100 i.u./d of vitamin D during May after obtaining the samples and then an average of 125 i.u./d from July to January. SUBJECTS: Seventeen healthy volunteers, who left Buenos Aires during the 1992 summer: ten arrived in the Belgrano II Base at the end of January and the other seven arrived in San Martín in March and stayed there up to summer 1993. RESULTS: BMD increased in lumbar spine (L2-L4), total body and the subarea of the legs but there were no differences between the pre- and post-campaign values in arms and pelvis. The percentage of fat mass decreased significantly after 1 y of residence in Antarctica, in comparison to the basal values. Most biochemical parameters remained unaltered and within the normal range during the whole study. PTH showed a nadir in March (end of the summer) when compared to initial levels (73.0 +/- 28.2 vs 39.9 +/- 32.7 pg/ml, P < 0.05), and recovered its initial value in spring. Calcium levels showed a significant decrease in March (9.5 +/- 0.4 vs 8.5 +/- 1.0 mg%, P < 0.01). 25OHD levels began to decrease in March (24.7 +/- 6.4 vs 18.7 +/- 5.3 ng/ml), reaching a minimum value whose difference approached statistical significance during the winter period (July: 16.4 +/- 8.2 ml, 0.05 < P < 0.06). No significant changes in serum phosphate, total alkaline phosphatase, urinary hydroxyproline/creatinine and calcium/creatinine ratios were found through the year. CONCLUSIONS: 25OHD levels decreased in autumn and winter (nadir in July) and recovered the initial levels by the end of the campaign. An unexplained marked diminution in PTH and serum calcium was found at the beginning of the campaign. In spite of the low vitamin D levels, bone mass in this group of young healthy men increased, probably because of their intense physical activity.     

维持性血液透析患者骨密度改变

为观察慢性肾衰维持性血透患者骨密度改变,要用ＤＥＸＡ方法测定１９５例维持性血透患者桡骨远端１／３点骨密度（ＢＭＤ）,同时检测其血清中段甲状旁腺素（Ｍ－ＰＴＨ）,碱性磷酸酶（ＡＬＰ）。结果显示血透患者骨密度低于相应年龄性别对照组,并随透析期间延长而更显突出。血透患者骨密度与ＰＴＨ,ＡＬＰ呈逆向改变关系。说明慢性肾衰血透患者存在骨量丢失,血透治疗似未能有效阻止其过程。骨密度测定对肾性骨病防治具有临床应     

Short-term effects of a very-low-protein diet supplemented with ketoacids in nondialyzed chronic kidney disease patients

OBJECTIVE: To evaluate the effects on the nutritional and metabolic parameters of a very-low-protein diet supplemented with ketoacids (VLPD+KA) in comparison with a conventional low-protein diet (LPD) in chronic kidney disease (CKD) patients. DESIGN: Prospective, randomized, controlled clinical study. SETTING: Outpatient Clinic of the Nephrology Division of Federal University of Sao Paulo, Brazil. SUBJECTS: The study involved 24 patients with advanced CKD (creatinine clearance <25 ml/min) that were randomly assigned to either a VLPD+KA (VLPD+KA group, 12 patients) or to a conventional LPD with 0.6 g/kg/day (LPD group, 12 patients). The patients were followed for 4 months. RESULTS: Nutritional status was adequately maintained with both diets for the studied period. Protein intake and serum urea nitrogen decreased significantly only in the VLPD+KA group (from 0.68+/-0.17 to 0.43+/-0.12 g/kg/day, P<0.05; from 61.4+/-12.8 to 43.6+/-14.9 mg/dl, P<0.001; respectively). Ionized calcium did not change in the VLPD+KA group but tended to decrease in the LPD group. Serum phosphorus tended to decrease in the VLPD+KA group probably as a result of a significant reduction in dietary phosphorus (529+/-109 to 373+/-125 mg/day, P<0.05) associated to the phosphorus-binding effect of the ketoacids. No change in these parameters was found in the LPD group. Serum parathormone increased significantly only in the LPD group (from 241+/-138 to 494+/-390 pg/ml, P<0.01). The change in PTH concentration was negatively correlated with changes in ionized calcium concentration (r=-0.75, P=0.02) and positively correlated with changes in serum phosphorus (r=0.71, P=0.03) only in the LPD group. CONCLUSION: This study indicates that a VLPD+KA can maintain the nutritional status of the patients similarly to a conventional LPD. Besides, an improvement in calcium and phosphorus metabolism and a reduction in serum urea nitrogen were attained only with the VLPD+KA. Thus, VLPD+KA can constitute another efficient therapeutic alternative in the treatment of CKD patients.     

Correlation between Vascular Calcification and Serum Sclerostin in MHD Patients

Objective Investigate the correlation between serum sclerostinlevel and chronic kidney disease-mineral and bone disorder(CKD-MBD),especially vascular calcification,in maintenance hemodialysis(MHD)patients.Methods This is across-sectional study,a total of 72 MHD patients were included from the first affiliated hospital of Jinan university.Measure the biochemical indicators of mineral metabolism,renal function,and serum sclerostin level by ELISA.The abdominal aorta calcification score(AACS)was assessed according to Kauppila method on lateral spine imaging using DEXA.Patients were distributed into two groups according to the level of serum sclerostin:low sclerostingroup(≤125 pg/ml)and high sclerostingroup(>125 pg/ml).Analyze the association of serum sclerostin level with the indicators of CKD-MBD.Results There was significant difference in i PTH level between high sclerost in group and low sclerost in group.Multivariate Logistic regression analysis demonstrated that dialysis duration,male and anuria were independent risk factor of high sclerostin level,and i PTH and Kt/V were protective factors.Conclusion Dialysis duration,man,anuria was independent risk factors and i PTH,Kt/V were protective factors of high serum sclerostin level in MHD patients.There was no correlation between abdominal aorta calcification and serum sclerostin level.     

扬州市早产儿血清钙、磷、碱性磷酸酶以及维生素D水平状况分析

目的 探索不同出生孕周、体重和出生季节的早产儿其血清钙(calcium,Ca),磷(phosphorus,P),碱性磷酸酶(alka-line phosphatase,ALP)以及维生素D(vitamin D,VD)水平的情况.方法 选取扬州市妇幼保健院新生儿科2018年6月-2019年7月出生的早产儿共计488例作为...     

碳酸镧对骨化三醇冲击治疗慢性肾衰竭持续非卧床腹膜透析继发性甲状旁腺功能亢进患者血钙、血磷的影响

目的：观察碳酸镧（lanthanum carbonate）在慢性肾衰竭持续非卧床腹膜透析（CAPD）患者应用骨化三醇治疗继发性甲状旁腺功能亢进（SHPT）时对血钙、血磷的影响。方法：将40例血清全段甲状旁腺激素（iPTH）300—500pg／ml、血钙磷乘积〈4．52（mmol／L）2的CAPD患者随机分为2组,每组20例。碳酸镧组给予口服碳酸钢500mg,3次／天,同时口服骨化三醇1．0μg,2次／周冲击治疗;碳酸钙组给予口服碳酸钙750mg,2次／天,同时口服骨化三醇1．0μg,2次／周。结果：碳酸镧组12周后血磷及iPTH较治疗前明显下降,碳酸镧组血钙、血磷明显低于碳酸钙组,差异有统计学意义（P〈0．05）。结论：碳酸镧能有效预防CAPD患者应用骨化三醇冲击治疗SHPT时的高钙血症及高磷血症。     

High prevalence of vitamin D deficiency among pregnant women and their newborns in northern India

BACKGROUND: Vitamin D deficiency is prevalent in India, a finding that is unexpected in a tropical country with abundant sunshine. Vitamin D deficiency during pregnancy has important implications for the newborn and infant. There are few data from India about the prevalence of hypovitaminosis D in pregnancy and in the newborn. OBJECTIVE: Our aim was to determine the prevalence of osteomalacia and hypovitaminosis D in pregnancy and in cord blood and to correlate maternal 25-hydroxyvitamin D [25(OH)D] status with sun exposure, daily calcium intake (dietary plus supplemental), and intact parathyroid hormone (PTH) concentrations. DESIGN: Serum calcium, inorganic phosphorus, 25(OH)D, heat-labile alkaline phosphatase, and PTH were studied in 207 urban and rural pregnant subjects at term. Alkaline phosphatase and 25(OH)D were measured in the cord blood of 117 newborns. RESULTS: Mean maternal serum 25(OH)D was 14 +/- 9.3 ng/mL, and cord blood 25(OH)D was 8.4 +/- 5.7 ng/mL. PTH rose above the normal range when 25(OH)D was <22.5 ng/mL. Eighty-four percent of women (84.3% of urban and 83.6% of rural women) had 25(OH)D values below that cutoff. Fourteen percent of the subjects had elevated alkaline phosphatase (17% of urban and 7% of rural subjects). Calcium intake was uniformly low, although higher in urban (842 +/- 459 mg/d) than in rural (549 +/- 404 mg/d) subjects (P < 0.001). Maternal serum 25(OH)D correlated positively with cord blood 25(OH)D (r = 0.79, P < 0.001) and negatively with PTH (r = -0.35, P < 0.001). CONCLUSION: We observed a high prevalence of physiologically significant hypovitaminosis D among pregnant women and their newborns, the magnitude of which warrants public health intervention.     

61例慢性肾脏病维持透析的HIV/AIDS患者血钙、血磷、全段甲状旁腺激素水平调查研究

目的了解广西地区维持性血液透析HIV/AIDS患者矿物质代谢紊乱情况及可能相关影响因素.方法收集2011—2016年在南宁市第四人民医院维持性血液透析3个月及以上合并HIV感染的61例患者作为观察组,根据其治疗情况,分为高效抗反转录病毒治疗(highly active antiretroviral therapy,HAART)组(51例)及非HAART组(10例),另选取30例非HIV感染维持血液透析大于3个月患者作为对照组.检测患者血钙、血磷及全段甲状旁腺激素(inact parathyroid hormone,iPTH)等矿物质代谢的评估指标,并对相关影响因素进行探讨.结果观察组中,血钙、血磷、iPTH的达标率分别为47.54%(29/61),24.59%(15/61)和21.31%(13/61);与对照组相比,在血钙、血磷、iPTH、HGB及ALB的平均值方面差异均有统计学意义(P均<0.05);在观察组中,HAART患者血钙、iPTH指标均高于非HAART患者,血磷指标低于非HAART患者(P均<0.05).结论广西地区维持性血液透析HIV/AIDS患者矿物质代谢异常有其独特的临床表现,对于该人群的透析方式、HAART方案、影响因素值得进一步研究.     

血清钙、磷、锌元素及骨碱性磷酸酶在佝偻病患儿中的水平分析

【目的】 分析不同病情佝偻病(different rickets,DR)患儿血清中钙、磷、锌及骨碱性磷酸酶的水平。 【方法】 选择广州市地区DR患儿60例,并按不同病情分轻度、中、重度组,同时选择60例同期体检健康儿童一同进行血清钙、磷、锌及骨碱性磷酸酶的双盲检测。 【结果】 中、重度DR 组的血清钙、磷和锌水平均明显低于对照组,轻度DR组与对照组差异无统计学意义;DR组骨碱性磷酸酶均明显高于对照组(P均<0.05)。在DR组内,中、重度DR 组的外周血清钙、磷和锌水平均明显低于轻度DR 组,骨碱性磷酸酶亦明显高于后者(P均<0.05)。 【结论】 骨碱性磷酸酶结合血清钙、磷、锌水平是反映佝偻病病情的敏感指标。     

肥胖干预对肥胖儿童血清维生素D、甲状旁腺激素和胰岛素抵抗指数的影响

目的:探讨肥胖干预对肥胖儿童的血清维生素D、甲状旁腺激素(PTH)水平及胰岛素抵抗指数的影响。方法:测定83例肥胖儿童的空腹血清25(0H)D、PTH、钙、磷和碱性磷酸酶、胰岛素、葡萄糖、BMI,并进行膳食调查和1年的肥胖干预。干预后根据BMI变化将肥胖儿童分为BMI减少组38例(即A组)和BMI未减少组45例(即B组)分析上述指标。结果:干预前两组儿童的膳食调查结果和各项指标无明显差异。干预后两组的热量和脂肪摄入均明显减少,A组的能量摄入明显低于B组;A组的血清25(OH)D明显上升,PTH和HOMA-IR明显下降;B组的各项指标无明显变化。结论:肥胖儿童的空腹血清PTH、HOMA-IR和25(OH)D在BMI下降后可得到矫正。