甲状旁腺激素对腹膜透析患者营养状况的影响及1,25(OH)2D3干预治疗的效果

【目的】评价持续性腹膜透析（CAPD）患者甲状旁腺激素（iPTH）水平对营养状况的影响,并进行干预治疗,为改善患者营养状况提供临床依据。【方法】选择在本院腹膜透析中心随诊治疗的CAPD患者45例,所有患者均稳定透析3个月以上,测定其iPTH浓度,同时测定所有患者血红蛋白（Hb）、血清白蛋白（Alb）、前白蛋白（PA）浓度。测量人体指数学指标：肱三头肌皮褶（TSF）、肱二头肌皮褶（BSF）、上臂中部周径（MAC）;使用改良整体主观评估法（MQSGA）评估患者营养状况;分析iPTH与各营养指标之间的关系。对存在继发性甲状旁腺功能亢进症（SHPT）的患者,分为对照组（常规低磷饮食,并补钙治疗）,1,25（OH）2D3治疗组[常规低磷饮食,补钙治疗及1,25（OH）2D3干预治疗],治疗3个月后比较服用前后各组iPTH与各营养指标变化情况。【结果】iPTH与Hb、Alb、PA、MAC呈负相关（P〈0．05）;与MQSGA呈正相关（P〈0．05）。45例CAPD患者中40例存在SHPT;1,25（OH）2D3治疗组治疗后iPTH、MQSGA均降低,Hb、Alb、PA、MAC增高,与治疗前相比差异有统计学意义。对照组iPTH及各营养指标无明显变化。【结论】iPTH是参与导致CAPD患者营养不良的重要因素。1,25（OH）2D3可通过降低CAPD患者的iPTH而改善其营养状态。     

Serum 25-Hydroxyvitamin D Level Could Predict the Risk for Peritoneal Dialysis-Associated Peritonitis

♦ Background:

As an immune system regulator, vitamin D is commonly deficient among patients on peritoneal dialysis (PD), which may contribute to their impaired immune function and increased risk for PD-related peritonitis. In this study, we aimed to investigate whether vitamin D deficiency could predict the risk of peritonitis in a prospective cohort of patients on PD.

♦ Methods:

We collected 346 prevalent and incident PD patients from 2 hospitals. Baseline demographic data and clinical characteristics were recorded. Serum 25-hydroxyvitamin D (25[OH]D) was measured at baseline and prior to peritonitis. The mean doses of oral active vitamin D used during the study period were also recorded. The outcome was the occurrence of peritonitis.

♦ Results:

The mean age of patients and duration of PD were 58.95 ± 13.67 years and 28.45 (15.04 – 53.37) months, respectively. Baseline 25(OH)D level was 16.15 (12.13 – 21.16) nmol/L, which was closely associated with diabetic status, longer PD duration, malnutrition, and inflammation. Baseline serum 25(OH)D predicted the occurrence of peritonitis independently of active vitamin D supplementation with a hazard ratio (HR) of 0.94 (95% confidence interval [CI] 0.90 – 0.98) after adjusting for recognized confounders (age, gender, dialysis duration, diabetes, albumin, residual renal function, and history of peritonitis). Compared to the low tertile, middle and high 25(OH)D level tertiles were associated with a decreased risk for peritonitis with HRs of 0.54 (95% CI 0.31 – 0.94) and 0.39 (95% CI 0.20 – 0.75), respectively.

♦ Conclusions:

Vitamin D deficiency evaluated by serum 25(OH)D rather than active vitamin D supplementation is closely associated with a higher risk of peritonitis.     

Comparative Mortality-Predictability Using Alkaline Phosphatase and Parathyroid Hormone in Patients on Peritoneal Dialysis and Hemodialysis

♦ Background: In hemodialysis (HD) patients, serum alkaline phosphatase (ALP) and parathyroid hormone (PTH) derangements are associated with mortality, but outcome-predictability using ALP and PTH in peritoneal dialysis (PD) patients remains uncertain.♦ Methods: In a cohort of 9244 adult PD patients from a large national dialysis organization (entry period 2001 - 2006, with follow-up through 2009), we used multivariable Cox models adjusted for case-mix and laboratory covariates to examine the associations of time-averaged ALP and PTH with all-cause mortality. We then compared mortality-predictability using ALP and PTH in 9244 PD and 99 323 HD patients.♦ Results: In PD patients, ALP concentrations exceeding 150 U/L were associated with increased mortality (reference ALP: 70 to <90 U/L). Hazard ratios (HRs) and 95% confidence intervals (CIs) were 1.18 (1.03 to 1.36), 1.27 (1.08 to 1.50), 1.49 (1.23 to 1.79), and 1.35 (1.19 to 1.53) for ALP concentrations of 150 to <170 U/L, 170 to <190 U/L, 190 to <210 U/L, and ≥210 U/L respectively. In contrast, we observed a U-shaped association between PTH concentration and death risk in PD patients, with PTH concentrations of less than 200 pg/mL and 700 pg/mL or more associated with increased mortality (reference PTH: 200 to <300 pg/mL). Hazard ratios and 95% CIs were 1.25 (1.12 to 1.41), 1.12 (1.02 to 1.23), 1.06 (0.96 to 1.18), 1.09 (0.97 to 1.24), 1.12 (0.97 to 1.29), 1.18 (0.99 to 1.40), and 1.23 (1.09 to 1.38) for PTH concentrations of <100 pg/mL, 100 to <200 pg/mL, 300 to <400 pg/mL, 400 to <500 pg/mL, 500 to <600 pg/mL, 600 to <700 pg/mL, and ≥700 pg/mL respectively. Compared with PD patients having serum concentrations of ALP and PTH within reference ranges, patients on HD experienced increased mortality across all ALP and PTH concentrations, particularly those in the lowest and highest categories.♦ Conclusions: In summary, higher ALP concentrations are associated with increased mortality, and lower and higher PTH concentrations are both associated with death risk in PD patients. The utility of ALP in the management of chronic kidney disease mineral bone disorders in PD patients warrants further study.     

Fatigue in Peritoneal Dialysis Patients and an Exploration of Contributing Factors: A Cross-Sectional Study

ContextFatigue is a common and detrimental symptom in dialysis patients; however, our understanding of it and investigation of its contributing factors is still very limited, especially in peritoneal dialysis (PD) patients.ObjectivesTo assess fatigue in PD patients and identify contributing factors.MethodsOne hundred eight PD patients in a comprehensive hospital in China were recruited. The fatigue severity of the participants was assessed using the Chalder Fatigue Scale 11. Demographic factors and results of physiological tests were collected. Quality of sleep, mental health, and social support were assessed with the Pittsburgh Sleep Quality Index, Symptom Checklist 90, and Social Support Rating Scale, respectively. Multiple linear regression models were conducted with candidate variables with a P-value of less than 0.1 on univariate analysis and variables that were clinically relevant to identify contributing factors for fatigue.ResultsThe fatigue level in PD patients was significantly higher than the community population, and 78.7% of them were suffering from fatigue. The factors that were significantly associated with fatigue were quality of sleep, normalized protein nitrogen appearance, transferrin, alkaline phosphatase, and total cholesterol (adjusted R squared 0.86). Among them, quality of sleep, transferrin, alkaline phosphatase, and total cholesterol were significant contributors for physical fatigue, whereas the quality of sleep and normalized protein nitrogen appearance were contributing factors for mental fatigue.ConclusionFatigue is a common symptom in PD patients, suggesting that increased awareness of this symptom is required. The identification of correlates by extensive exploration of multidimensional factors in this study may help practitioners to identify patients at higher risk and to develop a multidimensional and targeted intervention plan.     

昆明地区儿童血清 25羟基维生素 D水平检测及维生素 D营养状态分析

目的　了解昆明地区儿童血清 25羟基维生素 D [25（OH）D]水平及维生素 D营养状态,为儿童合理补充维生素 D提供科学依据。方法　选取昆明市第一人民医院 2016年 11月 ~2019年 10月体检儿童 0～ 14岁 600例为研究对象,采用液相色谱串联质谱（ LC-MS/MS）法检测血清 25（OH）D水平,分析不同性别、年龄及季节儿童血清 25（OH）D水平及营养状态。结果　600例 0～ 14岁儿童血清 25（OH）D水平为 27.44±8.82 ng/ml。血清 25（OH）D缺乏率为 19.33%（116/600）,不足率为 47.67%（286/600）,充足率为 33.00%（198/600）。女童的缺乏率（ 24.83%）高于男童（ 14.33%）,儿童血清 25（OH）D的缺乏、不足和充足率在不同性别间差异有统计学意义（ χ2=11.784,P<0.01）。6～ 14岁儿童血清 25（OH）D缺乏率高于 0～ 1岁、1～ 3岁和３～６岁儿童（ 46.81% vs 5.88%,5.86%和 19.53%）,血清 25（OH）D的缺乏、不足和充足率在不同年龄段上差异有统计学意义（ χ2=188.515,P<0.01）。夏、冬季的儿童血清 25（OH）D缺乏率高于春、秋季（ 22.00%,27.50% vs 12.80%,11.43%）,不同季节血清 25（OH）D的缺乏、不足和充足率差异有统计学意义（ χ2=14.492,P<0.05）。结论　昆明地区 0～ 14岁儿童血清 25（OH）D营养状况欠佳,应加强维生素 D健康宣传工作,提高儿童血清 25（OH）D的监测,特别关注 3～ 14岁阶段儿童维生素 D的补充。     

Chronic Kidney Disease-Mineral Bone Disorder in the Elderly Peritoneal Dialysis Patient

♦ Purpose:

The purpose of this paper was to review the literature concerning the treatment of chronic kidney disease-mineral bone disorder (CKD-MBD) in the elderly peritoneal dialysis (PD) patient.

♦ Results:

Chronic kidney disease-mineral bone disorder is a major problem in the elderly PD patient, with its associated increased fracture risk, vascular calcification, and accelerated mortality fracture risk. Peritoneal dialysis, however, bears a lower risk than hemodialysis (HD). The approach to CKD-MBD prophylaxis and treatment in the elderly PD patient is similar to other CKD patients, with some important differences. Avoidance of hypercalcemia, hyperphosphatemia, and hyperparathyroidism is important, as in other CKD groups, and is generally easier to attain. Calcium-free phosphate binders are recommended for normocalcemic and hypercalcemic patients. Normalization of vitamin D levels to > 75 nmol/L (> 30 pg/L) and low-dose active vitamin D therapy is recommended for all patients. Hyperparathryoidism is to be avoided by using active vitamin D and cinacalcet. Particular attention should be paid to treating protein malnutrition. Fracture prophylaxis (exercise, use of walkers, dwelling modifications) are important. Hypomagnesemia is common in PD and can be treated with magnesium supplements. Vitamin K deficiency is also common and has been identified as a cause of vascular calcification. Accordingly, warfarin treatment for this age group is problematic.

♦ Conclusion:

While treatment principles are similar to other dialysis patient groups, physicians should be aware of the special problems of the elderly group.     

The Association Between Body Mass Index and Mortality on Peritoneal Dialysis: A Prospective Cohort Study

♦ Background: Previous studies have demonstrated that increased body mass index (BMI) is associated with decreased mortality in hemodialysis (HD) patients. However, the association between BMI and survival has not been well established in patients undergoing peritoneal dialysis (PD). The aim of the study was to determine the association between BMI and mortality in the PD population using the Clinical Research Center (CRC) registry for end-stage renal disease (ESRD) cohort in Korea.♦ Methods: Prevalent patients with PD were selected from the CRC registry for ESRD, a prospective cohort study on dialysis patients in Korea. Patients were categorized into four groups by quartiles of BMI. Cox regression analysis was used to calculate the adjusted hazard ratio (HR) of mortality with a BMI of quartile 2 (21.4 - 23.5 kg/m²) as the reference.♦ Results: A total of 900 prevalent patients undergoing PD were included. The median follow-up period was 24 months. The multivariate Cox proportional hazard model showed that the lowest quartile of BMI was associated with higher mortality (HR 3.00, 95% confidence interval (CI), 1.26 - 7.15). However, the higher quartiles of BMI were not associated with mortality compared with the reference category of BMI quartile 2 (Quartile 3: HR 1.11, 95% CI, 0.43 - 2.85, Quartile 4: HR 1.64, 95% CI, 0.66 - 4.06) after adjustment for clinical variables.♦ Conclusions: Lower BMI was a significant risk factor for death, but increased BMI was not associated with mortality in Korean PD patients.     

Serum Cystatin C Does Not Predict Mortality or Treatment Failure in Peritoneal Dialysis: A Prospective Study

♦ Background:

Small solute clearance, especially that derived from residual renal function (RRF), is an independent risk factor for death in peritoneal dialysis (PD) patients. Assessment of solute clearance is time-consuming and prone to multiple errors. Cystatin C is a small protein which has been used as a glomerular filtration rate (GFR) marker. We investigated whether serum cystatin C concentrations are related to mortality in patients receiving PD.

♦ Methods:

New and prevalent PD patients (n = 235) underwent assessment of Kt/V_urea, RRF, weekly creatinine clearance (C_Cr), normalized protein catabolic rate (nPCR) and a peritoneal equilibration test (PET) at intervals. Blood was collected simultaneously for cystatin C measurement. Patients were followed for a median of 1,429 days (range 12 to 2,964 days) until death or study closure. Cause of death was recorded where given. Cox regression was performed to determine whether cystatin C had prognostic value either independently or with adjustment for other factors (age, sex, dialysis modality, diabetic status, cardiovascular comorbidity, Kt/V, C_Cr, RRF, nPCR or 4 h dialysate to plasma creatinine ratio (4 h D/P_cr) during the PET). The primary outcomes were all-cause mortality and treatment failure.

♦ Results:

There were 93 deaths. Increasing age and 4 h D/P_cr ratio, decreased RRF and presence of diabetes were significantly [p < 0.05] negatively associated with survival and treatment failure. Serum cystatin C was not related to either outcome.

♦ Conclusions:

Serum cystatin C concentration does not predict mortality or treatment failure in patients receiving PD.     

规律门诊随访对腹膜透析患者高血压控制率及相关疾病转归影响的回顾性分析

目的 探究规律门诊随访对腹膜透析患者高血压控制率、高血压相关疾病转归、高血压相关可控因素的影响。方法 纳入2009年1月—2019年12月在本中心置管并随访的腹膜透析患者,查阅病历收集患者基线资料、血压资料和相关疾病的记录;调查研究截止时仍未退出腹膜透析的患者高血压相关可控因素。据随访频率分为规律随访组（≥1次/3月）和非规律随访组（<1次/3月）,比较2组的高血压控制情况。结果 本研究共纳入526例腹膜透析患者,规律门诊随访率为52.3%。规律随访是腹膜透析患者高血压控制的独立影响因素（OR=1.705,95%CI：1.090~2.666,P=0.019）。规律随访与高血压相关疾病转归（退出腹膜透析、心血管疾病、心力衰竭）的发生无影响。规律随访改善了高血压相关可控因素。结论 规律门诊随访是改善腹膜透析患者的高血压控制情况的有效手段,应不断提高随访的质量,鼓励患者定期进行门诊随访。     

The Effect of Glycated Hemoglobin and Albumin-Corrected Glycated Serum Protein on Mortality in Diabetic Patients Receiving Continuous Peritoneal Dialysis

♦ Objective:

To explore the effect of glycated hemoglobin (HbA1c) and albumin-corrected glycated serum proteins (Alb-GSP) on the mortality of diabetic patients receiving continuous peritoneal dialysis (PD).

♦ Methods:

In this single-center retrospective cohort study, incident diabetic PD patients from January 1, 2006, to December 31, 2010, were recruited, and followed up until December 31, 2011. The effect of HbA1c and Alb-GSP on mortality was evaluated by Cox proportional hazards models.

♦ Results:

A total of 200 patients (60% male, mean age 60.3 ± 10.6 years) with a mean follow-up of 29.0 months (range: 4.3 – 71.5 months) were recruited. Sixty-four patients died during the follow-up period, of whom 21 died of cardiovascular disease (CVD). Mean values for HbA1c, GSP and Alb-GSP were 6.7% (range: 4.1 – 12.5%), 202 μmol/L (range: 69 – 459 μmol/L), and 5.78 μmol/g (range: 2.16 – 14.98 μmol/g), respectively. The concentrations of GSP and Alb-GSP were closely correlated with HbA1c (r = 0.41, p < 0.001 and r = 0.45, p < 0.001, respectively). In multivariate Cox proportional hazards models, patients with HbA1c ≥ 8% were associated with increased risk of all-cause mortality (hazard ratio [HR] = 2.29, 95% confidence interval [CI]: 1.06 – 4.96, p = 0.04), but no increased mortality in patients with 6.0% ≤ HbA1c ≤ 7.9%. Patients with Alb-GSP ≤ 4.50 μmol/g had increased all-cause and non-cardiovascular mortality (HR = 2.42, 95% CI: 1.13 – 5.19, p = 0.02; and HR = 2.98, 95% CI: 1.05 – 8.48, p = 0.04 respectively).

♦ Conclusions:

Increased HbA1c and decreased Alb-GSP may be associated with poorer survival in diabetic PD patients, with a non-significant trend observed for poorer survival with the highest level of Alb-GSP.     

Patient Education and Care for Peritoneal Dialysis Catheter Placement: A Quality Improvement Study

♦ Background and Objectives: Peritoneal dialysis catheter (PDC) complications are an important barrier to peritoneal dialysis (PD) utilization. Practice guidelines for PDC placement exist, but it is unknown if these recommendations are followed. We performed a quality improvement study to investigate this issue.♦ Methods: A prospective observational study involving 46 new patients at a regional US PD center was performed in collaboration with a nephrology fellowship program. Patients completed a questionnaire derived from the International Society for Peritoneal Dialysis (ISPD) catheter guidelines and were followed for early complications.♦ Results: Approximately 30% of patients reported not being evaluated for hernias, not being asked to visualize their exit site, or not receiving catheter location marking before placement. After insertion, 20% of patients reported not being given instructions for follow-up care, and 46% reported not being taught the warning signs of PDC infection. Directions to manage constipation (57%), immobilize the PDC (68%), or leave the dressing undisturbed (61%) after insertion were not consistently reported. Nearly 40% of patients reported that their PDC education was inadequate. In 41% of patients, a complication developed, with 30% of patients experiencing a catheter or exit-site problem, 11% developing infection, 13% needing PDC revision, and 11% requiring unplanned transfer to hemodialysis because of catheter-related problems.♦ Conclusions: There were numerous deviations from the ISPD guidelines for PDC placement in the community. Patient satisfaction with education was suboptimal, and complications were frequent. Improving patient education and care coordination for PDC placement were identified as specific quality improvement needs.     

Correlations between Serum P2X7, Vitamin A, 25‐hydroxy Vitamin D,and Mycoplasma Pneumoniae Pneumonia

BackgroundIdentifying new molecular diagnostic markers for Mycoplasma Pneumoniae Pneumonia (MPP) has always been an essential topic since MPP cases have increased every year, especially among children. Here, we examined the correlation between serum level of Purinergic receptor P2X7, vitamin A, and 25‐hydroxy vitamin D (25(OH)D) and the severity of MPP, aiming to identify molecules that have the potential to become diagnostic markers.MethodsThis study was conducted on 186 cases aged 1–14 (136 MPP and 50 non‐MPP patients). Serum levels of Purinergic receptor P2X7, vitamin A, 25(OH)D, and multiple inflammatory and immune factors were measured, compared, and tested for statistical significance.ResultsSerum P2X7, tumor necrosis factor‐α (TNF‐α), and interleukin‐1β (IL‐1β) levels were significantly increased in severe MPP patients, while serum vitamin A, 25(OH)D, IgA, and IgG levels were significantly decreased.ConclusionOur results demonstrated a positive correlation between serum P2X7 level and the severity of MPP, and negative correlations between serum levels of vitamin A and 25(OH)D and the severity of MPP, suggesting that high serum levels of P2X7 and low serum levels of vitamin A and 25(OH)D may indicate relatively severer MPP.     

The Occurrence of Increased Intraperitoneal Volume Events in Automated Peritoneal Dialysis in the US: Role of Programming,Patient/User Actions and Ultrafiltration

♦ Background, objectives and methods: Increased intraperitoneal volume (IIPV) can occur during automated peritoneal dialysis (APD). The contribution of factors such as cycler programming and patient/user actions to IIPV has not been previously explored. The relationship between IIPV and cycler programming, patient/user actions, and ultrafiltration over a two-year period was investigated using US data from Baxter cyclers. Drain/fill volume ratios of > 1.6 to ≤ 2.0 and > 2.0 were defined as Level I and Level II IIPV events, respectively.♦ Results: Level I IIPV events occurred in 2.39% of standard and 4.73% of small fill volume therapies, while Level II IIPV events occurred in 0.26% and 1.33% of therapies, respectively. IIPV events occurred significantly more often in association with tidal peritoneal dialysis (PD) compared to non-tidal PD therapies. In tidal therapies, IIPV events were primarily related to suboptimal programming of total ultrafiltration volume. Factors that increased the odds of IIPV events during standard therapies included programming the initial drain volume target to < 70% of the last fill, and setting minimum drain volumes to < 85% of the fill volume. Bypass of initial drain by patients/users was also associated with a significant increase in the odds of IIPV events in non-tidal, but not tidal PD. An increase in the odds for IIPV was also seen for standard therapies within the highest (> 1,245 mL) versus the lowest (< 427 mL) quartile of ultrafiltration. Similar trends were seen in small fill volume therapies. Clinical presentations associated with IIPV events were not assessed.♦ Conclusions: IIPV events are more frequent in tidal and small fill volume therapies. The greatest potential for IIPV occurred when the total ultrafiltration was set too low for the patient’s UF requirements during tidal therapy. Patient/user bypass of drains without reaching the target drain volume contributes significantly to IIPV events in non-tidal PD therapies. Poorly functioning PD catheters may be central to the cycler programming and patient/user actions that lead to IIPV.     

Serum 25-Hydroxyvitamin D Values and Risk of All-Cause and Cause-Specific Mortality: A Population-Based Cohort Study

Objective

To determine the relationship between 25-hydroxyvitamin D (25[OH]D) values and all-cause and cause-specific mortality.

妊娠期、产褥期妇女维生素D和PTH营养状况的评价

目的了解妊娠期、产褥期妇女钙吸收水平和维生素D、甲状旁腺激素(PTH)的分布水平和营养状况。方法选取2014年9月至2015年11月来围产门诊就诊的孕妇和产褥期妇女共740例设为观察组,分为孕中期组、孕晚期组和产褥期组。随机抽取同期健康非孕妇女100例作为对照组。用电化学发光法检测所有研究对象血清25-羟基维生素D(25-OH-D)、PTH的水平,联合检测镁(Mg)、磷(P)、碱性磷酸酶(ALP)、钙(Ca)等指标,并比较各组结果的差异。结果孕中期组妇女25-OH-D水平为(57.9±18.2)nmol/L,孕晚期组为(39.4±15.0)nmol/L,产褥期组为(65.1±19.6)nmol/L,对照组为(78.6±16.2)nmol/L,组间对比差异有统计学意义(P0.05)。PTH水平孕晚期组高于孕中期组,两组对比差异有统计学意义(P0.05)。血清中钙、镁、ALP水平观察组低于对照组,差异有统计学意义(P0.05)。结论妊娠期和产褥期妇女普遍存在低钙、低镁、维生素D不足或缺乏的现象,补钙同时补充维生素D及其他矿物质元素是必要的。     

Serum Calcium and Gastric Secretion in Chronic Gastric Fistula Rat: Influences of Parathyroid Hormone and Calcitonin

Abstract. The influence of the serum calcium level and of the hormones regulating it, parathyroid hormone (PTH) and calcitonin (CT), on gastric secretion has been studied in the intact, parathyroidectomized (PTX) and thyro-parathyroidectomized (TX-PTX) chronic gastric fistula rat. The following test substances have been administered: CaCl₂, bovine parathyroid hormone, Na²-EDTA and porcine calcitonin. An increase of the serum calcium level caused a marked inhibition of gastric secretion, the parathyroid hormone did not show any effect without changes of the calcium level. Calcium decreases after EDTA as well as after calcitonin were also followed by a reduction of gastric secretion. There was no significant difference demonstrable between the intact, PTX-and TX-PTX-animals. The calcitonin effect could be compensated by calcium substitution. A direct influence of PTH and CT on gastric secretion was not detectable; the hormones only exerted indirect effects via the changes of the serum calcium level they induced.     

代谢综合征患者血清抵抗素与血脂、肥胖和胰岛素抵抗关系的研究

目的:探讨代谢综合征患者血清抵抗素水平与血脂、肥胖和胰岛素抵抗的关系。方法: 60 例代谢综合征患者和28 例年龄相匹配的正常对照者,按体重指数将代谢综合征患者分为肥胖组和非肥胖组。采用ELISA方法测定受试者空腹血清抵抗素和瘦素水平,同时检测其身高、体重、腰围、臀围、血压、血糖、血脂及胰岛素水平,并计算体重指数(BMI)、腰臀比(WHR)和胰岛素抵抗指数(HOMA)。结果:代谢综合征患者肥胖组和正常对照组相比其血清抵抗素水平明显升高(28.28±11.7μg/L与19.44±5.79μg/L,P<0.01);非肥胖组和正常对照组相比其血清抵抗素水平明显升高(26.14±11.9μg/L与19.44±5.79μg/L,P<0.05)。肥胖组和正常对照组相比其血清瘦素水平明显升高(1.47±0.57μg/L与0.31±0.13μg/L,P<0.01);非肥胖组和正常对照组相比其血清瘦素水平明显升高(1.35±0.57μg/L与0.31±0.13μg/L,P<0.01)。肥胖组和非肥胖组相比其血清抵抗素、瘦素水平无显著差异。相关分析显示空腹抵抗素水平与腰臀比、空腹胰岛素、胰岛素抵抗指数呈显著正相关(分别为r=0.22,0.22,0.19;P<0.05);与体重指数、腰围、臀围、瘦素呈显著正相关(分别为r=0.31,0.32,0.36,0.28;P<0.01);而与收缩压、舒张压、总胆固醇、甘油三酯、低密度脂蛋白胆固醇(LDL C)、血     

儿童原发性肾病综合征血清全段甲状旁腺激素平变化及与25羟维生素D的关系

[目的]了解儿童原发性肾病综合征(Primary nephrotic syndrome,PNS)血清全段甲状旁腺激素(intact PTH,iPTH)的水平及与25羟维生素D[25 hydroxy vitamin D,25(OH)D]之间的关系,探讨PNS患儿甲状旁腺功能的状态.[方法]选择2013年6月至2015年3月本院收治的临床资料完整的PNS患儿131例作为研究对象(观察组),选择同期60例健康体检者为对照组.分析其血清iPTH水平及与血清25(OH)D的关系.[结果]①初发组25(OH)D为(28.31±16.67)nmol/L低于复发组的(38.99±21.41) nmol/L,差异有统计学意义(P＜0.05);非频复发iPTH为(2.48±1.50)pmol/L低于频复发的(3.83±2.35) pmol/L,差异有统计学意义(P＜0.05).②Pearson相关分析显示,复发组低iPTH组,血iPTH与25(OH)D呈正相关(r=0.4737,P＜0.05),与钙磷乘积呈正相关(r=0.5046,P＜0.05).③4例伴有甲状旁腺功能减低症的PNS患儿,随访4个月至1年半甲状旁腺功能均恢复.[结论]①PNS患儿部分存在血清iPTH水平降低;②血清iPTH水平与血磷、钙磷乘积及25(OH)D水平相关;③PNS出现的甲状旁腺功能减退的现象可能是暂时性的,予以补钙和骨化三醇治疗后可恢复.