维持性血液透析患者甲状旁腺激素水平的临床分析

Objective To investigate the different factors in maintenance hemodialysis patients with different serum levels of intact parathyroid hormone(iPTH).Methods To choose 20 patients with higher serum iPTH levels(iPTH > 1000 μg/L)and other 20 patients with lower serum iPTH levels(iPTH < 150 μg/L)among the chronic renal failure(CRF)patients who received hemodialysis in Beijing Shijitan Hospital from September 2006 to August 2009.The two groups were analyzed retrospectively.Results There were significant differences in age,disease death rate,primary diseases and the levels of serum creatinine(Scr),blood urea nitrogen(Bun),plasma-albumin(Alb),phosphorous(P)and product Ca × P between the two groups However,there Were no significant differences in sex and the levels of serum calcium(Ca),hemoglobin(Hb),cholesterol(CHOL),triglyceride(TRIG)and carbon dioxide combining power(CO2CP)between them.Conclusions Among the CRF patients which received hemodialysis:The incidence of the lower serum iPTH levels among the elderly and CRF patients due to diabetic nephrosis is obviously high;The death rate of group 2 is obviously higher than that of group 1;The levels of Scr,P and product Ca×P of group 1 are obviously higher than that of group 2 and nutritional status of the former is better than that of the latter.     

维持性血液透析患者甲状旁腺激素水平的临床分析

Objective To investigate the different factors in maintenance hemodialysis patients with different serum levels of intact parathyroid hormone(iPTH).Methods To choose 20 patients with higher serum iPTH levels(iPTH > 1000 μg/L)and other 20 patients with lower serum iPTH levels(iPTH < 150 μg/L)among the chronic renal failure(CRF)patients who received hemodialysis in Beijing Shijitan Hospital from September 2006 to August 2009.The two groups were analyzed retrospectively.Results There were significant differences in age,disease death rate,primary diseases and the levels of serum creatinine(Scr),blood urea nitrogen(Bun),plasma-albumin(Alb),phosphorous(P)and product Ca × P between the two groups However,there Were no significant differences in sex and the levels of serum calcium(Ca),hemoglobin(Hb),cholesterol(CHOL),triglyceride(TRIG)and carbon dioxide combining power(CO2CP)between them.Conclusions Among the CRF patients which received hemodialysis:The incidence of the lower serum iPTH levels among the elderly and CRF patients due to diabetic nephrosis is obviously high;The death rate of group 2 is obviously higher than that of group 1;The levels of Scr,P and product Ca×P of group 1 are obviously higher than that of group 2 and nutritional status of the former is better than that of the latter.     

高通量血液透析对维持性透析患者血清钙磷及甲状旁腺激素水平的影响

目的 研究高通量血液透析对维持性血液透析患者血清钙磷及甲状旁腺激素水平影响.方法 本试验为前瞻性自身对照研究.44例常规低通量血液透析患者转换为高通量透析(Fresenius FX60,超纯透析液)治疗1年.采用单因素方差分析比较试验前0月、试验后6个月、试验后12个月血磷(P)、血钙(Ca)、全段甲状旁腺激素(iPTH)、肌酐(Cr)、尿素氮(BUN)、C-反应蛋白(CRP)等指标水平的变化.结果 高通量透析6、12个月后较低通量透析时P、iPTH、CRP等指标有明显不同,差异有统计学意义(P＜0.05).血BUN、Cr、Ca等生化指标在转化为高通量透析后,与低通量时比较差异无统计学意义(P＞0.05).结论 高通量血液透析治疗后P、iPTH有下降趋势,改善钙磷及甲状旁腺激素代谢紊乱,可能有助于提高血液透析病人的生存质量.     

不同甲状旁腺激素水平对维持性血液透析患者心肌损伤的影响

目的 探讨不同水平的甲状旁腺激素对慢性肾功能衰竭维持性血液透析患者心肌损伤的影响.方法 将慢性肾功能衰竭维持性血液透析患者中血甲状旁腺激素＞ 300 ng/L的42例患者作为高甲状旁腺激素组;将血甲状旁腺激素＜ 150 ng/L的36例患者作为低甲状旁腺激素组,在血液透析前检测两组患者的血肌酐、尿素氮、血浆白蛋白、血红蛋白、血钙、血磷、钙磷乘积、全段甲状旁腺素及心肌肌钙蛋白Ⅰ等指标进行对比观察.结果 高甲状旁腺激素组患者血磷、钙磷乘积水平、心肌肌钙蛋白Ⅰ与低甲状旁腺激素组患者比较差异有统计学意义(P＜0.05).结论 继发性甲状旁腺功能亢进与心肌损伤关系密切.     

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.     

高通量血液透析联合血液灌流对维持性血液透析患者血清钙、磷及甲状旁腺激素代谢的影响

目的 研究高通量血液透析(HFD)联合血液灌流(ⅢP)对维持性血液透析患者血清钙磷及甲状旁腺激素代谢的影响.方法 40例维持性血液透析患者随机分为对照组(高通量血液透析)和观察组(高通量血液透析联合血液灌流),在试验前及试验1和3个月后分别检测两组患者透析前肌酐(Cr)、尿素氮(BUN)、磷(P)、钙(Ca)、全段甲状旁腺激素(iPTH)等生化指标并进行比较.结果 高通量血液透析联合血液灌流与单纯高通量透析者间比较,血清BUN、Cr、Ca差异无统计学意义(P＞0.05);但iPTH、P在两种血液净化模式下差异有统计学意义(P＜0.05).结论 HFD+ HP血液净化方式能有效降低维持性血液透析患者P、iPTH水平,进而可能会提高其生存质量.     

维持性血液透析患者生存风险分析

目的 了解维持性血液透析患者影响生存风险的因素.方法 选择2008年1月1日至2010年5月31日486例在我院行维持性血液透析的患者进行回顾性分析.所有患者入选后记录姓名、性别、年龄、透析开始时间,原发病、肝炎及到观察日期截止时生存情况.登记患者透析3～6个月时血肌酐、血红蛋白、白蛋白、血钙、血磷及乙、丙型肝炎资料的各项指标.结果 486例患者中年龄≥65岁中老年人116例,年龄在18～64岁之间的青壮年患者370例.两组患者开始透析治疗3～6个月后血红蛋白、白蛋白、血肌酐、血钙、血磷等生化水平比较差异无统计学意义(P＞0.05).患者生存率逐年下降,中老年组患者透析12个月后生存率明显低于青壮年组,60个月时青壮年组生存率为81％,中老年组生存率为52％,120个月时,青壮年组生存率为59％,中老年组生存率为29％.采用Cox Regression法对多个生存影响的因素进行多变量分析表明,血磷水平是透析生存的独立危险因素.结论 透析后血磷水平是维持性血液透析患者独立危险因素.中老年组透析生存率低于青壮年组.     

维持性血液透析患者骨质疏松的患病情况及危险因素

目的分析维持性血液透析患者骨质疏松的患病情况及危险因素。方法人组的稳定血液透析患者52例，男27例（占51．9％），测定其血清全段甲状旁腺激素（iPTH）、钙、磷、钙磷乘积及骨密度等，分析骨密度的可能危险因素。结果骨量丢失者21例（占40．4％），骨质疏松者13例（占25．0％），其中女性占所有骨质疏松者的92．3％；多元线性回归分析显示非透析人群中的传统危险因素如干体重、糖尿病、碱性磷酸酶等多种因素均与骨密度相关，而iPTH尽管是调节钙磷代谢的重要因子，多元回归分析显示iPTH并不与骨密度相关。结论在维持性血液透析患者中骨质疏松是个较为严重的问题，传统因素如干体重低、糖尿病等均是骨质疏松的危险因素，碱性磷酸酶高者骨密度低，而iPTH并不是骨密度的独立危险因素。     

维持性血液透析患者贫血治疗达标情况及其影响因素分析

目的:观察维持性血液透析患者贫血治疗的有效性,并分析贫血治疗的影响因素。方法:选取维持性血液透析≥3个月,持续红细胞生成素(EPO)治疗≥3个月患者200例,EPO剂量100～150 Iu.kg-1.W-1,每月监测患者血常规,每3个月监测患者血甲状旁腺素(PTH)、透前透后生化、铁指标,根据检验结果及时调整透析方案、EPO剂量、补铁方案及营养指导。记录患者最近一次血红蛋白、PTH、白蛋白、二氧化碳结合力、铁蛋白、转铁蛋白饱和度指标,统计血透患者贫血达标情况,分析贫血与PTH、白蛋白、二氧化碳结合力、铁蛋白、转铁蛋白饱和度的关系。结果:患者贫血达标率(Hb≥110 g/L)49%(98/200),100 g/L≤Hb<110 g/L之间21%(42/200),Hb<100 g/L有30%(60/200)。将患者分为治疗达标组(Hb≥110 g/L组)和治疗未达标组(Hb<110 g/L组)。未达标组PTH、铁蛋白较达标组高,但差异无统计学意义(P>0.05),二氧化碳结合力两组差异无统计学意义(P>0.05),血白蛋白、转铁蛋白饱和度则达标组高于未达标组,差异存在统计学意义(P<0.05)。结论:血液透析患者贫血达标率49%,与患者原发病、基础疾病、营养状况、血白蛋白、缺铁状态等因素密切相关,与PTH、酸中毒、铁蛋白水平无关。     

高通量透析对维持性血液透析患者钙磷代谢的影响

目的 探讨高通量透析对维持性血液透析患者甲状旁腺素及钙磷代谢紊乱的影响.方法 40例维持性血液透析患者按随机数字表法分为高通量透析组及普通低通量透析组并治疗3个月.所有患者采集入组后第1天透析前、后血标本及治疗3个月后透析前血标本,检测血钙、磷及甲状旁腺激素水平,同时检测患者血清尿素氮、肌酐、白蛋白、血红蛋白、β2微球...     

Potential factors regulating serum parathyroid hormone in maintenance hemodialysis patients: 4-year retrospective study

Background. This study was carried out to evaluate potential factors affecting long-term parathyroid function in patients on maintenance hemodialysis. Methods. Biochemical parameters, including intact parathyroid hormone (i-PTH) and intact osteocalcin (i-OC) were analyzed retrospectively in 120 outpatients receiving hemodialysis, for the 4 years between 1992 and 1996. Patients were classified into the following three groups according to their serum i-PTH levels in 1996: low PTH (<100 pg/ml), normal PTH (100–450 pg/ml), and high PTH (≧450 pg/ml). Results. Among the three PTH groups, no differences were found in age, sex, duration of dialysis, and laboratory parameters, except for serum levels of alkaline phosphatase (ALP), i-PTH, and i-OC. The percentage of diabetic patients was higher in the low PTH group than in the other two PTH groups. Both serum ALP and i-PTH levels increased in the high PTH group, and serum i-PTH level decreased in the low PTH group during the 4 years. The change in serum calcium (Ca) level was negatively correlated with that in serum i-PTH level (1994–1996, r = −0.623, 1992–1996, r = −0.565; P <0.0001). A higher correlation coefficient was observed in the low PTH group than in the other PTH groups, although the difference was not significant. A weak positive correlation of the changes in serum inorganic phosphorus (IP) level (1994–1996) and i-PTH level (1994–1996) was found in the high PTH group (r = 0.379, P < 0.05). Conclusion. Serum Ca level may play a determinant role in suppressing serum i-PTH level in hemodialysis patients. Serum IP level may stimulate serum i-PTH level in patients with hyperparathyroidism, although the physiological role of serum IP is yet to be established. Received: March 23, 1999 / Accepted: September 1, 1999     

维持性血液透析患者甲状旁腺素水平与左心室肥厚关系的研究

目的探讨维持性血液透析(maintenance hemodialysis,MHD)患者甲状旁腺素(parathyroid hormone,PTH)水平与左心室肥厚(1eft ventrieular hypertrophy,LVH)的关系。方法选择同济大学附属同济医院血液透析中心MHD患者50例,根据患者PTH水平分成L-PTH组(PTH300 ng/L)、H-PTH组(PTH300 ng/L)。通过对2组患者进行心脏超声及临床生化检测,比较2组患者的心脏超声结构及LVH发生率,并作相关性分析。结果 2组患者的性别构成、年龄、血压、脑钠肽、血红蛋白、血钙和血白蛋白均无统计学差异(P0,05)。H-PTH组的透析时间、血磷均明显高于L-PTH组[(8,66±4,91)年比(5.4±5.73)年、(1.81±0.37)mmol/L比(1.51±0.32)mmol/L,P0.05]。H-PTH组的左室舒张末内径、左室收缩末内径、室间隔厚度与左室心肌质量指数均明显高于L-PTH组[(49.56±4.59)rmm比(45.84±5.65)mm、(32.44±4.26)mm比(29.6±5.00)mm、(11.12±1.45)mm比(10.16±1.41)mm、(144.29±31.82)g/m~3比(122.83±38.34)g/m~3,P0.05];2组的左房内径、左室后壁厚度及射血分数均无统计学差异[(43.96±3.98)mm比(42.52±5.86)mm、(9.56±1.58)mm比(9.08±1.29)mm、(63.16±6.97)%比(65.72±6.67)%,P0.05]。H-PTH组的LVH发生率明显高于L-PTH组(72%比40%,P0.05)。Spearman相关性分析表明,PTH水平与左室心肌质量指数、左室舒张末内径、左室收缩末内径、室间隔厚度呈正相关(r=0.325,0.330,0.348,0.310,P0.05),而与左房内径、左室后壁厚度、射血分数相关性无统计学意义(r=0.088,0.115,-0.210,P0.05)。结论MHD患者PTH水平增高可能是导致左心室肥厚的重要因素之一。     

Association between osteopontin and intact parathyroid hormone in maintenance hemodialysis patients

Objective To explore possible associations between osteopontin(OPN) and intact parathyroid hormone(iPTH), to investigate effects of them on the progression of carotid artery calcification in patients receiving long-term hemodialysis. Methods Forty-eight maintenance hemodialysis (MHD) patients and 28 age- and sex-matched healthy volunteers were recruited. The concentration of OPN in peripheral blood was determined by enzyme linked immunosorbent assay (ELISA). Levels of iPTH and presence of plaques in the common carotid arteries were also measured. The demographics were recorded. Results Compared with controls, levels of OPN[(137.4±80.8)ng/L vs (31.6±6.7) ng/L, P＜0.01] and iPTH[(456.4±326.4) ng/L vs (66.9±19.3)ng/L, P＜0.01] were higher inMHD patients before hemodialysis, the numbers of calcific plaques in the common carotid arteries were increased in MHD patients (P＜0.01). There was a positive correlation between pre-dialysis OPN levels and iPTH levels (r＝0.620, P＜0.01) in MHD patients. Higher levels of OPN and iPTH correlated with greater numbers of calcific plaques in the common carotid arteries after division into three subgroups of MHD patients based on calcific plaques. In multiple linear regression analysis, the correlation between the pre-dialysis OPN and iPTH levels remained the same even if adjusting for confounding effects[β＝0.468, 95%CI (0.036, 0.195), t＝2.936, P＝0.005]. Conclusion OPN level is positively correlated with iPTH level in hemodialysis patients, which suggesting that both of them play important roles in the progression of carotid artery calcification.     

不同血液净化方法对尿毒症患者甲状旁腺素水平的影响

目的比较联机血液透析滤过（HDF）和常规血液透析（HD）对尿毒症患者甲状旁腺素（iPTH）水平的影响。方法选择我院血液净化中心2004年6月至2006年12月期间透析龄超过9个月且iPTH明显升高的尿毒症患者60例,其中男38例、女22例,平均年龄43．5岁,平均透析龄（18．6±9．3）月。将患者随机分为HDF组和HD组,每组30例。两组患者每周均透析三次,HDF组为1次HDF、2次HD,每次透析4h。HDF组使用F60滤过器;HD组使用F6HPS透析器,统一低分子肝素抗凝。检测透析前后患者血液血肌酐（SCr）、血尿素氮（BUN）及iPTH水平并计算其清除百分率。结果SCr与BUN清除率在HD组分别为（70.6％±3．2％）和（74．2%±4．0％）,在HDF组分别为（71．8％±2．3％）和（76．2%±3．8％）,两组之间差异无统计学意义。HD组血iPTH值透析前后无显著差异,清除率仅为（1．7%±0．9%）,而HDF组iPTH的清除率为（32．8％±7．8％）,该组透析前后溶质浓度及清除率的差异均有统计学意义。结论两种血液净化治疗方式对小分子物质的清除效果无差异,但HDF对中分子物质（iPTH）的清除效果明显优于HD。定期HDF有利于iPTH的清除、防止iPTH异常导致的钙磷代谢紊乱、降低代谢性骨病等并发症的发生率。