糖尿病与非糖尿病维持性血液透析患者血管钙化的对比研究

目的探讨糖尿病维持性血液透析（MHD）患者血管钙化的影响因素。方法选择我院MHD患者90例，其中糖尿病组21例、非糖尿病组69例。检测2组透析前、后血压、心率、相关血生化指标以及全段甲状旁腺素（iPTH）、1，84-PTH、25一羟一维生素功，比较2组血管钙化情况，探讨糖尿病组患者血管钙化的相关因素。结果与非糖尿病组相比，糖尿病组透析前血肌酐较低，三酰甘油较高，高密度脂蛋白胆固醇较低（P〈0．05）。糖尿病组iPTH达标率高于非糖尿病组，而钙磷乘积低于后者（P〈0．05）。糖尿病组钙化发生率和钙化积分高于非糖尿病组（P〈0．05）。对糖尿病MHD患者，血管钙化积分与糖尿病病程、慢性肾脏病（CKD）病程、透析时间、iPTH、碱性磷酸酶呈正相关（r值分别为0．491、0499、0．652、0．727和0．564，P值均〈0．05）。结论与非糖尿病患者相比，患有糖尿病的MHD患者有较高的血管钙化发生率及较重的血管钙化程度；其中糖尿病病程、CKD病程、透析时间、iPTH、ALP可能参与糖尿病患者血管钙化的发生和发展。

Comparison of vascular calcification between diabetic and non-diabetic maintenance hemodialysis patients

Objective To explore the related factors of vascular calcification in diabetes patients. Methods Maintenance hemodialysis（MHD） patients in our hospital were enrolled with demographic and clinical data taken. Among the enrolled 90 MHD patients, there were 21 cases in diabetic group and 69 in non-diabetic group. Blood pressure and heart rate were recoded pre- and post-hemodi- alysis. Serum intact PTH （iPTH）, 1, 84-PTH, 25-OH-vitamin D3 and other serum parameters were measured. Prevalence of vascular calcification in diabetic and non-diabetic patients was compared, and the related factors of vascular calcification were studied. Results Serum triglyceride level was higher, and pre-dialysis serum creatinine level, high density lipoprotein cholesterol level and calcium-phosphorus product were lower in diabetic group than in non-diabetic group （P〈0. 05）. There was no significant difference in serum albumin, hemoglobin, 25-OH-vitamin D3, iPTH and 1, 84-PTH, alkaline phosphatase, serum calcium and serum phosphorus between two groups （P〉0. 05）. Prevalence and severity of vascular calcification in diabetic patients were greater than in non-diabetic patients （P〈0. 05）. Pearson correlation analysis showed a positive correlation between vascular calcification and di- abetes duration, chronic kidney disease duration, hemodialysis duration, iPTH, and alkaline phosphatase （ALP） （r=0.491,0499,0.652,0.727,0.564 respectively, P〈0.05）. Conclusions Compared with non-diabetic MHD patients, vascular calcification is more prevalent in diabetic MHD patients. Duration of CKD, diabetes and hemodialysis, iPTH, serum ALP may have contributions to development and progression of vascular calcification in diabetic MHD patients.