老年慢性肾病患者矿物质骨代谢紊乱的临床研究

目的研究老年慢性肾病（CKD）患者矿物质骨代谢紊乱的临床特征。方法选择年龄〉65岁非透析的CKD住院患者151例,根据2002年K/DOQI指南提出的CKD定义及分期系统分为CKD1-2期组92例、CKD3期组50例和CKD4-5期组9例。记录一般资料,观察肾功能、血白蛋白、血常规、血钙、尿钙、血磷、尿磷、全段甲状旁腺激素（iPTH）和25-羟基维生素D3等实验室指标。结果 151例患者年龄65~96岁,中位数81岁。观察对象总体血钙、血磷水平多处于正常范围低限,尿钙基本正常,〉90%患者尿磷减少,维生素D不足或缺乏高达97.3%,CKD3-5期患者尿钙和尿磷下降,CKD4-5期患者血钙降低、血磷和iPTH升高。CKD各期血钙磷及iPTH水平多符合或低于K/DOQI指南目标范围。血白蛋白水平随肾损害加重逐渐降低。结论老年CKD患者随肾功能减退呈现低血钙、高血磷和高iPTH趋势,但发生异常的程度较轻、时间滞后。

Clinical analysis of chronic kidney disease- mineral and bone disorder in elderly inpatients

Objective To analyze the clinical characteristics of chronic kidney disease-mineral disorder（CKD-MBD） in eldly.Methods This cross-sectional study was based upon clinical records of undialysis in-patients elder than 65 years old.Patients were divided into three groups by the stage of CKD1-2,CKD3 and CKD4-5 according to K/DOQI guideline proposed in 2002.General information and laboratory test results（including serum calcium,phosphorus and serum intact parathyroid hormone iPTH etc.） were collected and recorded.Results 151 patients with the range of age from 65 to 96,median age of 81.The serum calcium and phosphorus level of the majority of elderly patients in study group were in the lower range of normal level,while urine calcium was generally normal.In 90% of the cases,the urine phosphorus were below the normal level And more than 97.28% of the patients were found lack of vitamin D.urinary calcium and urinary phosphorus level were declined in the CKD3-5 group.In the CKD4-5 group,the level of serum calcium declined while serum phosphorus and iPTH levels increased.Levels of serum calcium,phosphorus and iPTH were within or below the target range recommended by K/DOQI.Conclusions It was found that deterioration of kidney function in eldly CKD patients were accompanying with declining of serum calcium level and increasing of serum phosphorus and iPTH levels at the same time.However,the abnormality was not quite serious and there was latancy.