腹膜透析患者血磷水平及其影响因素分析

目的了解持续性非卧床腹膜透析（continuous ambulatory peritoneal dialysis,CAPD）患者血磷水平及其影响因素。方法随机选择病情稳定CAPD患者58例,进行膳食调查、残肾功能及透析充分性评估,测定血清钙（Ca~（2＋））、磷（P~（3＋））、全段甲状旁腺激素（intact parathyroid hormone,IPTH）水平以及血浆蛋白、血脂、内皮素和C反应蛋白。结果透析后血P~（32＋）、IPTH较透析前明显下降（P〈0.01）,高磷血症的发生率45%（26/58）。血磷与膳食磷、胆固醇、蛋白质、热能摄入量呈正相关（r=0.575,r=0.449,r=0.353,r=0.367;P〈0.01）;与透析充分性和残肾功能无明显相关,但与血尿素氮、肌酐呈正相关（r=0.578,r=0.560;P〈0.01）;血磷与血清白蛋白、前白蛋白呈正相关（r=0.269,P〈0.05;r=0.404,P〈0.01）;血磷与血清胆固醇、低密度脂蛋白呈负相关（r=-0.407,r=-0.311;P〈0.01）,与血浆内皮素呈正相关（r=0.359,P〈0.01）。结论腹膜透析在一定程度上改善了钙磷代谢紊乱,血磷水平与膳食摄入量及尿毒症毒素蓄积有关,同时高血磷可刺激血浆内皮素的释放。

Phosphorus levels in peritoneal dialysis patients and related influencing factors

Objective To investigate the phosphorus levels in patients undergoing continuous ambulatory peritoneal dialysis(CAPD) and related influencing factors.Methods Fifty-eight stable CAPD patients were enrolled in the study.Dietary survey was conducted,estimated residual kidney function(RRF) and dialysis adequacy were evaluated.Serum phosphate,calcium,intact parathyroid hormone(IPTH),albumin(ALB),pre-albumin(PA),lipids,endothelin(ET) and C-reactive protein (CRP) were measured.Results The levels of serum phosphate and IPTH were decreased after dialysis in CAPD patients(P<0.01),26 of 58(45%) patients had hyperphosphatemia.Serum phosphate levels were positively correlated with dietary phosphate,cholesterol,protein and energy intake(r= 0.575,r=0.449,r=0.353 and r=0.367,respectively;P<0.01).Serum phosphate levels were not correlated with dialysis adequacy and RRF,but correlated with serum urea nitrogen and creatinine(r= 0.578,r=0.560,respectively;P<0.01).Serum phosphate levels were positively correlated with serum albumin and pre-albumin(r=0.269,P<0.05;r=0.404,P<0.01),and negatively correlated with TC and LDL levels(r=-0.407,r=-0.311;P<0.01).Serum phosphate levels were also positively correlated with ET(r=0.359;P<0.01).Conclusion CAPD contributes to improve calcium-phosphate metabolism disorder.Serum phosphate levels are associated with dietary intake and uremic toxin accumulation.Hyperphosphatemia may stimulate ET release.