维持性血液透析患者全血微量元素与甲状旁腺激素水平的相关性分析

目的探讨维持性血液透析(maintenance hemodialysis,MHD)患者血清甲状旁腺激素(parathyroid hormone,PTH)与全血微量元素之间的关系。方法采用单中心横断面研究,纳入2019年9月在暨南大学附属广州红十字会医院血液透析中心行MHD的患者。记录患者临床资料、用药情况,测定透析前血常规、血清生化指标和全血微量元素锌、铜、锰、铅、硒(电感耦合等离子体质谱仪法)。根据血清PTH数值分为高PTH组(PTH≥300pg/ml)和低PTH组(PTH<300pg/ml),比较2组患者的临床特征。应用单因素和多因素logistic回归分析PTH≥300pg/ml的相关因素。结果共纳入MHD患者153例,其中高PTH组46例,低PTH组107例。与低PTH组患者相比,高PTH组患者有较高的透析前血清总钙、磷、肌酐、碱性磷酸酶、白蛋白、前白蛋白、铁蛋白以及全血铅水平,余微量元素在两组间无统计学差异。多因素Logistic回归分析结果显示,较高的透析前血清总钙、血清磷、较高的骨化三醇使用率及全血铅高于中位数44.3μg/L是MHD患者血清PTH≥300pg/ml的独立相关因素(OR值分别为13.646,2.859,3.400,2.655;95%CI分别为1.470~126.649,1.442~5.667,1.470~7.863,1.162~6.113;P值分别为0.022,0.003,0.004,0.021)。结论MHD患者全血铅>44.3μg/L和血清PTH≥300pg/ml独立相关,值得临床关注并进一步进行相关研究。

Correlation analysis between whole blood trace elements and parathyroid hormone level in maintenance hemodialysis patients

Objectives To investigate the correlation between whole blood trace elements and serum parathyroid hormone(PTH)in maintenance hemodialysis(MHD)patients.Method This was a cross-section and singlEcenter study.A total of 153 MHD patients treated during September 2019 in our center were enrolled in this study.Their clinical data and drug usage were collected.Laboratory parameters and blood trace elements were measured before dialysis.According to serum PTH level,patients were divided into high PTH group(PTH≥300pg/ml,n=46)and the low PTH group(PTH<300pg/ml,n=107).Clinical characteristics were compared between the two groups.Univariate and multivariate logistic regressions were utilized to analyze the factors relating to the high PTH level.Results Compared with the patients in the low PTH group,those in the high PTH group had higher prEdialysis levels of serum calcium,phosphorus,creatinine,alkaline phosphatase,albumin,prealbumin,ferritin and whole blood lead,but had no significant differences in other trace elements.Multivariate binary logistic regression showed that higher levels of serum calcium and phosphorus,use of calcitriol and blood lead>44.3μg/L were independently correlated with the higher serum PTH.Conclusion Whole blood lead>44.3μg/L was independently correlated with the serum PTH≥300pg/ml in MHD patients.