长期血液透析患者继发性甲状旁腺功能亢进症的流行病学分析

目的：了解近年血液透析患者继发性甲状旁腺功能亢进症（SHPT）的发病率及其相关因素。方法：回顾2001年、2002年、2004年、2005年及2006年血液透析治疗〉1年并有〉3次全段甲状旁腺激素（iPTH）结果的患者．以iPTH水平≥300ng／ml为界定点，统计分析SHPT的发病率及其与年龄、性别、透析龄、原发病（糖尿病或非糖尿病）、血清钙、血清磷的关系。结果：在2001年、2002年、2004年、2005年及2006年分别有102例、101例、97例、139例及169例患者进入统计分析，SHPT的发病率分别为47．1％、51．5％、53．8％、49．6％及57．9％，逐年相比无显著性变化。2005年及2006年的统计结果显示，低钙血症分别占13．8％和26．6％；高磷血症分别占49．5％和45．5％。SHPT患者明显年轻化（P〈0．05）：并且拥有长的透析龄（P〈0．05）；糖尿病的发病率明显低于非糖尿病患者（P〈0．05）。透析龄、高磷血症是SHPT的独立危险因素（P〈0．05）结论：SHPT的发病率与透析龄、高磷血症有关．临床治疗必须早期干预．高度重视高磷血症。

An epidemiologic study of secondary hyperparathyroidism on long-term hemodialysis

Objective：To investigate the rate and its correlational factors of secondary hyperparathyroidism（SHPT）in hemodialysis patients,and to guide the clinical treatment.Methods：The patients who had received hemodialysis therapy for more than one year and had detected serum intact parathyroid hormones（iPTH）levels from 2001 to 2006 consecutively were studied retrospectively.The relationship among SHPT（iPTH≥300ng/ml）, age,gender,duration of dialysis,protopathy （diabetic and nondiabetic nephropathy）,metabolism of calcium and phosphorus,et al were analyzed.Results：The data of 102 patients in 2001,101 patients in 2002,97 patients in 2004, 139 patients in 2005 and 169 patients in 2006 were analyzed.The rates of SHPT were 47.1%,51.5%, 53.8%,49.6% and 57.9% respectively and no significant difference.In 2005,2006,there were 13.8% patients, 6.6% patients with hypocalcemia,and 49.5% patients,45.5% with hyperphosphataemia respectively.The prevalence of SHPT was higher in young patients, patients with long duration of dialysis and nondiabetic patients （P〈0.05）.Muhiple regression analyses indicated duration of dialysis and the levels of serum phosphorus were independent risk factors of SHPT（P〈0.05）.Conclusion：SHPT is correlative with duration of dialysis and hyperphosphataemia.The treatment of SHPT must be stressed and started early.