慢性肾脏病5期与5D期患者血清矿物质及骨代谢异常调查

目的比较慢性肾脏病(CKD)5期与5D期患者血清矿物质及骨代谢异常(MBD)状况。方法回顾性分析240例终末期肾脏病患者的临床资料。根据血液透析情况将患者分为CKD5期组(非透析)和CKD5D期组(已透析),比较2组血清矿物质及骨代谢相关指标(血清钙、磷、全段甲状旁腺素、碱性磷酸酶等),评估血钙、血磷和甲状旁腺激素的达标情况。结果CDK5D期组患者血清全段甲状旁腺素(iPTH)、校正血钙、钙磷乘积、血清白蛋白高于CKD5期组,估算肾小球滤过率(eGFR)低于CKD5期组,差异均有统计学意义(P<0.01)。CKD5期组、CDK5D期组患者高磷血症发生率分别为83.75%、91.25%,低钙血症发生率分别为31.25%、17.50%,高钙血症发生率分别为1.88%、30.00%,高甲状旁腺激素发生率分别为37.50%、63.75%。结论终末期肾脏病患者伴有严重的钙、磷和甲状旁腺激素指标异常,CKD5期患者突出表现为高磷、低钙和高甲状旁腺激素。CKD5D期患者的CKD-MBD状况并未因血液透析而得到改善,反而变得更加严重,突出表现为高磷、高钙和高甲状旁腺激素。

Investigation in serum minerals and bone disorder in patients with chronic kidney disease at stages 5 and 5D

Objective To compare the serum minerals and bone disorder(MBD)between patients with chronic kidney disease(CKD)at stages 5 and 5D.Methods Clinical data of 240 patients with end-stage renal disease were retrospectively analyzed.According to the condition of hemodialysis,the patients were divided into CKD5 group(treated without dialysis)and CKD5D group(treated with dialysis).The related indexes of serum minerals and bone disorder(serum calcium,phosphorus,whole parathyroid hormone,alkaline phosphatase,etc.)were compared between two groups,and the standard-reaching rates of serum calcium,phosphorus and parathyroid hormone were evaluated.Results The levels of serum intact parathyroid hormone(iPTH),corrected serum calcium,calcium-phosphorus product and serum albumin in the CDK5D group were significantly higher than those in the CKD5 group,and the estimated glomerular filtration rate(eGFR)was significantly lower than that in the CKD5 group(P<0.01).The incidence rates of hyperphosphatemia,hypocalcemia,hypercalcemia and high parathyroid hormone in the CKD5 and CDK5D groups were 83.75%and 91.25%,31.25%and 17.50%,1.88%and 30.00%,37.50%and 63.75%,respectively.Conclusion Patients with end-stage renal disease are accompanied by severe abnormalities of calcium,phosphorus and parathyroid hormone.Patients with CKD at stage 5 are characterized by high phosphorus,low calcium and high parathyroid hormone.The CKD-MBD status of patients with CKD at 5D stage do not improve due to hemodialysis,but become more serious,which are characterized by high levels of phosphorus,calcium and parathyroid hormone.