老年血液透析患者甲状旁腺功能异常及其影响因素的研究

目的分析老年血液透析患者钙磷代谢紊乱和甲状旁腺功能异常的情况及其影响因素。方法 :选择2010年1月至2010年12月在上海市解放军第455医院、上海市第七人民医院和上海市静安区中心医院行维持性血液透析病情稳定的慢性肾衰竭患者286例,根据年龄分为老年组(≥65岁)和非老年组(<65岁)。所有患者于透析前空腹抽血送检血红蛋白(Hb)、血清肌酐(Scr)、尿素氮(BUN)、钙、磷、全段甲状旁腺激素(iPTH)、超敏C反应蛋白(HsCRP)、白蛋白(Alb)等,同时测定透析后血清尿素氮浓度,记录超滤量、透析后体质量和透析时间,根据公式计算血清白蛋白校正钙(Ac-Ca)和尿素清除指数(Kt/V)。结果老年血液透析患者占同期血液透析人口的51.4%。老年组慢性肾衰竭的主要病因是原发性高血压,占35.4%,其次为慢性肾小球肾炎和糖尿病,分别占21.1%和19.7%。非老年组慢性肾衰竭的主要病因是慢性肾小球肾炎,占43.2%,其次为糖尿病和原发性高血压,分别占23.7%和12.2%。与非老年组比较,老年组的透析龄更短,干体质量更轻,使用维生素D和/或钙剂的患者数更少,收缩压更高,舒张压更低,血清BUN、Scr、P、iPTH、Alb、标准蛋白氮呈现率(nPNA)浓度更低,Hs-CRP更高,低iPTH血症(<150pg/L)的发生率更高(分别达55.8%和36.7%),均有统计学意义,P<0.05,而2组的Hb、AC-Ca和Kt/V比较无明显差异,P>0.05。logistic多元回归分析表明,患者的年龄、血磷、白蛋白和nPNA是老年维持性血液透析患者继发性甲状旁腺功能减退的独立危险因素。结论老年维持性血液透析患者多数存在甲状旁腺功能低下的现象,其发生可能与年龄、营养不良等因素有关,有待进一步研究。

parathyroid dysfunction and its related factors in elderly patients on hemodialysis

Objective To observe abnormal calcium and phosphorus metabolism,parathyroid dysfunction,and their related factors in elderly maintenance hemodialysis(MHD) patients.Methods A total of 286 MHD patients with stable disease status were recruited from the 455th Hospital of PLA and Shanghai Jing’an District Central Hospital during the period of January 2010 to December 2010.They were divided into two groups:elderly group(=65 years of age) and non-elderly group(<65 years of age).Before dialysis,fasting blood specimens were drawn to assay hemoglobin(Hb),serum creatinine(Scr),blood urea nitrogen(BUN),calcium,phosphorus,intact parathyroid hormone(iPTH),high-sensitivity C-reactive protein(hsCRP),albumin(Alb),etc.After dialysis,serum BUN,ultrafiltration volume,body weight change,and dialysis time were recorded.Serum albumin corrected calcium(Ac-Ca) and urea removal index(Kt/V) were then calculated.Results Elderly MHD patients accounted for 51.4% of the total hemodialysis cases over this observation period.In elderly group,the major causes of renal failure were hypertension(35.4%),followed by chronic glomerulonephritis(21.1%) and diabetes(19.7%).In non-elderly group,the main causes of renal failure were chronic glomerulonephritis(43.2%),followed by diabetes(23.7%) and hypertension(12.2%).When comparison was made between elderly group and non-elderly group,patients in elderly group were found to have shorter dialysis age,less dry body weight,less cases treated with vitamin D and/or calcium,higher systolic pressure,lower diastolic pressure,lower levels of serum BUN,Scr,P,iPTH,Alb and standard protein nitrogen present rate(nPNA),higher hsCRP(present in 55.8% patients,P<0.05),lower iPTH(<15 pg/L in 36.7% patients,P<0.05).However,the differences in levels of Hb,AC-Ca and Kt/V were insignificant between the two groups(P>0.05).Logistic multiple regression analysis demonstrated that older age,lower levels of plasma phosphorus,albumin and nPNA were the independent risk factors for secondary hypoparathyroidism in elderly MHD patients.Conclusion Most elderly MHD patients were complicated with hypoparathyroidism,which may be related to older age,malnutrition and other factors.Hypoparathyroidism in elderly MHD patients needs to be further studied.