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目的探讨钙磷代谢与慢性肾功能不全患儿心血管结构与功能关系。方法研究对象为1998—2004年在哈尔滨医科大学附属第一医院住院的44例慢性肾功能不全非透析患儿(非透析组)、另选40例维持性透析患儿(透析组),40例健康志愿者设为对照组。测量指标包括入选对象血液生化指标、超声心动图及颈动脉超声。结果与对照组比较,非透析组及透析组患儿均出现明显的颈动脉增厚、左心室肥厚、舒张功能减退。透析组动脉厚度及心室肥厚指标高于非透析组,且其动脉硬化较其他两组明显。两个肾脏疾病组颈动脉壁增厚与钙磷乘积增加呈正相关,动脉硬化、心室肥厚及舒张功能减退与血清磷及全段甲状旁腺素增加有关。结论慢性肾脏疾病患儿可合并心血管结构与功能异常;血液透析患儿心血管疾病的加重与钙磷代谢异常有关。

Relationship between calcium-phosphorus metabolism and cardiac and vascular change in patients with chronic renal failure

ObjectiveTo study the cardiac and vascular adaptation in patients with chronic renal failure(CRF) and approach the rule of calcium-phosphorus metabolism.MethodsBlood biochemical indicators,echocardiography and B-ultrasound data of the carotid artery were collected from 44 patients with chronic renal insufficiency(ND group),40 patients who were on maintenance dialysis(D) and 40 healthy individuals(Control).Carotid artery intima-media thickness(cIMT) was measured and arterial compliance was calculated to obtain carotid artery structure and function.ResultsBoth the ND and D group had greater Cimt,higher left ventricular mass(LVM) index,and poorer diastolic function than the control group.Patients who were on dialysis had greater cIMT and higher LVM index than those with ND and greater stiffness than both ND and control group.Calcium-phosphrous product has positive correlation with cIMT.Increased intact parathyroid hormone(iPTH) was concerned with arterial stiffness,LVM index and poor diastolic function.ConclusionThere are cardiac and vascular abnormalities in CRF patients;the aggravation of cardiac and vascular disease are related with the abnormality of calcium-phosphorus metabolism.