维持性血液透析患者钙磷代谢及全段甲状旁腺激素水平调查分析

目的通过调查维持性血液透析患者的钙磷代谢情况及全段甲状旁腺激素(iPTH)水平,了解其达标情况和治疗状况。方法回顾性分析90例终末期肾病患者矫正的血钙、血磷、钙磷乘积及iPTH的水平及临床资料。结果 90例患者矫正的血钙、血磷、钙磷乘积和iPTH的达标率分别为35.56%(32例)、33.33%(30例)、61.11%(55例)、27.78%(25例)。90例患者四项指标中,1项达标占31.11%(28例)、2项同时达标占30.00%(27例)、3项同时达标占17.78%(16例)、4项同时达标占3.33%(3例)。29例低钙血症患者中8例(27.59%)患者在服用钙剂,56例高磷血症患者中有20例(35.71%)患者在服用磷结合剂碳酸钙,55例iPTH>300 pg/ml的患者中有11例(20%)患者在服用骨化三醇。透析时间>3年的40例患者iPTH水平较透析时间≤3年的50例患者明显增高(t=3.99,P<0.05)。透析充分组的10例患者与透析不充分组的11例患者血钙、血磷、钙磷乘积、iPTH水平比较,差异均无统计学意义(t分别=0.09、0.29、0.12、0.16,P均>0.05)。结论本次研究多数维持性血液透析患者钙磷代谢及iPTH的控制仍未达到K/DOQI指南推存的应保持的目标范围,以血磷及iPTH增高更为明显。有相当一部分患者没有得到及时有效的治疗。

Investigation to the metabolism of calcium and phosphorus and he level of intact parathyroid hormone in the maintain hemodialysis patients

Objective To observe the metabolism of calcium and phosphorus and the level of intact parathyroid hormone in the maintain hemodialysis patients. Methods Serum calcium and phosphorus and level of intact parathyroid hormone and clinical data of 90 hemodialysis patients were analyzed retrospectively. Results Eligibility rate about serum calcium and phosphorus and multiplication and the level of intact parathyroid hormone were 35.56%, 33.33%,61.11%,27.78% respectively. One item eligibility was 31.11%; two items eligibility was 30%; three items eligibility was 17.78%; four items eligibility was 3.33%. 27.89% hypocalcemia patients had taken calcium; 35.71% hyperphosphatemia patients had taken phosphate binder; 20% secondly hyperparathyroidism patients had taken vitamin D analogues. The level of intact parathyroid hormone was higher in patients whose hemodialysis vintage lower 3 years than patients whose hemodiaysis vintage over 3 years （t=3.99, P〈0.05 ）. The metabolism of calcium and phosphorus and the level of intact parathyroid hormone had not statistical difference between patients own adequate dialysis dose and patients with inadequate dialysis dose （t=0.09,0.29,0.12,0.16, P〉0.05）. Conclusions Most dialysis patients did not have eligible serum and phosphorus and the level of intact parathyroid hormone.