维持性血液透析患者矿物质代谢研究

目的 探讨新乡地区维持性血液透析（MHD）患者矿物质代谢现况及相关影响因素,以提高本地区MHD患者生存质量.方法 收集2012年1月至2013年8月新乡地区4家综合性医院466例MHD3个月以上患者的临床资料.检测血清钙离子、磷、全段甲状旁腺激素（iPTH）及碱性磷酸酶（ALP）水平.分析MHD患者矿物质代谢现况及其与年龄、透析龄、营养不良、透析充分性的关系.结果 466例患者血钙平均值为（1.95±0.34） mmol/L,血磷平均值为（2.54± 1.38）mmol/L,iPTH平均值为（409±346）ng/L;钙、磷、iPTH达标率分别为34.3％（160/466）、20.4％（95/466）和25.5％ （119/466）.年龄≥60岁组（n=159）患者的血磷（2.27±0.95）mmol/L比（2.68± 1.54） mmol/L]、iPTH（344±235） ng/L比（437±383）ng/L]、ALP值（49.0±36.4）mmol/L比（77.1±78.5） mmol/L]均低于年龄＜60岁组（n=307）（P均＜0.01）.iPTH＞ 300ng/L组（n=242）的血磷、ALP、透析龄明显高于iPTH≤300 ng/L组（n=224）（均P＜0.01）.透析龄≥24个月组（n=228）患者的血磷（2.70±1.49） mmol/L比（2.35±1.20） mmol/L]、血钙（1.88±0.35） mmol/L比（2.03±0.31） mmol/L]、iPTH（493±384） ng/L比（301±249） ng/L]、ALP值（74.3±73.3） mmol/L比（52.0±51.0）mmol/L]与透析龄＜24个月组（n=238）比较差异均有统计学意义（均P＜0.05）.结论 该地区MHD患者存在着明显的矿物质代谢紊乱及甲状旁腺机能亢进症,透析龄长的患者及年轻透析患者高磷血症、低钙血症更为突出.

Mineral metabolism in patients with maintenance hemodialysis in Xinxiang District

Objective To investigate the present situation and related factors of the mineral metabolism in patients,with maintenance hemodialysis （MHD）.Methods A total of 466 MHD patients clinical data in 4 hospital in Xinxiang didtrict during January 2012 and August 2013 were enrolled in this study,and they received a minimum of 3 months＇ MHD therapy.The evaluation index of all 466 MHD patients were monitored,such as serum calcium,serum phosphorus,intact parathyroid hormone（iPTH） and alkaline phosphatase（ALP）.Results The level of serum calcium,serum phosphorus and iPTH in 466 MHD patients was （1.95 ± 0.34） mmol/L,（2.54 ± 1.38） mmol/L and （409 ± 346） ng/L,and the control rate of them was 34.3％ （160/466）,20.4％ （95/466） and 25.5％ （119/466）,respectively.The level of serum phosphorus（2.27 ± 0.95） mmol/L vs（2.68 ± 1.54） mmol/L],iPTH （344 ± 235）ng/L vs （437 ± 383）ng/L],ALP（49.0± 36.4） mmol/L vs（77.1 ± 78.5）mmol/L] in the group of age≥ 60 years old （n =159） was obviously lower than that in the group of age ＜ 60 years old（n =307） （all P ＜ 0.01）.And the level of serum phosphorus,alkaline phosphatase and dialysis ages in the group of iPTH ＞ 300 ng/L was higher than that in the group of iPTH ≤ 300 ng/L（P ＜ 0.01）.There was statistical significance with the level of serum calcium,serum phosphorus,ALP and iPTH between the dialysis ages≥ 24 months and dialysis ages ＜ 24 months（all P ＜ 0.05）.Conclusions There were obvious disorder of mineral metabolism and hyperparathyroidism with the MHD patients in Xinxiang District.With the delay of the dialysis,the hyperphosphatemia and hypocalcemia is more outstanding in these patients.