中国血液净化

中国血液净化 ›› 2021, Vol. 20 ›› Issue (05): 315-319.doi: 10.3969/j.issn.1671-4091.2021.05.007

• 临床研究 • 上一篇    下一篇

低基线全段甲状旁腺激素的维持性血液透析患者临床特点及预后分析

罗春雷1,边学燕1,鲍玲玲1,黄坚成1,包斯增1,任利玲1,俞强1   

  1. 1宁波市第一医院肾内科
  • 收稿日期:2020-12-21 修回日期:2021-02-22 出版日期:2021-05-12 发布日期:2021-05-06
  • 通讯作者: 边学燕 b875487903@163.com E-mail:bianxueyan@medmail.com.cn
  • 基金资助:
    浙江省医药卫生科技项目(2020376032)

Clinical characteristics and prognosis in maintenance hemodialysis patients with low baseline serum intact parathyroid hormone 

  1.  1Department of Nephrology, Ningbo First Hospital, Ningbo 315010, China
  • Received:2020-12-21 Revised:2021-02-22 Online:2021-05-12 Published:2021-05-06

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摘要： 【摘要】目的探讨低基线全段甲状旁腺激素(intact parathyroid hormone,iPTH)的维持性血液透析患者的临床特点及预后。方法选取宁波市第一医院起始并维持血液透析治疗的患者共224 例，根据iPTH 水平将患者分为iPTH 低下组(iPTH＜150pg/ml)和iPTH 升高组(iPTH≥150pg/ml)。比较2 组患者的各项指标的差异，并应用Kaplan-Meier 生存曲线分析2 组的生存时间差异。结果iPTH 低下组和iPTH升高组分别为74例和150 例患者。与iPTH 升高组相比，iPTH 低下组患者平均年龄较大、血红蛋白较高、血清白蛋白较低、血肌酐较低、总胆固醇较低、血钙较高、血磷较低(t 值分别为2.943, 2.210, -2.297, - 3.171, - 2.136, 5.679, - 4.592；P 值分别为0.004, 0.028, 0.023, 0.002, 0.034, ＜0.001, ＜0.001)。iPTH 低下组平均生存时间为(58.3±6.7)月(95% CI: 45.2～71.5)，iPTH 升高组为(82.6±4.6)月(95% CI: 73.6～91.6)，iPTH 低下组生存时间较短(χ2=9.313,P=0.002)。进一步比较iPTH 持续升高组、iPTH升高但出现下降组、iPTH 持续低下组及iPTH 低下但出现升高组发现，iPTH 持续低下组生存时间最短(χ2=31.059, P＜0.001)。结论低基线iPTH 的维持血液透析的患者年龄相对较大、营养状况较差，贫血及低钙高磷程度相对较轻，生存时间较短，预后较差，尤其是iPTH 持续偏低的患者，预后最差。

关键词: 全段甲状旁腺激素, 血液透析, 临床特点, 预后

Abstract: 【Abstract】Objective To investigate clinical characteristics and prognosis in maintenance hemodialysis (MHD) patients with low baseline intact parathyroid hormone (iPTH). Methods A total of 224 MHD patients treated in Ningbo First Hospital were recruited and retrospectively studied. They were divided into two groups according to serum iPTH level, low iPTH group (iPTH<150pg/ml, n=74) and high iPTH group (iPTH≥150pg/ml, n=150). Clinical indicators were compared between the two groups. Kaplan-Meier survival curve was used to analyze the survival time between the two groups. Results Compared with the high iPTH group, patients in the low iPTH group had older age (t=2.943, P=0.004), higher hemoglobin (t=2.210, P=0.028), lower serum albumin (t=-2.297, P=0.023), lower creatinine (t=-3.171, P=0.002), lower total cholesterol (t=-2.136, P=0.034), higher blood calcium (t=5.679, P<0.001) and, lower blood phosphorus (t=- 4.592, P<0.001). The mean survival time was 58.3±6.7 (95% CI: 45.2～71.5) months in the low iPTH group, and was 82.6±4.6 (95% CI: 73.6～91.6) months in the high iPTH group, indicating the shorter survival time in the low iPTH group (χ2=9.313, P=0.002). When the patients in the two group were divided into several subgroups based on the iPTH change during follow- up period, we found that the subgroup with persistently low iPTH had the
shortest survival time (χ2=31.059, P<0.001). Conclusions MHD patients with low baseline iPTH had the characteristics of older age, subnormal nutritional status, mild anemia, relatively higher serum calcium and lower serum phosphorus, shorter survival time and unfavorable prognosis, especially those with persistently low iPTH.

Key words: Intact parathyroid hormone, Hemodialysis, Clinical characteristics, Prognosis

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