中国血液净化

中国血液净化 ›› 2020, Vol. 19 ›› Issue (01): 17-20.doi: 10.3969/j.issn.1671-4091.2020.01.005

• 临床研究 • 上一篇    下一篇

基线甲状旁腺激素水平对腹膜透析患者预后影响的探讨

武蓓1,王梅1,赵慧萍1,左力1,芦丽霞1,乔婕1,门春翠1,何玉婷1   

  1. 1. 北京大学人民医院肾内科
  • 收稿日期:2019-09-20 修回日期:2019-11-19 出版日期:2020-01-20 发布日期:2019-12-30
  • 通讯作者: 王梅wangmei1949@163.com E-mail:wangmei1949@163.com

The effect of baseline parathyroid hormone level on the prognosis of peritoneal dialysis patients

  1. 1Department of Nephrology, Peking University People’s Hospital, Beijing 100044, China
  • Received:2019-09-20 Revised:2019-11-19 Online:2020-01-20 Published:2019-12-30

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摘要： 【摘要】目的本研究旨在探讨新进入腹膜透析人群中甲状旁腺激素水平分布，影响因素，及其对腹膜透析患者长期生存的影响。方法新进入腹膜透析治疗的成人终末期肾病患者按患者全段甲状旁腺激素(intact parathyroid hormone，iPTH)水平分为A 组iPTH＜150 pg/ml；B 组iPTH 150～300pg/ml；C 组iPTH 300～600pg/ml；D 组iPTH ≥600pg/ml。比较各组患者的临床及化验资料；使用多元线性回归筛选与基线iPTH 相关的危险因素。应用COX 回归模型分析影响生存率的因素。应用Kaplan-Meier 生存分析、COX 回归模型分析比较4 组患者的生存情况。结果共222 例腹膜透析患者入选。其中，基线iPTH＜150pg/ml 的患者占43.7%。这组患者的特点包括：年龄大(F=6.235, P＜0.001)，合并糖尿病比例高(F=16.277, P=0.001)，合并症多(F=4.348, P=0.005)，eGFR 较高(F= 5.699, P=0.001)。但经过元线性回归分析，仅年龄(β=-8.700, P＜0.001)、是/否合并糖尿病(β=145.400, P =0.012)对基线iPTH 有独立的影响。生存曲线显示不同基线iPTH 组间总体生存率存在差异(P =0.002)。多因素COX 回归分析发现，仅年龄(B=0.066,P＜0.001)是预测死亡的独立危险因素，基线iPTH(B＜0.001,P=0.507)不能独立预测死亡。结论初进入腹膜透析治疗的患者中，年龄大、合并糖尿病的患者，更容易出现低iPTH 的情况。但是，基线iPTH并不能独立预测死亡。

关键词: 腹膜透析, 全段甲状旁腺激素, 生存率, 矿物质骨代谢异常

Abstract: 【Abstract】Objective The purpose of this study was to investigate the changes of serum intact parathyroid hormone (iPTH) and its related factors in incident peritoneal dialysis (PD) patients, and to assess its impact on long-term survival of PD patients. Methods Clinical data were analyzed for all adult chronic renal failure patients initiating PD therapy. According to the iPTH level, patients were divided into four groups: group A (iPTH ＜150pg/ml), group B (iPTH 150~300pg/ml), group C (iPTH 300~ 600 pg/ml), and group D (iPTH ≥600pg/ml). Variance analysis and χ2 test were used to compare the clinical and laboratory data of the four groups. Multiple linear regression was used to screen the risk factors for baseline iPTH level. Cox regression model was used to analyze the factors for survival rate. Kaplan-Meier survival analysis and Cox regression model were used to compare the survival rate of the four groups. Results This study enrolled 222 patients, in which baseline iPTH <150 pg/ml accounted for 43.7% of the patients. The patients with baseline iPTH <150 pg/ml had the characteristics of older age (F=6.235, P<0.001), higher incidence of diabetes mellitus (F=16.277, P=0.001), more complications (F=4.348, P=0.005), and higher eGFR (F= 5.699, P=0.001). However, multiple linear regression revealed that only age (β =- 8.700, P＜0.001) and diabetes mellitus
(β=145.400, P=0.012) had the independent effects on baseline iPTH level. Kaplan- Meier survival curve showed that the survival rate was different among the four groups (P=0.002). Multivariate COX regression showed that only age (β=0.066, P< 0.001) was the independent risk factor for predicting mortality, and baseline iPTH level (P=0.507) could not independently predict mortality. Conclusion The incident PD patients with older age and diabetes mellitus were more likely to have lower baseline iPTH. However, baseline iPTH level could not independently predict mortality.

Key words: Peritoneal dialysis, Intact parathyroid hormone, Survival rate, Mineral and bone disorder

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