中国血液净化

中国血液净化 ›› 2014, Vol. 13 ›› Issue (09): 636-638.doi: 10.3969/j.issn.1671-4091.2014.09.007

• 临床研究 • 上一篇    下一篇

维持性透析患儿钙磷代谢和甲状旁腺功能的变化

焦莉平,陈鹭,马军梅,沈颖   

  1. 首都医科大学附属北京儿童医院肾内科
  • 收稿日期:2014-07-15 修回日期:2014-07-29 出版日期:2014-09-12 发布日期:2014-09-02
  • 通讯作者: 沈颖 ying_116sh@sohu.com E-mail:ying_116sh@sohu.com

Changes of calcium-phosphorus metabolism and parathyroid function in maintenance hemodialysis children

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  • Received:2014-07-15 Revised:2014-07-29 Online:2014-09-12 Published:2014-09-02

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摘要： 目的探讨维持性血液透析(MHD)患儿钙磷代谢和甲状旁腺功能的变化。方法观察首都医科大学附属北京儿童医院肾内科血液净化中心行MHD 的19 例终末期肾脏病患儿，记录透析前及透析3 月后钙、磷、碱性磷酸酶及全段甲状旁腺激素(iPTH)水平，根据改善全球肾脏病预后国际组织指南标准进行比较,分析透析患儿钙磷代谢的达标率。结果19 例MHD 患儿透析前高磷血症16 例(84.21%)；低钙血症17 例(89.47%)；碱性磷酸酶增高11 例(57.69%)；血iPTH 高于600pg/ml 的13 例(66.42%)。透析3 月后血磷(1.83±0.76)mmol/L、血钙(2.27±0.26)mmol/L、碱性磷酸酶(401.63±315.61)U/L 及iPTH(675.97±581.66)ng/L，达标率分别为10 例(52.63%)、15 例(78.95%)、5 例(26.32%)及10 例(52.63%)。透析3 月后与透析前比较，碱性磷酸酶无统计学意义(t=-1.497，P＞0.05)，血磷、血iPTH 水平明显下降(分别为t=3.477，P＜0.01；t=2.397，P＜0.05)，血钙水平明显升高(t=-7.392，P＜0.01)。结论MHD 患儿普遍存在钙磷代谢紊乱和甲状旁腺功能异常，应当予以重视。通过本组研究发现，应用MHD 联合血液透析滤过方案可以改善钙磷代谢紊乱。儿童碱性磷酸酶是否可以作为钙磷代谢紊乱的观察指标尚需进一步研究。

关键词: 维持性透析, 钙代谢障碍, 磷代谢障碍, 甲状旁腺素

Abstract: Objective To investigate the changes of serum calcium-phosphorus metabolism and parathyroid function in maintenance hemodialysis (MHD) children. Methods A total of 19 MHD children treated in our blood purification center were enrolled in this study. Serum calcium, phosphate and intact parathyroid hormone (iPTH)  were measured before and after MHD for 3 months. Results Before MHD, hyperphosphatemia was found in 16 patients (84.21%), hypocalcemia in 17 patients (89.47%), elevated alkaline phosphatase in 11 patients (57.69%), and iPTH level ＞600 pg/ml in 13 patients (66.42%). After MHD for 3 months, the mean level of serum phosphorus, calcium, alkaline phosphatase, and iPTH was 1.83±0.76 mmol/L, 2.27±0.26 mmol/L, 401.63±315.61 U/L, and 675.97±581.66 ng/L, respectively, approaching the target level of serum phosphorus, calcium, alkaline phosphatase, and iPTH in 10 patients (52.63% ), 15 patients (78.95% ), 5 patients (26.32%), and 10 patients (52.63%), respectively. While serum alkaline phosphatase changed insignificantly (t =-1.497，P＞0.05), serum phosphorus and iPTH decreased (t =3.477, P＜0.01, and t =2.397, P＜0.05, respectively) and serum calcium increased (t =-7.392, P＜0.01) after MHD for 3 months as compared to those before MHD. Conclusions MHD children are frequently complicated with calcium-phosphorus metabolic derangements and secondary hyperparathyroidism, which should be carefully monitored. MHD combined with hemodiafiltration may be more effective to improve these derangements. Whether alkaline phosphatase can be used as the indicator for calcium-phosphorus metabolic changes in children needs to be further studied.

Key words: Maintenance hemodialysis, Calcium metabolism disorder, Phosphorus metabolism disorder, Parathyroid hormone