中国血液净化

中国血液净化 ›› 2015, Vol. 14 ›› Issue (08): 469-473.doi: 10.3969/j.issn.1671-4091.2015.08.007

• 临床研究 • 上一篇    下一篇

维持性血液透析患者血磷达标状况与颈动脉粥样硬化的关系

邬碧波,张黎明,唐琦,贺云岚,俞勇,郝晓萍   

  1.  上海市闸北区中心医院肾内科
  • 收稿日期:2015-02-26 修回日期:2015-06-10 出版日期:2015-08-12 发布日期:2015-08-12
  • 通讯作者: 邬碧波 xts2626@163.com E-mail:bibowu1966@hotmail.com
  • 基金资助:

    上海市科委医学引导类重大项目(1141196b0300)

Maintaining serum phosphorus in the target range and its correlation with carotid atherosclerosis in maintenance hemodialysis patients with hyperphosphatemia

  • Received:2015-02-26 Revised:2015-06-10 Online:2015-08-12 Published:2015-08-12

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摘要： 【摘要】目的通过对维持性血液透析(maintenance hemodialysis,MHD)合并高磷血症的患者采用磷结合剂治疗，探讨血磷达标状况对MHD 患者颈动脉粥样硬化(carotid atherosclerosis,AS)的影响。方法①选择在上海市闸北区中心医院血液净化中心透析龄超过3 个月的MHD 患者80例，其中男44 例，女36 例，平均年龄(57.1±13.8)岁，平均透析龄(38.7±14.8)月；透析前血磷＞1.78mmol/L，饮食保持稳定且依从性好；病情稳定，预期生存期＞2 年。②对所有入选患者进行降磷治疗，分别口服碳酸钙、醋酸钙、碳酸镧，共进行为期24 个月随访，期间根据血磷和血钙的变化，及时调整药物品种和剂量。③分别于治疗前、治疗后6、12、18、24 个月末检测患者的血磷、血钙、全段甲状旁腺激素(iPTH)、血红蛋白、血清白蛋白等；计算钙磷乘积和尿素清除指数(kt /V)。④分别于治疗前、治疗后12、24 个月末行颈动脉超声检测。⑤在随访结束24 个月末将资料完整的80 例患者，根据血磷水平分为高血磷组(血磷≥1.78mmol/L)和正常血磷组(血磷＜1.78 mmol/L)，分析血磷达标状况对MHD 患者AS 的影响。结果①与治疗前比较，治疗后6、12、18、24 个月患者血磷、iPTH 及钙磷乘积均显著下降、血钙水平均显著升高(P＜0.05 或P＜0.01)；Hb、Alb 及kt/V 差异无统计学意义。②在随访结束后分析发现，与高血磷组比较，正常血磷组血磷、iPTH 显著降低(P＜0.05 或P＜0.01)，血钙、Hb、Alb 及kt /V 的差异无统计学意义；颈动脉内膜中层厚度(IMT)及斑块形成、颈动脉硬化的患病率均显著降低(P＜0.05 或P＜0.01)。③直线相关分析显示，血磷与iPTH 及IMT、斑块形成、颈动脉硬化的患病率呈正相关、与血钙呈负相关(P＜0.05 或P＜0.01)。④多因素逐步回归分析显示，血磷、iPTH 和年龄是MHD 患者AS 的独立危险因素。结论高磷血症是MHD 患者并发AS 的危险因素之一，血磷达标状况与MHD 患者AS 的发生密切相关。

关键词: 血液透析, 高磷血症, 动脉粥样硬化

Abstract: 【Abstract】Objective To investigate the achievement of serum phosphorus in the target range, and its correlation with carotid atherosclerosis (AS) in maintenance hemodialysis (MHD) patients with hyperphosphatemia and treated with phosphate binders. Methods We recruited 80 patients subjected to MHD for at least 3 months and with serum phosphorus >1.78 mmol/L. They were given one of the three phosphate binders for 2 years. Phosphate binder and its doses were adjusted to obtain serum phosphorus in target range. Serum phosphorus, calcium and intact parathyroid hormone (iPTH) were assayed every 6 months during the treatment period. Carotid ultrasonography was performed to detect AS. After the therapy for 2 years, the patients were divided into high serum phosphorus group (≥1.78 mmol/L, n=50) and normal serum phosphorus group (＜1.78 mmol/L, n=30). Results After the treatment for 6 months, serum phosphorus and iPTH decreased significantly and serum calcium increased significantly in all patients as compared with these parameters before treatment (P＜0.05 or ＜0.01). Serum phosphorus and iPTH decreased gradually with the duration of phosphate binder therapy. Serum phosphorus and iPTH, carotid intimal medial thickness (IMT), and the prevalence of AS were lower in normal serum phosphorus group than in high serum phosphorus group (P＜0.05 or ＜0.01). Serum phosphorus was positively correlated with the levels iPTH and IMT and the prevalence of AS in all MHD patients with hyperphosphatemia (P＜0.05 or ＜0.01). A negative correlation was found between serum levels of phosphorus and calcium (P＜0.05). Conclusion Hyperphosphatemia is a significant and independent risk factor of the advanced arteriosclerosis in MHD patients. Maintaining serum phosphorus concentration in the target range is effective to decrease the prevalence of AS in MHD patients.

Key words: Hemodialysis, Hyperphosphatemia, Atherosclerosis