中国血液净化

›› 2004, Vol. 3 ›› Issue (9): 471-473.

• 论著 • 上一篇    下一篇

继发性甲状旁腺功能亢进症及钙磷代谢异常对维持性血液透析患者残余肾功能的影响

刘明媛 袁伟杰   

  1. 200433 上海，第二军医大学附属长海医院肾内科
  • 收稿日期:1900-01-01 修回日期:1900-01-01 出版日期:2004-09-12 发布日期:2004-09-12

  • Received:1900-01-01 Revised:1900-01-01 Online:2004-09-12 Published:2004-09-12

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摘要：

目的 探讨高 甲状旁腺素（PTH）血症及钙磷代谢异常对维持性血液透析患者残余肾功能 (RRF residual renal function）的影响。方法 检测140例慢性肾功能衰竭（CRF）门诊维持性血液透析患者的平均动脉压、血钙、磷、PTH、碱性磷酸酶(ALP)、甘油三酯(TG）、空腹血糖、血红蛋白（Hb）、左心室心肌重量(LVMI)及服用钙三醇情况，并分析其与RRF的相关性。结果 63.6％的维持性血液透析患者存在着不同程度的继发性甲状旁腺功能亢进症(SPHT)；高PTH组较PTH正常组血清磷、钙磷乘积（ P<0.01）、 碱性磷酸酶（ALP）、平均动脉压、左心室心肌重量指数(LVMI)、甘油三酯(TG)、空腹血糖(P<0.05)水平高， 血红蛋白（Hb） （P<0.05）、 Ccr（ P<0.01）水平低；所有血液透析患者血清磷、钙磷乘积、 PTH水平与Ccr呈线性负相关（ P<0.05）； PTH与ALP、平均动脉压、LVMI、TG、空腹血糖呈正相关 ( P<0.05)， 与 Hb 呈负相关( P < 0.05)。服用钙三醇组较未服用钙三醇组骨痛、皮肤瘙痒症状轻（P<0.01）， PTH、ALP、平均动脉压、LVMI、TG、空腹血糖水平低（ P<0.05），钙、Ccr、Hb水平高(P<0.05)。结论 提示 SPHT及钙磷代谢异常对维持性血液透析患者RRF及心血管系统、内分泌系统、血液系统、骨骼等影响显著，钙三醇治疗可有效纠正SPHT及钙磷代谢异常，延缓RRF的减退。

关键词: 甲状旁腺素, 钙磷代谢, 残余肾功能, 血液透析

Abstract:

Objective To investigate the effects of secondary hyperparathyroidism and abnormity of calcium-phosphorus matabolism on residual renal function in long-term hemodialysis patients. Methods The pulse pressure，serum calcium,phosphorus, PTH, ALP, TG, fasting blood sugar, Hb, LVMI and oral administration of Calcitriolum were counted in 140 cases of hemodialytic patients.The relation of those to RRF was analyzed. Results There were 63.6% hemodialytic patients suffered from secondary hyperparathyroidism. The levels of phosphorus, calcium-phosphorus product（P<0.01）, ALP, pulse pressure, LVMI, TG，fasting blood sugar（P<0.05） were higher and the level of Hb（P<0.05） was lower in the hyperparathyroidism patients than in other patients.There were negative correlation（P<0.05） between phosphorus，calcium-phosphorus product, PTH and Ccr in all of the patients.There were positive correlation（P<0.05） between ALP, pulse pressure, LVMI, TG, fasting blood sugar and PTH in all of the patients. There was negative correlation （P<0.05） between Hb and PTH in all of the patients.The levels of PTH、ALP、pulse pressure、LVMI、TG、fasting blood sugar were lower（P<0.01） and the levels of calcium, Ccr，Hb （P<0.05） were higher in the patients who were given Calcitriolum than in the subjects who were not given Calcitriolum.Conclusion The effects of secondary hyperparathyroidism and abnormity of calcium-phosphorus matabolism on residual renal function, cardiovasculir system,endocrine system, hematopoietic system, skeleton in hemodialytic patients is significant. Calcitriolum can slow down the deterioration of RRF.

Key words: Calcium－phosphorus metabolism, Residual renal function, Hemodialysis

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