维持性血液透析患者矿物质代谢异常与血管钙化的相关性研究

›› 2011, Vol. 10 ›› Issue (6): 331-334.

维持性血液透析患者矿物质代谢异常与血管钙化的相关性研究

王莉吴姝焜洪大情何强蒲蕾王正通王君如刘章锁

四川省医学科学院四川省人民医院肾内科, 郑州大学第一附属医院肾脏内科

收稿日期:2010-11-15 修回日期:1900-01-01 出版日期:2011-06-12 发布日期:2011-06-12
通讯作者: 刘章锁

Research on relationship between mineral disorders and vascular calcification in maintenance hemodialysis patients

WANG Li, WU Shu-kun, HONG Da-qing, HE Qiang, PU Lei, WANG Zheng-tong, WANG Jun-run, LIU Zhang-suo

¹Department of Nephrology, Sichuan Provincial People’s Hospital, Sichuan 610072, China; ²Department of Nephrology, the First Affiliated Hospital, Zhengzhou University, Zhengzhou 450052, China

Received:2010-11-15 Revised:1900-01-01 Online:2011-06-12 Published:2011-06-12

摘要/Abstract

摘要：

目的研究维持性血液透析(maintenance hemodialysis,MHD)患者矿物质代谢异常与血管钙化的关系。方法纳入四川省人民医院血液透析中心的MHD患者91例，检测其血钙、血磷、全段甲状旁腺激素(intact parathyroid hormone,iPTH)、甲状旁腺激素(parathyroid hormone,PTH)(1-84)、25-羟维生素D[25(OH)D]和血清碱性磷酸酶(alkaline phosphatase,ALP)水平，并完善腰椎侧位、骨盆和双手X光片检查进行钙化评分。比较不同钙化程度MHD患者骨矿物质代谢异常的特点。计量资料比较采用单向方差分析，两两比较采用SNK法；相关分析采用Pearson检验。结果根据X线钙化评分将患者分为无钙化（0分，22例）、轻度钙化（1～3分，38例）、中度钙化（4～6分，20例）和重度钙化（7～10分，11例）。血管钙化发生率75.8%。重度钙化组的iPTH水平较其余3组水平明显升高，差异有统计学意义(P＜0.05)。重度钙化组ALP水平较中度钙化组水平明显升高，差异有统计学意义(P＜0.05)。iPTH水平与钙化评分之间呈正相关关系（r＝0.323,P＝0.003）；血ALP水平与钙化评分之间呈正相关关系（r＝0.359,P＝0.007）；25(OH)D水平与血iPTH水平呈负相关关系（r＝－0.207,P＝0.012）；血PTH（1-84）与血iPTH正相关(r＝0.729,P＜0.01)，与ALP水平正相关（r＝0.215,P＝0.041）。不同组之间的血钙、血磷、钙磷乘积、25(OH)D和PTH（1-84）差异无统计学意义(P＞0.05)。25(OH)D水平与血钙、血磷、ALP和钙磷乘积无相关性。结论 矿物质代谢异常是MHD患者的常见并发症，且与血管钙化程度有一定相关性，控制矿物质代谢异常能否改善或延缓血管钙化进程值得进一步研究。

关键词: 矿物质代谢异常, 维持性血液透析, 血管钙化, 碱性磷酸酶, 钙化评分

Abstract:

Objective To study the relationship between mineral metabolic disorders and vascular calcification in maintenance hemodialysis (MHD) patients. Methods A total of 91 MHD patients in our dialysis center were enrolled, and their serum calcium, phosphorous, intact PTH (iPTH), 1-84 PTH, 25(OH)D and ALP were measured. X-ray examinations of hands, pelvis and lateral lumbar spine were applied to evaluate vascular calcification. One-way ANOVA and Student-Newman-Keuls were used to compare the differences in quantitative data. Pearson correlation was used to study correlation between two parameters. Result Twenty-two patients scored 0 without vascular calcification, 38 patients scored 1~3 with mild degree of vascular calcification, 20 patients scored 4~6 with moderate degree of vascular calcification, and 11 patients scored 7~10 with severe degree of vascular calcification. The prevalence of vascular calcification was 75.8%. Serum iPTH was higher in severe calcification group than in the other 3 groups (p<0.05), and serum ALP was the highest in severe calcification group. There was a positive correlation between iPTH and calcification score (r＝0.323, P＝0.003), a positive correlation between ALP and calcification score (r＝0.359, P＝0.007), a negative correlation between 25(OH)D and iPTH (r＝-0.207, P＝0.012), a positive correlation between 1-84 PTH and iPTH, and a positive correlation between PTH and ALP (r＝0.729, P＝0.000/r＝0.215, P＝0.041). There were no differences in calcium, phosphorus, calcium × phosphorus product, 25(OH)D and 1-84 PTH among the 4 groups. Conclusions Mineral metabolic disorders are common in MHD patients, and they may contribute to vascular calcification. Further study is needed to find out whether appropriate control of mineral metabolic disorder can improve or delay the process of vascular calcification.

Key words: Maintenance hemodialysis (MHD), Vascular calcification

王莉吴姝焜洪大情何强蒲蕾王正通王君如刘章锁. 维持性血液透析患者矿物质代谢异常与血管钙化的相关性研究[J]. , 2011, 10(6): 331-334.

WANG Li;WU Shu-kun;HONG Da-qing;HE Qiang;PU Lei;WANG Zheng-tong;WANG Jun-run;LIU Zhang-suo. Research on relationship between mineral disorders and vascular calcification in maintenance hemodialysis patients [J]. , 2011, 10(6): 331-334.