中国血液净化

中国血液净化 ›› 2013, Vol. 12 ›› Issue (10): 552-556.

• 临床研究 • 上一篇    下一篇

MHD人群慢性肾脏病矿物质和骨异常单中心横断面研究

  

  1. 1. 四川省人民医院
    2. 四川省医学科学院.四川省人民医院
  • 收稿日期:2013-08-12 修回日期:2013-08-23 出版日期:2013-10-12 发布日期:2013-10-12
  • 通讯作者: 王莉 scwangli62@163.com E-mail:scwangli62@163.com

Cross-sectional screening on chronic kidney disease-mineral and bone disorder in maintenance hemodialysis (MHD) patients in a single center

  • Received:2013-08-12 Revised:2013-08-23 Online:2013-10-12 Published:2013-10-12
  • Contact: li wang E-mail:scwangli62@163.com

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摘要： 【摘要】目的：了解我院维持性血液透析（MHD）患者的慢性肾脏病-矿物质和骨异常（CKD-MBD）的患病情况，并分析其相关危险因素。方法：对2010年7月至2011年3月在我院血液透析中心进行规律维持性血液透析的患者217例进行调查，收集患者的一般资料,测定血钙、血磷、血iPTH,行腹部侧位、骨盆正位、双手正位X线摄片，采用Kauppila评分进行血管钙化评分。分析CKD-MBD各指标在血透患者中患病率、达标率以及相关危险因素。结果：本次217 例MHD患者中，高磷血症患病率为45.16% ，低钙血症患病率为31.8%，高钙血症患病率为21.66 % ，高iPTH患病率为48.85 % ,低iPTH患病率为20.74 % 。X片显示有血管钙化的患者有154人（占70.97%），有钙磷代谢异常、PTH、血管钙化一项或多项异常，符合KDIGO关于CKD-MBD诊断的患者比例高达96.31%。本组MHD患者血钙、血磷、PTH达标率分别为45.16%、 44.7%、30.88%。血钙、磷、PTH均达标仅有20人（占9.22%）。血钙和血磷的达标率低于DOPP4。多因素Logistic回归分析显示高PTH的危险因素有高磷血症、低钙血症。低PTH 的危险因素有年龄、透析龄和活性维生素D服用史。血管钙化的危险因素有高龄、高ALP、高磷血症和高CRP。结论：CKD-MBD在MHD患者中普遍存在，与DOPP4比较，存在CKD-MBD各项指标达标率较低。

关键词: 矿物质和骨异常, 慢性肾脏病, 钙磷代谢, 甲状旁腺激素, 血管钙化

Abstract: 【ABSTRACT】Objective: To explore the morbidity and the management of the chronic kidney disease-mineral and bone disorder (CKD-MBD) in maintenance hemodialysis (MHD) patients at our hospital center, to analyze the related risk factors. Methods: The target population was the 217 patients who receive treatment of hemodialysis inhemodialysis center of our hospital during Jul.2010 to Mar.2011. We gathered the demographic information and the CKD-MBD related indicators,such as serum calcium, phosphorus, PTH, Vascular calcifications were determined by lateral abdominal, frontal pelvic and hands X-rays, counted the vascular calcification scores by the method of Kauppila and finally analyzed the morbidity ,the control rate and the potential relative risk factors of the abnormalities of the indicators by the multi-variance Logistic regression analysis. Results: 217 patients were evaluable for this study; The morbidity of hyperphosphatemia, hypercalcinemia, hypocalcemia, reduced PTH and elevated PTH were 45.16%, 31.80%, 21.66%, 20.74% and 48.39% respectively. On X-rays, 154 patients (70.94% of the whole population) had evidence of vascular calcification, The proportion of patients meeting the criteria of CKD-MBD was as high as 96.31%. The percentage of patients who achieved the recommended standard levels of serum calcium, phosphorus, PTH were 45.16%、44.7% and 30.88% respectively. Only 20 patients achieved all the recommended standard levels of serum calcium, phosphorus, PTH, accounting for 9.22% of the whole population. The control rates of serum Ca and P were lower the results in DOPPS4.From the multi-variance Logistic regression analysis, The potential relative risk factors were as follows: elevated PTH: hyperphosphatemia and hypocalcemia; reduced PTH: advanced age and history of taking activated vitamin D; vascular calcification were as follows: advanced age, ALP, hyperphosphatemia and CRP. Conclusion: CKD-MBD is prevalent in MHD patients.The control rates of the CKD-MBD related targets were lower than the results in DOPPS4.

Key words: mineral and bone disorder, chronic kidney disease, calcium phosphorus metabolism, parathyroid hormone, vascular calcification