中国血液净化

中国血液净化 ›› 2015, Vol. 14 ›› Issue (08): 478-481.doi: 10.3969/j.issn.1671-4091.2015.08.009

• 临床研究 • 上一篇    下一篇

血液透析患者钙磷代谢紊乱现状及影响因素分析

朱金荣,张枫,张晓宇,苏春燕   

  1. 北京大学第三医院肾内科
  • 收稿日期:2015-03-06 修回日期:2015-05-13 出版日期:2015-08-12 发布日期:2015-08-12
  • 通讯作者: 苏春燕 scybmu@126.com E-mail:scybmu@126.com
  • 基金资助:

    院种子基金资助，基金编号76441-1

The present status and the related factors of abnormal calcium- phosphorous metabolism in maintenance hemodialysis patients

  • Received:2015-03-06 Revised:2015-05-13 Online:2015-08-12 Published:2015-08-12

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摘要： 【摘要】目的调查血液透析患者(MHD)钙磷代谢紊乱的现状及影响因素。方法对北京大学第三医院肾内科维持性血液透析中心2013 年6～7 月127 名MHD 患者的化验结果、用药情况、以及钙磷代谢相关知识进行调查，并对结果进行分析。结果在这127 名患者中，血磷的达标率33.1%，高磷血症患病率明显高于DOPPS4 的数据；血钙达标率43.3%，低钙血症患病率(20.5%)高于DOPPS4 的数据；iPTH 达标率和DOPPS4 相当，但是低iPTH 患病率(47.2%)高，高iPTH 患病率(18.1%) 低。只有6 例患者(4.7%)3 项指标都达标。本组MHD 患者钙磷代谢相关知识得分普遍较低，总得分为37.19±17.00 分。73 例患者(57.5%)有进食不健康高磷饮食的习惯，只有21 例患者(16.5%)的患者认为自己能够完全听从医务人员的建议来合理选择食物，23 例(19.1%)患者不知道如何正确服用磷结合剂，79 例(62.2%)表示自己会忘了在餐中服用磷结合剂。Logistic 回归结果显示透析前尿素水平、透析龄、年龄和BMI 是高磷血症的影响因素。结论维持性血液透析患者钙磷代谢紊乱的发生率较高，原因可能是多方面的，应该从透析、药物、饮食3 方面来进行综合干预。

关键词: 血液透析, 钙磷代谢, 横断面研究

Abstract: 【Abstract】Objective To investigate the current situation and the related factors of abnormal calciumphosphorous metabolism in maintenance hemodialysis (MHD) patients. Methods A total of 127 MHD patients in our hemodialysis center during the period of June to July 2013 were included in this study. Their demographic data and knowledge about calcium-phosphate metabolism were investigated by questionnaire. Laboratory examination results of the patients were collected from the hospital information system. Results In the 127 patients, the rate of serum phosphate in the target range was 33.1%, much lower than that of DOPPS4; the rate of serum calcium in the target range was 43.3%; the prevalence of hypocalcemia was 20.5%, higher than that of DOPPS4. The rate of iPTH in the target range was nearly the same as that of DOPPS4, but with higher rate of reduced iPTH (47.2%) and lower rate of elevated iPTH (18.1%) compared to those of DOPPS4. Only 6 patients(4.7%)reached the three target ranges of serum phosphate, calcium and iPTH. The score of calciumphosphorous metabolism knowledge was relatively low in these patients (37.19 ± 17.00). Seventythree patients (57.5%) had a habit of eating high phosphorus food; only 21 patients (16.5%) followed the suggestions from medical staffs to have appropriate food. Twenty-three patients (19.1%) took phosphate binder improperly, and 79 patients (62.2%) said that they sometimes forgot taking phosphate binders. Logistic regression analyses demonstrated that the influencing factors of hyperphosphatemia were predialysis serum BUN, dialysis duration, age, and body mass index (BMI). Conclusion The prevalence of abnormal calciumphos-phorous metabolism was high in MHD patients. Many factors may influence this abnormality. Comprehensive interventions involving dialysis, drugs and diet management need to be implemented for MHD patients with abnormal calcium-phosphorous metabolism.