中国血液净化

中国血液净化 ›› 2015, Vol. 14 ›› Issue (12): 725-727.doi: 10.3969/j.issn.1671-4091.2015.12.007

• 临床研究 • 上一篇    下一篇

老年透析患者矿物质骨代谢紊乱的临床特征

李玓嬗,陈海平,林俊,马清,马麟麟   

  1. 首都医科大学附属北京友谊医院肾内科
  • 收稿日期:2015-05-25 修回日期:2015-10-07 出版日期:2015-12-12 发布日期:2015-12-12
  • 通讯作者: 陈海平chp3@sina.com E-mail:chp3@sina.com

Clinical analysis of mineral and bone disease pattern in elderly hemodialysis patients

  • Received:2015-05-25 Revised:2015-10-07 Online:2015-12-12 Published:2015-12-12

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摘要： 目的研究老年透析患者矿物质骨代谢紊乱的临床特征。方法横断面研究：将符合入选标准维持性血液透析患者109 例根据年龄分为老年组46 例(年龄≥65 岁，中位数72 岁)及非老年组63 例(年龄＜65 岁，中位数50 岁)。记录一般资料，血白蛋白(ALB)、血钙(Ca)、磷(P)、全段甲状旁腺激素(iPTH)等实验室指标；评估尿素清除率(URR)及尿素清除指数(Kt/V)。比较2 组患者上述指标差异。结果老年患者导致ESRD 病因主要为肾小球肾炎、糖尿病肾病和高血压肾损害，非老年患者主要为肾小球肾炎，肾移植术后移植肾无功能及间质性肾损害。老年患者合并心血管疾病比例高于非老年患者(89.13% vs.46.03%；χ2=21.493，P=0.000)。老年组患者较非老年组患者血磷[(1.65±0.52)mmol/L vs.(2.03±0.65)mmol/L；t=3.270，P=0.001]、iPTH[135.00 pg/ml(49.40 pg/ml～279.50 pg/ml) vs. 246.30 pg/ml
(78.90 pg/ml～785.60 pg/ml);Z=-2.041,P =0.041]、碱性磷酸酶(74.50 U/L(60.75 U/L～74.50 U/L) vs. 91.00U/L(69.00 U/L～135.00 U/L);Z =- 2.7777,P =0.005)、血清白蛋白(37.23 ± 3.23)g/L vs.(38.93 ± 2.78)g/L;t=2.933,P =0.004) 及三酰甘油[(1.49 ± 0.79)mmol/L vs.(1.87 ± 0.92)mmol/L; t =2.260,P =0.026]水平低，但是血钙、血红蛋白及透析相关指标(干体质量、透析时间、URR、Kt/V)无统计学差异。老年组患者应用活性维生素D 的人群比例(39.13% vs. 68.25%; χ2=9.150,P = 0.002)以及应用维生素D 人群中处方剂量[0.50 μg/d(0.25 μg/d～0.50 μg/d) vs. 0.50 Mg/d(0.50 μg/d～1.00μg/d);Z =-3.544,P =0.000]均低于非老年组。结论老年透析患者血磷、钙磷乘积、全段甲状旁腺素和碱性磷酸酶水平低于非老年组患者，血钙水平无差异。

关键词: 维持性血液透析, 矿物质骨代谢紊乱, 老年

Abstract: Objective To analyze the clinical characteristics of mineral and bone disease pattern in elderly hemodialysis patients. Materials and Methods This cross-sectional study was based on clinical records of 109 maintenance hemodialysis patients. They were divided into two groups by age: elderly group (age >65,
median age =72 years, n=46) and non-elderly group (age <65, median age =50 years, n=63). Serum phosphorus, calcium, parathyroid hormone (PTH), albumin, and C- reactive protein were measured. Urea clearance rate (URR) and Kt/V were calculated. These parameters were compared between the two groups. Results Elderly patients exhibited lower serum phosphorus (1.65 + 0.52 mmol/L vs. 2.03 + 0.65 mmol/L; t=3.270, P= 0.001), serum alkaline phosphatase [74.50 (60.75～74.50) U/L vs. 91.00 (69.00～135.00) U/L; Z=-2.7777, P= 0.005] and parathyroid hormone [74.50(60.75～74.50) pg/ml vs. 91.00 (69.00～135.00) pg/ml; Z=-2.7777, P= 0.005) as compared with those in the non-elderly group. However, serum calcium, hemoglobin, URR, Kt/V, dry body weight and hemodialysis age were similar between the two groups. Elderly patients also had lower serum albumin (37.23±3.23 g/l vs. 38.93±2.78 g/l; t=2.933, P=0.004) and serum triglyceride (1.49±0.79 mmol/ L vs. 1.87 ± 0.92 mmol/l; t=2.260, P=0.026), and less a Cctive vitamin D derivatives usage (39.13% vs. 68.25%; χ2=9.150, P=0.002) and active vitamin D dosage [0.50 (0.25～0.50) μg/d vs. 0.50 (0.50～1.00) μg/d; Z = -3.544, P=0.000). Conclusions Serum phosphorus, iPTH and alkaline phosphatase levels were lower in elderly hemodialysis group than in non-elderly hemodialysis group. But serum calcium was similar between the two groups.

Key words: haemodialysis, mineral and bone disease, elder