血液透析患者矿物质和骨代谢紊乱控制情况的单中心研究

山东大学学报(医学版) ›› 2012, Vol. 50 ›› Issue (8): 116-119.

血液透析患者矿物质和骨代谢紊乱控制情况的单中心研究

孔祥雷，宝群，魏勇，贾晓妍，陈萍，唐利军，王尊松，李文斌，崔美玉，许冬梅

山东大学附属千佛山医院肾内科, 济南 250014

收稿日期:2012-04-01 出版日期:2012-08-10 发布日期:2012-08-10
通讯作者: 许冬梅(1963- )，女，主任医师，硕士生导师，主要从事慢性肾脏病患者心血管疾病发病机制研究。 E-mail:xudongmei63@163.com
作者简介:孔祥雷(1985- )，男，住院医师，硕士研究生，主要从事血液透析患者血管钙化发病机制研究

Mineral and bone disorders in hemodialysis patients：
a single center study

KONG Xiang-lei, BAO Qun, WEI Yong, JIA Xiao-yan, CHEN Ping, TANG Li-jun,
WANG Zun-song, LI Wen-bin, CUI Meiyu, XU Dong-mei

Department of Nephrology, Qianfoshan Hospital Affiliated to Shandong University, Jinan 250014， China

Received:2012-04-01 Online:2012-08-10 Published:2012-08-10

摘要/Abstract

摘要：

目的探讨血液透析患者矿物质和骨代谢紊乱的控制情况。方法从本院透析中心选取规律血液透析的患者共91例进行横断面研究，收集其临床资料、用药情况，检测矿物质代谢的指标。根据2003年美国肾脏病生存质量指导指南建议，与透析预后及实践模式(DOPPS 4)研究作比较，分析血液透析患者矿物质代谢紊乱的控制情况及相关因素。结果血透患者血钙、血磷、甲状旁腺激素(iPTH)的达标率分别为58.2%、49.5%和34.1%，与DOPPS4的研究结果(血钙、血磷及iPTH的达标率分别为56.0%、54.5%和32.1%)比较差异无统计学意义(P＞0.05)。Logistic回归分析显示，年龄(优势比OR值:0.96,95% CI：0.94~0.99)和血清前白蛋白(优势比OR值:1.01,95% CI：1.0~1.02)与高磷血症独立相关。结论血液透析患者的矿物质代谢紊乱控制情况与发达国家相似，但高磷血症的问题更加突出，应引起进一步重视。

关键词: 终末期肾脏病；矿物质；骨疾病，代谢性；流行病学；血液透析

Abstract:

Objective To explore the spectrum of mineral and bone disorders among hemodialysis patients. Methods Ninety-one maintenance hemodialysis patients from our dialysis center were included in the study. Markers of mineral and bone disorders, including plasma phosphorus (P), calcium (Ca) and intact parathyroid hormone (iPTH) were measured among ninety-one patients receiving hemodialysis. The controlling rates of those markers were compared with the results in the Dialysis Outcomes and Practice Study (DOPPS) 4 study. Factors associated with hyperphosphatemia were examined. Results According to the Kidney Disease Outcomes Quality Initiative target for plasma P, Ca and iPTH levels, the percentages of patients with controlled Ca (58.2% vs 56.0%), P (49.5% vs 54.5%) and iPTH (34.1% vs 32.1%) were not statistically different compared with those in the DOPPS 4 study. The percentage of hemodialysis patients with serum phosphorus level above 5.5mg/dL was 42.9%. Age (odd ratio 0.96, 95% confidence interval: 0.94-0.99) and pre-albumin (odd ratio 1.01, 95% confidence interval: 1.0-1.02) were independently associated with hyperphosphatemia. Conclusion Status of mineral and bone disorders is relatively optimal among our hemodialysis patients compared with those in the DOPPS 4 study. Hyperphosphatemia is prominent and needs further attention.

Key words: End stage renal disease; Mineral; Bone diseases, metabolic; Epidemiology； Hemodialysis

中图分类号:

R692.5

孔祥雷，宝群，魏勇，贾晓妍，陈萍，唐利军，王尊松，李文斌，崔美玉，许冬梅. 血液透析患者矿物质和骨代谢紊乱控制情况的单中心研究[J]. 山东大学学报(医学版), 2012, 50(8): 116-119.

KONG Xiang-lei, BAO Qun, WEI Yong, JIA Xiao-yan, CHEN Ping, TANG Li-jun, WANG Zun-song, LI Wen-bin, CUI Meiyu, XU Dong-mei. Mineral and bone disorders in hemodialysis patients：
a single center study[J]. JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES), 2012, 50(8): 116-119.

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