维持性血液透析患者冠状动脉钙化危险因素分析及硫代硫酸钠的干预作用

发布时间：2018-01-10 07:31

本文关键词：维持性血液透析患者冠状动脉钙化危险因素分析及硫代硫酸钠的干预作用　出处：《福建医科大学》2015年硕士论文　论文类型：学位论文

【摘要】：目的:分析维持性血液透析(Maintenance hemodialysis,MHD)患者冠状动脉钙化(Coronary artery calcification,CAC)及其与相应临床指标的关系,探讨影响CAC的相关危险因素。进一步观察硫代硫酸钠(Sodium Thiosulfate,STS)对冠状动脉钙化进展的干预作用及其安全性。方法:通过菲利普256层螺旋CT对38例MHD患者胸部进行平扫,行CAC评分。依据CAC评分结果分为冠状动脉钙化组(CAC积分10分)和无钙化组,透析前抽血检测血钙、血磷、甲状旁腺激素、C反应蛋白、血清白蛋白、血脂及血红蛋白等指标,并计算钙磷乘积。比较两组年龄、透析时间、血压和血清学指标的差异。另外将CAC积分大于50分的患者随机分为两组,一组患者(n=10)常规治疗3个月,另一组患者(n=17,15例患者完成STS治疗)在血液透析结束后接受STS(0.18g/kg体重,溶于100ml生理盐水)静脉滴注治疗,滴注时间30分钟,每周3次,为期3个月。STS治疗前患者行肝肾功能、电解质、血脂、血常规、甲状旁腺激素、C反应蛋白、25羟维生素D、骨源性碱性磷酸酶、成纤维细胞生长因子23及骨密度等相关检查,治疗结束后再次复查上述指标。分析影响血管钙化的相关因素,比较两组血管钙化患者治疗前后影像学、生化及骨密度等相关指标的改变情况,以及观察STS治疗过程中出现的不良反应。结果:1.38例MHD患者中有27例(71.05%)患者冠状动脉发生钙化,冠状动脉钙化组的年龄、透析时间、血磷、钙磷乘积、甲状旁腺激素和C反应蛋白水平显著高于无钙化组(p=0.017,0.037,0.038,0.037,0.013,0.006);而白蛋白水平前者低于后者(p=0.026)。其它指标差异均无统计学意义。2.在治疗前两组相关指标基线值基本一致的情况下,STS治疗组CAC积分治疗前后无明显差异(p=0.053),而常规治疗组CAC积分显著增加(p=0.021)。两组治疗前后CAC积分差值有显著差异(p=0.004)。STS治疗后C反应蛋白水平降低(p=0.016),HCO3-水平降低(p=0.020),血钙水平升高(p=0.005)。其它指标如甲状旁腺激素、25羟维生素D、骨源性碱性磷酸酶、成纤维细胞生长因子23在STS治疗组治疗前后均无明显变化(p0.05)。3.硫代硫酸钠不良反应:恶心、呕吐3例,乏力1例,口渴2例、打喷嚏1例,骨密度降低5例。常规治疗组骨密度下降发生1例,而两组间骨密度下降例数做卡方检验,χ2=1.791,P=0.345,无统计学差异。结论:1.维持性血液透析患者普遍存在冠状动脉钙化,其发生主要与年龄、透析时间、钙磷代谢异常、炎症反应、营养不良等因素有关。2.硫代硫酸钠治疗可能延缓冠状动脉钙化进展,抑制炎症反应,治疗过程中无严重不良反应发生,但对骨密度的影响还需进一步研究。
[Abstract]:Objective: to analyze maintenance maintenance hemodialysis. The relationship between coronary artery calcification and clinical indexes in patients with MHD. To investigate the risk factors affecting CAC and to observe sodium Thiosulfate. Methods: the chest of 38 patients with MHD were examined by Philip 256-slice spiral CT. According to the CAC score, the patients were divided into coronary artery calcification group (10 points) and no calcification group. Blood calcium, serum phosphorus and parathyroid hormone C reactive protein were measured before dialysis. Serum albumin, serum lipids and hemoglobin were calculated and calcium and phosphorus products were calculated. Age and dialysis time were compared between the two groups. The difference of blood pressure and serological indexes. Patients with CAC score greater than 50 were randomly divided into two groups: one group (n = 10) was treated with routine therapy for 3 months and the other group (n = 17). After hemodialysis, 15 patients received STS(0.18g/kg body weight, dissolved in 100ml of normal saline) and received intravenous drip for 30 minutes. Patients were given liver and kidney function, electrolyte, blood lipid, blood routine, parathyroid hormone C-reactive protein 25 hydroxyvitamin D and osteogenic alkaline phosphatase before treatment for 3 months. Fibroblast growth factor 23 (FGF23) and bone mineral density (BMD) were examined again after treatment. The factors affecting vascular calcification were analyzed and compared between the two groups before and after treatment. Changes of biochemical and bone mineral density. Results 27 out of 1.38 patients with MHD had coronary artery calcification and the age of coronary artery calcification group was 71.05%. Dialysis time, serum phosphorus, calcium and phosphorus product, parathyroid hormone and C-reactive protein levels were significantly higher than those in non-calcified group. 0.006; The albumin level in the former group was lower than that in the latter group (0.026%). There was no significant difference in other indexes. 2. Under the condition that the baseline values of the two groups were basically the same before treatment. There was no significant difference in CAC score before and after treatment in STS group. However, the CAC score in the routine treatment group increased significantly (P < 0.05). The difference of CAC score between the two groups before and after treatment was significantly different (P < 0.05). The level of C-reactive protein decreased (P < 0.05). P0. 016). The level of HCO3- was decreased by 0.020%, and the level of serum calcium was increased (P 0.005). Other indexes such as parathyroid hormone 25 hydroxyvitamin D and osteogenic alkaline phosphatase were found. There was no significant change of fibroblast growth factor 23 in STS group before and after treatment. Adverse reactions of sodium thiosulfate were nausea and vomiting in 3 cases, fatigue in 1 case and thirst in 2 cases. 1 case sneezed and 5 cases decreased BMD. In routine treatment group, BMD decreased in 1 case, but the number of BMD decrease between two groups was chi-square test, 蠂 ~ 2 ~ (2) ~ (1) 791U ~ (-1) P ~ (-1) P ~ (-1) P ~ (0.345). There is no statistical difference. Conclusion 1. Coronary artery calcification is common in maintenance hemodialysis patients, which is mainly associated with age, dialysis time, abnormal calcium and phosphorus metabolism, inflammatory reaction. 2. Sodium thiosulfate treatment may delay the progress of coronary artery calcification and inhibit inflammatory reaction. There is no serious adverse reaction in the course of treatment, but the effect of sodium thiosulfate on bone mineral density needs further study.
【学位授予单位】：福建医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R459.5

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