慢性肾脏病不同分期代谢性酸中毒的相关因素分析

发布时间：2018-06-01 02:29

本文选题：慢性肾脏病 + 代谢性酸中毒　；参考：《大连医科大学》2017年硕士论文

【摘要】：目的:代谢性酸中毒是慢性肾脏病常见并发症,代谢性酸中毒对人体可产生多种危害。本研究旨在研究慢性肾脏病代谢性酸中毒的发生情况以及分析相关影响因素。方法:选取大连医科大学附属第二医院肾内科2016年1月-2016年9月新入院患者301例,辽宁肾人民医院肾内科2016年4月-2016年12月新入院患者567例。入选标准:确诊为慢性肾脏病。排除标准:1.年龄18岁。2.急性肾功能衰竭。3.行甲状旁腺素切除。4.明确诊断存在甲状腺功能异常。5.存在乳酸酸中毒或酮症酸中毒。6.存在原发性肾小管酸中毒。慢性肾脏病的定义和分期参考美国肾脏病基金会制定的KDOQI指南。估算肾小球滤过率(eGFR),应用CKD-EPF(2007)计算公式。本研究分析了同时具有血气分析碳酸氢根离子浓度和静脉血二氧化碳结合力资料190例,经线性相关分析结果显示碳酸氢盐浓度与二氧化碳结合力有很好的正相关性,二氧化碳结合力可以作为代谢性酸中毒的评估指标。因此,本研究将二氧化碳结合力22 mmol/L定义为代谢性酸中毒。依据二氧化碳结合力水平CO2-CP 22-30 mmol/L和CO2-CP22 mmol/L分为非代谢性酸中毒和代谢性酸中毒组。记录患者一般信息:性别、年龄、身高、体重、BMI、收缩压、舒张压、原发病的类型,是否合并高血压、糖尿病,是否服用钙离子拮抗剂、β受体阻滞剂、ACEI/ARB类药物,是否行肾脏替代疗法及肾脏替代疗法的类型。所有血液标本均为入院当天采集,血液透析患者为透析前采血,心电图检查为入院当天完成。化验检查指标:血肌酐、二氧化碳结合力、HCO3-浓度、血红蛋白、C反应蛋白、三碘甲状原氨酸(T3)、甲状腺素(T4)、促甲状腺素(TSH)、甲状旁腺素、总蛋白、白蛋白、球蛋白、白球比、尿素氮、胱抑素C、血尿酸、甘油三酯、总胆固醇、高密度脂蛋白、低密度脂蛋白、脂蛋白a、血钾、血钠、血氯、血钙、血磷、血镁。心电图检查:QT间期,QTc间期。所有数据经SPSS23.0统计软件进行分析。结果:1.一般资料:本研究一共入选868例患者,其中男性447例,女性421例,年龄(19~93)岁,平均年龄63.16±14.29岁。ckd1期47例,ckd2期64例,ckd3期83例,ckd4期88例,ckd5期非透析310例,血液透析患者84例,腹膜透析患者192例。原发病分类:原发性肾小球肾炎541例,2型糖尿病192例,高血压59例,间质性肾炎30例,多囊肾23例,痛风5例,系统红斑狼疮4例,泌尿系感染2例,anca相关性血管炎2例,肾囊肿2例,过敏性紫癜2例,其他一共6例。2.分析190例患者静脉血二氧化碳结合力与动脉血碳酸氢根离子浓度关系发现:二氧化碳结合力均值18.65±5.20mmol/l,碳酸氢根浓度均值19.35±5.31mmol/l,经独立样本t检验,差异无统计学意义(p0.05);两组计量资料经过直线关系分析,皮尔逊相关系数r=0.933(p0.001),提示二氧化碳结合力与碳酸氢盐浓度呈线性正相关,二氧化碳结合力可以作为衡量代谢性酸中的指标,因此本研究将二氧化碳结合力22mmol/l定义为代谢性酸中毒。3.本研究依据ckd分期分为ckd1-5组、血液透析组、腹膜透析组。7组之间二氧化碳结合力均值差异有统计学意义(p0.05)。经两两比较ckd1期患者二氧化碳结合力均值高于ckd4期、ckd5期及血液透析患者二氧化碳结合均值,差异有统计学意义(p0.05)。ckd2期、ckd3期、ckd4期、ckd5期二氧化碳结合力均值呈下降趋势,经两两比较co2-cp均值差异有统计学意义(p0.05)。行血液透析患者二氧化碳结合力均值低于行腹膜透析患者二氧化碳结合力均值(22.57±4.58vs25.28±4.41)mmol/l,差异有统计学意义。ckd早期和ckd晚期患者二氧化碳结合力水平差异有统计学意义。ckd早期与已行肾脏替代治疗的患者二氧化碳结合力水平差异没有统计学意义。4.比较慢性肾脏病不同分期代谢性酸中毒发生率情况。ckd1期患者代谢性酸中毒发生率低于ckd4期、ckd5期和血液透析患者的代谢性酸中毒发生率,经样本率比较x2检验,差异有统计学意义(p0.05)。ckd2~ckd5期代谢性酸中毒发病率升高,两两比较差异均有有统计学意义(p0.05)。血液透析患者发生代谢性酸中毒的概率高于行腹膜透析患者,差异有统计学意义(p0.05)。5.糖尿病组代谢性酸中毒发生率高于非糖尿病组(45.07%vs40.04%),差异有统计学意义(p0.05)。糖尿病患者二氧化碳结合力低于非糖尿病患者(22.07±2.19VS22.18±5.47)mmol/L,差别没有统计学意义。代谢性酸中毒患者高血压患病率高于非代谢性酸中毒患者(72.41%VS65.14%),差别有统计学意义(P0.05)。代谢性酸中毒组与非代谢性酸中毒组糖尿病的患病率比较(40.05%VS37.04%),差别无统计学意义(P0.05)。6.代谢性酸中毒组与非代谢性酸中毒组临床指标比较,代谢性酸中毒组血浆肌酐、尿素氮、胱抑素C、尿酸、钾离子、氯离子、磷酸根离子浓度及收缩压更高,血红蛋白、红细胞比容、T3、白蛋白、白球比、脂蛋白a、血浆钙离子浓度更低。以上临床因素在两组之间均值差别有统计学意义(P0.05)。7.分析CO2-CP水平与临床指标的关系,CO2-CP水平eGFR、Hb、Alb、A/G、脂蛋白a、血钙呈正相关,CO2-CP水平与收缩压、Scr、BUN、尿酸、氯离子浓度、磷酸根浓度呈负相关。8.多因素logistic回归分析显示肾小球滤过率下降(OR=2.38,P0.05)、氯离子浓度升高(OR=1.116,P0.05)是慢性肾脏病代谢性酸中毒的危险因素;脂蛋白a浓度升高(OR=0.998,P0.05)是慢性肾脏病代谢性酸中毒的保护因素。结论:1.代谢性酸中毒是慢性肾脏病常见并发症,慢性肾脏病早期甚至CKD1期即可发生代谢性酸中毒,预防和治疗代谢性酸中毒应从慢性肾脏病早期开始。2.慢性肾脏病合并代谢性酸中毒患者高血压患病率高于慢性肾脏病无代谢性酸中毒患者,代谢性酸中毒可能是慢性肾脏病患者血压升高或者血压难以控制的原因之一。3.随着慢性肾脏病的进展代谢性酸中毒的发生率呈逐渐升高趋势,肾小球滤过率下降、血氯浓度升高是慢性肾脏病代谢性酸中毒的危险因素,脂蛋白a浓度升高是慢性肾脏病代谢性酸中毒的保护因素。
[Abstract]:Objective: metabolic acidosis is a common complication of chronic renal disease. Metabolic acidosis can produce a variety of hazards to the human body. The purpose of this study was to study the occurrence of metabolic acidosis in chronic kidney disease and analyze the related factors. Methods: the nephrology department of the Second Affiliated Hospital of Dalian Medical University was selected in the new hospital in September -2016 January 2016. 301 patients, Liaoning renal people's Hospital, Renmin Hospital of Nephrology, 567 new hospitalized patients in December -2016 April 2016. The criteria were diagnosed as chronic renal disease. 1. age 18 years old.2. acute renal failure.3. parathyroidectomy.4. clearly diagnosed the existence of thyroid dysfunction.5. presence of lactic acidosis or ketoacidosis.6. presence Primary renal tubular acidosis. The definition and staging of chronic kidney disease refer to the KDOQI guidelines established by the American kidney disease foundation. Estimate the glomerular filtration rate (eGFR) and use the CKD-EPF (2007) formula. This study analyzed 190 cases of simultaneous blood gas analysis of bicarbonate ion concentration and venous blood carbon dioxide binding force, and the meridional phase The results show that the concentration of bicarbonate has a good positive correlation with the binding force of carbon dioxide, and carbon dioxide binding force can be used as an indicator of metabolic acidosis. Therefore, the carbon dioxide binding force 22 mmol/L is defined as metabolic acidosis. According to the level of carbon dioxide binding force CO2-CP 22-30 mmol/L and CO2-CP22 MMO L/L is divided into a group of non metabolic acidosis and metabolic acidosis. The general information of patients: sex, age, height, weight, BMI, systolic pressure, diastolic pressure, type of primary disease, whether with hypertension, diabetes, calcium antagonists, beta blockers, ACEI/ARB drugs, renal replacement therapy and renal replacement therapy All blood samples were collected on the day of admission, hemodialysis patients were collected before dialysis and electrocardiogram was completed on the day of admission. Blood creatinine, carbon dioxide binding force, HCO3- concentration, hemoglobin, C reactive protein, three iodarine protryptine (T3), thyroxine (T4), thyrotropin (TSH), parathyroid hormone, Total protein, albumin, globulin, white ball ratio, urea nitrogen, Cystatin C, blood uric acid, triglyceride, total cholesterol, high density lipoprotein, low density lipoprotein, lipoprotein a, blood potassium, blood sodium, blood chlorine, blood calcium, blood phosphorus, blood magnesium. Electrocardiogram examination: QT interval, QTc interval. All data were analyzed by SPSS23.0 software. Results: 1. general data: the general data: our research A total of 868 patients were selected, including 447 males, 421 females, age (19~93) years, 47 cases with average age of 63.16 + 14.29 years, 64 cases in ckd2 stage, 83 cases in ckd3 stage, 88 in ckd4 stage, 310 in ckd5 phase, 84 in hemodialysis patients and 192 in peritoneal dialysis. 59 cases of blood pressure, 30 cases of interstitial nephritis, 23 cases of polycystic kidney, 5 cases of gout, 4 cases of systemic lupus erythematosus, 2 cases of urinary tract infection, 2 cases of ANCA related vasculitis, 2 cases of renal cyst, 2 cases of renal cysts, 2 cases of anaphylactoid purpura, and 6 cases of.2. analysis in the other 6 cases: the relationship between carbon dioxide binding force of venous blood and the concentration of bicarbonate ion in blood vessel blood found: carbon dioxide binding The mean value of the force was 18.65 + 5.20mmol/l and the mean concentration of bicarbonate was 19.35 + 5.31mmol/l. The difference was not statistically significant (P0.05) by the independent sample t test. The two groups of measurement data were analyzed in a linear relationship and the Pearson correlation coefficient r=0.933 (p0.001), suggesting that the carbon dioxide binding force was linearly correlated with the concentration of bicarbonate, and the carbon dioxide binding force could be found. As a measure of metabolic acid, this study defined carbon dioxide binding force 22mmol/l as metabolic acidosis.3.. This study was divided into ckd1-5 group according to CKD staging. The mean difference of carbon dioxide binding force among the.7 groups in the hemodialysis group and the peritoneal dialysis group was statistically significant (P0.05). The carbon dioxide junction of the ckd1 patients was compared by 22. The mean value of the combined force was higher than that of the ckd4 stage. The mean value of carbon dioxide binding in ckd5 and hemodialysis patients was statistically significant (P0.05).Ckd2, ckd3, ckd4, and the mean value of carbon dioxide binding force in ckd5 phase decreased, and the difference of co2-cp mean value was statistically significant (P0.05) after 22. The mean of carbon dioxide binding force in hemodialysis patients was lower than that in hemodialysis patients. The mean (22.57 + 4.58vs25.28 + 4.41) mmol/l of carbon dioxide binding force in patients undergoing peritoneal dialysis (22.57 + 4.41), there was significant difference in the level of carbon dioxide binding force between early.Ckd and CKD advanced patients, and there was no statistically significant difference in the level of carbon dioxide binding force between the early.Ckd and the patients who had been treated with renal replacement therapy (.4.). The incidence of metabolic acidosis in different stages of kidney disease in.Ckd1 patients was lower than that in ckd4 stage, and the incidence of metabolic acidosis in ckd5 and hemodialysis patients was compared with x2 test. The difference was statistically significant (P0.05), the incidence of metabolic acidosis in.Ckd2~ckd5 phase increased, and there were 22 different differences in the incidence of metabolic acidosis. There was statistical significance (P0.05). The probability of metabolic acidosis in hemodialysis patients was higher than that in peritoneal dialysis patients. The difference was statistically significant (P0.05) the incidence of metabolic acidosis in.5. diabetic group was higher than that of non diabetic group (45.07%vs40.04%), and the difference was statistically significant (P0.05). Patients (22.07 + 2.19VS22.18 + 5.47) mmol/L, the difference was not statistically significant. The prevalence of hypertension in patients with metabolic acidosis was higher than that of non metabolic acidosis (72.41%VS65.14%), and the difference was statistically significant (P0.05). The prevalence rate of diabetes in the metabolic acidosis group and the non metabolic acidosis group was compared (40.05%VS37.04%). Study significance (P0.05).6. metabolic acidosis group and non metabolic acidosis group clinical indicators, metabolic acidosis group plasma creatinine, urea nitrogen, Cystatin C, uric acid, potassium ion, chloride ion, the concentration of phosphate ion and systolic pressure higher, hemoglobin, erythrocyte specific volume, T3, albumin, white ball ratio, lipoprotein a, plasma calcium concentration more The mean difference between the two groups was statistically significant (P0.05).7. analysis of the relationship between the level of CO2-CP and the clinical indicators, CO2-CP level eGFR, Hb, Alb, A/G, lipoprotein a, positive correlation of blood calcium, CO2-CP level and systolic pressure, Scr, BUN, uric acid, chloride concentration and negative correlation of phosphate concentration The decrease of glomerular filtration rate (OR=2.38, P0.05), the increase of chloride concentration (OR=1.116, P0.05) is a risk factor for the metabolic acidosis of chronic kidney disease; the increase of lipoprotein a (OR=0.998, P0.05) is a protective factor for the metabolic acidosis of chronic kidney disease. Conclusion: 1. metabolic acidosis is a common complication of chronic kidney disease and chronic kidney disease early Metabolic acidosis can occur during the period of CKD1, and the prevention and treatment of metabolic acidosis should start from the early stage of chronic kidney disease with.2. chronic kidney disease and metabolic acidosis, the prevalence of hypertension is higher than that of chronic renal disease without metabolic acidosis. Metabolic acidosis can be the blood pressure rise or blood of patients with chronic kidney disease. One of the reasons why the pressure is difficult to control.3. is gradually increasing with the progression of chronic renal disease. The rate of glomerular filtration is decreasing and the increase of blood chloride concentration is a risk factor for the metabolic acidosis of chronic kidney disease. The increase of lipoprotein a is the protective factor for the metabolic acidosis of chronic kidney disease.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R692

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