腹膜透析与血液透析患者矿物质和骨异常患病情况及其相关影响因素分析

发布时间：2018-04-18 07:26

本文选题：腹膜透析 + 血液透析　；参考：《宁夏医科大学》2016年硕士论文

【摘要】：目的:观察对比血液透析及腹膜透析患者钙磷控制达标情况及慢性肾脏病-矿物质和骨异常(Chronic Kidney Disease-Mineral and Bone Disorder,CKD-MBD)患病情况,分析影响达标的危险因素,为有效控制CKD-MBD寻求途径。方法:单中心横断面观察性研究。纳入2013年3月至2015年3月在宁夏医科大学总医院肾脏内科规律行透析治疗3月以上且病情稳定的患者共448例。其中持续非卧床腹膜透析(Continuous ambulatory peritoneal dialysis,CAPD)患者355例,维持性血液透析(maintenance hemodialysis,MHD)患者93例。收集患者一般资料、生化指标及评估指标。根据2003年KDOQI“关于慢性肾脏病骨代谢及其疾病的临床实践指南”制定的血钙、血清磷、i PTH达标率分析比较不同透析方式的患者CKD-MBD患病率、达标率及相关影响因素。结果:1、CAPD患者中,男性182例(51.5%),平均年龄(52.9±13.1)岁,中位透龄17.7(8.4,43.7)个月,主要原发病为慢性肾小球肾炎176例(49.6%),糖尿病肾脏疾病76例(21.4%),高血压性肾损害75例(21.1%)。其中37.2%服用磷结合剂,14.9%服用活性维生素D。MHD患者男性55例(59.1%),平均年龄(52.1±14.4)岁,中位透龄21.1(7.9,32.7)个月,主要原发病为慢性肾小球肾炎46例(49.5%),糖尿病肾脏疾病18例(19.3%),高血压性肾损害10例(10.8%)。其中47.7%服用磷结合剂,32.3%服用活性维生素D。2、CAPD组和MHD组患者的血钙达标率分别为65.6%、65.6%;血清磷达标率分别为50.4%和46.2%;i PTH标率分别为26.4%、24.7%;血钙、血清磷、i PTH三项全部达标分别为11.8%和6.5%,以上指标达标率两组无统计学差异。3、与发达国家的透析预后与实践模式(DOPPS4)达标率比较,MHD组血钙达标的比例(65.6%vs56%,p=0.06)、血清磷达标的比例(46.2%vs54.5%,p=0.11)、i PTH达标的比例(24.7%vs32.1%,p=0.13)。4、MHD组的低钙血症发生率明显高于CAPD组(17.2%vs2.8%,p0.01);MHD组的高磷血症发生率明显高于CAPD组(34.4%vs20.2%,p0.01);CAPD组和MHD组高i PTH及低i PTH发生率均无明显差异(25.8%vs32.3%,47.8%vs43.0%,p0.05)。5、多因素Logistic回归分析显示:(1)对于CAPD组患者,高龄、较长的透析龄是血钙未达标的独立危险因素;未规律服用磷结合剂、残余肾功能的降低是血清磷未达标的独立危险因素;高龄、较长的透析龄、高血磷是i PTH未达标的独立危险因素。(2)对于MHD组患者,高i PTH是血钙未达标的独立危险因素;高i PTH,未规律服用磷结合剂是血清磷未达标的独立危险因素;高血磷、低血红蛋白水平是i PTH未达标的独立危险因素。结论:本中心透析患者CKD-MBD的患病率较高,与国内外其他中心报道结果相当。腹膜透析与血液透析患者钙、磷、i PTH达标水平及CKD-MBD患病率无明显差异。其中血液透析患者,钙磷的达标率总体达到了DOPPS4的控制标准。提高血红蛋白水平、降低血清磷水平、保护残余肾功能、规范服用磷结合剂可能有助于钙磷代谢紊乱的纠正,但在治疗过程中也应注意切勿过度医疗。
[Abstract]:Objective: to observe and compare the standard of calcium and phosphorus control in hemodialysis and peritoneal dialysis and the prevalence of chronic Kidney Disease-Mineral and Bone disorder CKD-MBD in patients with chronic kidney disease, and to analyze the risk factors affecting the control of CKD-MBD, so as to find a way to control CKD-MBD effectively.Methods: single-center cross-sectional observation.From March 2013 to March 2015, a total of 448 patients with stable condition were treated with dialysis from March 2013 to March 2015 in the Department of Renal Medicine, General Hospital of Ningxia Medical University.Continuous ambulatory peritoneal dialysis was performed in 355 patients and maintenance hemodialysis in 93 patients.Collect general data of patients, biochemical indicators and evaluation indicators.According to the clinical practice guide on bone metabolism and disease of chronic kidney disease (KDOQI) in 2003, the serum calcium and serum phosphorous PTH were used to analyze and compare the prevalence of CKD-MBD, the rate of reaching the standard and the related influencing factors among the patients with different dialysis methods.Results there were 182 male patients with CAPD with mean age of 52.9 卤13.1years, median age of 17.7 卤8.4g / 43.7 months. The main primary diseases were chronic glomerulonephritis in 176 patients with chronic glomerulonephritis (n = 176), diabetic nephropathy in 76 patients with renal disease (n = 76) and hypertension in 75 patients with renal damage (n = 75).37.2% of them took active vitamin D 路MHD (59.2%). The average age was 52.1 卤14.4 years (mean age: 52.1 卤14.4) years. The median age was 21.17.932.7months. The main primary diseases were chronic glomerulonephritis (n = 46), diabetic nephropathy (n = 18), diabetic nephropathy (n = 18), and hypertensive renal damage (n = 10, n = 10).Of these, 47.7% of patients took active vitamin D 路2CAPD and 65.6% of patients took active vitamin D 路2CAPD and 65.6% of MHD, respectively, and the rate of reaching the standard of serum phosphorus was 50.4% and 46.2%, respectively. The standard rate of PTH was 26.4% and 24.7%, respectively.There was no statistical difference between the above two groups. There was no statistical difference between the two groups. Compared with the dialysis prognosis and practice mode in developed countries, the ratio of meeting the standard of serum calcium was 65.6 vs 6.5. the ratio of serum phosphorus reached the standard was 65.6 vs 0.06 in the group of dialysate prognosis and practice mode in the developed countries.The incidence of hypocalcemia in group B was significantly higher than that in group CAPD (17.2vs2.8p0.01MHD) than in group CAPD (34.4vs20.2p0.01). There was no significant difference in the incidence of high I PTH and low PTH between CAPD group and MHD group, 25.8vs32.37.8vs47.8vs43.0p0.05.5. the incidence of hyperphosphatemia was significantly higher than that of CAPD group (34.4vs20.2p0.01). There was no significant difference in the incidence of hyperi PTH and hypi PTH between CAPD group and MHD group (25.8vs32.37.8vs43.08 vs 43.05.05). There was no significant difference in the incidence of hyperphosphatemia between the CAPD group and the MHD group (25.8vs32.37.8vs43.08 vs 43.05.05).For CAPD patients,Old age, long dialysis age is the independent risk factor of blood calcium not meeting the standard; the decrease of residual renal function is the independent risk factor of serum phosphorus not up to standard; the elder, the longer dialysis age, the longer dialysis age, the lower residual renal function is the independent risk factor that serum phosphorus does not reach the standard.Hyperphosphorous is an independent risk factor for I PTH substandard.) for patients with MHD, high I PTH is an independent risk factor for substandard calcium, and irregular administration of phosphorus binder is an independent risk factor for serum phosphorus substandard.Low hemoglobin level was an independent risk factor for I PTH substandard.Conclusion: the prevalence of CKD-MBD in dialysis patients in our center is higher than that in other centers at home and abroad.There was no significant difference between peritoneal dialysis and hemodialysis patients in the level of calcium and phosphorous PTH and the prevalence of CKD-MBD.In hemodialysis patients, calcium and phosphorus reached the standard of DOPPS4.Raising the level of hemoglobin, lowering the level of serum phosphorus, protecting the residual renal function and taking phosphorus binder standard may help to correct the disorder of calcium and phosphorus metabolism, but we should also pay attention not to excessive medical treatment in the course of treatment.
【学位授予单位】：宁夏医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R692.5

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