四川地区维持性血液透析人群慢性肾脏病矿物质与骨异常的多中心横断面研究

发布时间：2018-04-20 04:25

本文选题：维持性血液透析 + 矿物质和骨代谢异常　；参考：《肾脏病与透析肾移植杂志》2017年05期

【摘要】：目的:了解四川地区维持性血液透析(MHD)患者慢性肾脏病矿物质与骨异常(CKD-MBD)的患病率、各个指标达标率及其发病危险因素。方法:纳入四川地区15个血液透析中心MHD患者1 150例,搜集患者一般临床资料及实验室检查结果,以超声心动图、骨盆正位片、腹部侧位片评价血管钙化。检测血清25羟维生素D[25(OH)D]、25(OH)D3、成纤维细胞生长因子23(FGF-23)和血清可溶性klotho蛋白(s KL)。以K/DOQI指南建议的目标值为标准,分析CKD-MBD患病率、各项指标达标情况及相关危险因素。结果:1 150例MHD中诊断为CKD-MBD的患者1 113例(96.78%)。其中低血磷7.80%、高血磷55.90%;低血钙31.40%、高血钙28.30%、低甲状旁腺激素(PTH)17.20%、高PTH 58.30%;心脏瓣膜钙化的患者169例(30.02%);腹主动脉钙化患者168例(45.41%);髂股动脉钙化106例(27.46%)。患者血钙、血磷、血i PTH达标率分别为36.78%、36.30%、24.50%。收缩压、血清肌酐、血尿素氮、高密度脂蛋白、血i PTH与高磷血症独立相关。透析龄、血i PTH、血清FGF-23与高血钙独立相关。血磷、白蛋白、碱性磷酸酶(ALP)与高血i PTH独立相关。结论:四川地区的MHD患者的CKDMBD的患病率高,达标率低,受多种因素影响。
[Abstract]:Objective: to investigate the prevalence of mineral and bone abnormality CKD-MBD in patients with maintenance hemodialysis (MHD) in Sichuan area. Methods: 1 150 patients with MHD in 15 hemodialysis centers in Sichuan were included. The clinical data and laboratory results were collected. Vascular calcification was evaluated by echocardiography, pelvic positive film and lateral abdominal radiography. Serum 25 hydroxyvitamin D [25(OH)D], fibroblast growth factor 23FGF-23 and serum soluble klotho protein were detected. Using the target value recommended by the K/DOQI guidelines as the standard, the prevalence rate of CKD-MBD, the achievement of each index and the related risk factors were analyzed. Results among 1 150 MHD patients, 1 113 were diagnosed as CKD-MBD. Low blood phosphorus 7.80, high blood phosphorus 55.90; low blood calcium 31.40; high blood calcium 28.30; low parathyroid hormone PTH 17.20; high PTH 58.30; cardiac valve calcification 169 cases; abdominal aortic calcification 168 cases 45.411; femoral artery calcification 106 cases 27.46B. The blood calcium, phosphorus and I PTH reached the standard rate of 36.780.The blood calcium, phosphorus and I PTH reached the standard rate of 36.780.The blood calcium, phosphorus and I PTH reached the standard rate of 24.50%, respectively. Systolic blood pressure, serum creatinine, blood urea nitrogen, high density lipoprotein and serum I PTH were independently associated with hyperphosphatemia. Serum I PTH and serum FGF-23 were independently correlated with hypercalcemia at dialysis age. Serum phosphorus, albumin and alkaline phosphatase (ALP) were independently correlated with high blood I PTH. Conclusion: the prevalence of CKDMBD in MHD patients in Sichuan area is high and the rate of reaching the standard is low, which is affected by many factors.
【作者单位】：四川省医学科学院四川省人民医院肾脏科;广汉市第二人民医院;简阳市人民医院;攀钢集团总医院;绵阳四○四医院;自贡市第四人民医院;仁寿县人民医院;凉山州第二人民医院;内江市第二人民医院;雅安市人民医院;凉山州德昌县人民医院;武警四川省总队医院;成都市第二人民医院;成都市第三人民医院;南充市中心医院;
【基金】：四川省科技厅课题(2011FZ0138)
【分类号】：R692

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