透析患者微炎症状态与血脂代谢及钙磷代谢的相关性研究

发布时间：2018-04-24 21:26

本文选题：钙磷代谢 + 血脂代谢　；参考：《昆明医科大学》2017年硕士论文

【摘要】：[目的]近年来,随着慢性肾脏病(chronic kidney disease,CKD)发病率的增高,终末期肾脏病(end stage renal disease,ESRD)发病率也逐年升高,尽管血液透析、腹膜透析及肾移植延长了 ESRD患者生存时间,但透析患者死亡率仍明显升高[1]。ESRD患者常常出现多种并发症,如水、酸碱平衡紊乱,钙磷代谢紊乱,血脂代谢异常,心血管疾病等。已有多项研究证实ESRD患者的高磷血症和严重继发性甲状旁腺亢进,可以引起心血管系统并发症,如冠状动脉、心脏瓣膜及大动脉发生钙化,且病死率增高[2][3]。而心脑血管疾病是透析患者主要的死亡原因。目前微炎症状态已成为CKD研究领域的热点之一,有研究指出,炎症指标是维持性血液透析(maintenance hemodialysis,MHD)患者心血管疾病及死亡的预测因素之一[4]。也有研究指出,持续性非卧床腹膜透析(continous ambulatory peritoneal dilaysis,CAPD)患者也存在微炎症状态,这种微炎症反应一方面会逐渐使腹膜纤维化,腹膜超滤功能衰竭,另一方面会增加心血管事件的风险[5]。由此可见MHD和CAPD患者的微炎症状态可能是影响透析患者心血管事情的危险因素之一,这是国内外临床研究者的共识。但对于ESRD透析患者微炎症状态与血脂及钙磷代谢异常有无相关性,目前尚无明确定论。有研究显示:CAPD患者微炎症因子水平与肌酐、血钙、血磷、胆固醇水平无关[6]。也有研究表明MHD患者血(high sensitive C reactive protein,hs-CRP)与总胆固醇、甘油三脂、低密度蛋白胆固醇间呈明显正相关,与高密度蛋白胆固醇及钙磷代谢间无明显相关性[7]。本研究通过分析透析患者微炎症状态与脂代谢及钙、磷代谢的相关性,为透析患者减少并发症、延长生命、减少医疗费用寻找有效的方法和途径,并为今后进一步的研究透析患者微炎症反应发生机制提供理论依据。[方法]1.病例资料选取选取昆明医科大学第一附属医院及第二附属医院2015年6月-2016 年 6 月 CAPD 患者 31 例为腹膜透析(peritoneal dilaysis,PD)组:PD 组,男16例,女15例。选取同时期昆明医科大学第一附属医院MHD患者31例为血液透析(hemodialysis,HD)组:HD组,男15例,女16例。另选18名健康志愿者为对照组,男10例,女8例。2.透析方式(1)血液透析血液透析患者使用日本威高透析机,聚砜膜透析器以无糖透析液行碳酸氢盐透析,透析膜面积1.3～1.7m2,抗凝剂使用普通肝素或低分子肝素,血流量为200～250 m L/min,透析流量为500 m L/min,钾离子、钙离子浓度分别为2.0 mmol/1L和1.5mmol/L。透析2～3次/周,3～4h/次,脱水1.5～3.5kg。(2)腹膜透析即给予1.5%或2.5%浓度的乳酸盐透析液,溶液量为2000 ml/次,每天进行腹膜透析时,要在透析过程中至少更换4次腹透液,实行24 h不间断透析。3.临床血标本收集用化学发光免疫分析法检测hs-CRP、血甲状旁腺素。全自动生化分析仪检测血肌酐、尿素氮,总胆固醇、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、甘油三酯、血钙、血磷等。4.统计方法用统计方法分析各个观察指标,P0.05为差异有统计学意义。[结果]1.HD组患者血钙的达标率为45.2%,PD组患者血钙达标率为16.1%,HD患者血钙达标率高于PD组患者,差异有统计学意义(P0.05);而PD组患者血磷达标率(45.2%)、甲状旁腺素达标率(51.6%)高于HD组患者血磷达标率(32.3%)、甲状旁腺素达标率(32.3%),但差异无统计学意义(P0.05)。2.HD组患者总胆固醇达标率(96.8%)、低密度脂蛋白胆固醇达标率(93.5%)、甘油三酯达标率(80.6%)高于PD组患者总胆固醇达标率(90.3%)、低密度脂蛋白胆固醇达标率(90.3%)、甘油三酯达标率(71.0%);高密度脂蛋白胆固醇达标率(38.7%)低于PD组患者高密度脂蛋白胆固醇达标率(54.8%),但差异均无统计学意义(P0.05)。3.与正常对照组相比,HD组患者及PD组患者的血hs-CRP升高,差异有统计学意义(P0.05),但HD组患者与PD组患者的血hs-CRP相比,差异无统计学意义(P0.05)。4.HD组患者总胆固醇、血钙、血磷、血甲状旁腺激素及钙磷乘积较正常对照组升高,高密度脂蛋白胆固醇较正常组下降,差异均有统计学意义(P0.05);而甘油三脂及低密度脂蛋白胆固醇与正常对照相比较差异无明显统计学意义(P0.05)。5.PD组患者总胆固醇、血磷、血甲状旁腺激素及钙磷乘积较正常对照组升高,血钙较正常对照组下降,差异均有统计学意义(P0.05);高密度脂蛋白胆固醇、甘油三脂及低密度脂蛋白胆固醇与正常对照相比差异无明显统计学意义(P0.05)。6.HD组患者与PD组患者的总胆固醇、甘油三酯、低密度脂蛋白、高密度脂蛋白、血钙、血磷、钙磷乘积、甲状旁腺激素差异无明显统计学意义(P0.05)。7.PD组患者甘油三脂与hs-CRP具有正相关性(r=0.36,P0.05),其余血脂及钙磷代谢指标与hs-CRP均无明显相关性(P0.05);HD组患者血脂代谢及钙磷代谢指标与hs-CRP均无明显相关性(P0.05)。[结论]长期透析患者存在微炎症状态,同时伴有血脂代谢紊乱及钙磷代谢异常,但微炎症反应与透析患者血脂及钙磷代谢没有显著相关性。
[Abstract]:[Objective] in recent years, with the increase of the incidence of chronic renal disease (chronic kidney disease, CKD), the incidence of end-stage renal disease (end stage renal disease, ESRD) is also increasing year by year. Although hemodialysis, peritoneal dialysis and renal transplantation extend the survival time of ESRD patients, the mortality rate of dialysis patients is still significantly higher than that of [1].ESRD patients. There are many complications, such as water, acid-base balance disorder, disorder of calcium and phosphorus metabolism, abnormal metabolism of blood lipid, cardiovascular disease, and so on. Many studies have confirmed that hyperphosphoremia and severe secondary hyperparathyroidism in ESRD patients can cause cardiovascular system complications, such as coronary artery, heart valve and large artery calcification, and the fatality rate increases [2] [3]. and cardiovascular and cerebrovascular diseases are the main causes of death in dialysis patients. Microinflammation has become one of the hotspots in the field of CKD research. Studies have shown that the inflammatory index is one of the predictors of cardiovascular disease and death in patients with maintenance hemodialysis (MHD), and [4]. has also been studied. There is also a state of micro inflammation in patients with continous ambulatory peritoneal dilaysis (CAPD). This micro inflammatory reaction will gradually make peritoneal fibrosis, peritoneal ultrafiltration failure, and the risk of cardiovascular events increase on the other, [5]. can be found that the micro inflammatory state of MHD and CAPD patients may affect the heart of dialysis patients. One of the risk factors of vascular events is the consensus of clinical researchers at home and abroad. However, there is no definite correlation between the microinflammatory state of ESRD dialysis patients and the abnormal metabolism of blood lipids and calcium and phosphorus. Studies have shown that the levels of microinflammatory factors in CAPD patients are not related to creatinine, blood calcium, blood phosphorus, and cholesterol levels [6]. also have been studied. MHD patients' blood (high sensitive C reactive protein, hs-CRP) is positively correlated with total cholesterol, glycerol three fat, low density protein cholesterol, and no significant correlation with HDL cholesterol and calcium and phosphorus metabolites [7]. based on the analysis of the correlation between the symptoms of hemodialysis patients and lipid metabolism, calcium and phosphorus metabolism, for dialysis patients. To reduce complications, prolong life, reduce medical costs and find effective ways and ways, and provide a theoretical basis for further research on the pathogenesis of micro inflammation in patients. [methods]1. case data were selected and selected to select the First Affiliated Hospital of Kunming Medical University and the two Affiliated Hospital of Kunming Medical University in June June 2015, -2016, in June. 31 cases were peritoneal dilaysis (PD) group: group PD, 16 male and 15 female. 31 cases of MHD patients at the First Affiliated Hospital of Kunming Medical University were selected as hemodialysis (HD) group: HD group, 15 male and 16 female. Another 18 healthy volunteers were selected as group, 10 male, 8 case of.2. dialysis (1) hemodialysis and hemodialysis patients Using the Japanese high altitude dialyzer, the polysulfone membrane dialyzer took the bicarbonate dialysis with sugar free dialysate, the area of the dialysis membrane was 1.3 ~ 1.7m2, the anticoagulant used ordinary heparin or low molecular weight heparin, the blood flow rate was 200~250 m L/min, the dialysis flow rate was 500 m L/min, the potassium ion, the concentration of calcium ion was 2 mmol/1L and 1.5mmol/L. dialysis 2~3 times per week respectively, 3 To 4h/ times, 1.5 to 3.5kg. (2) peritoneal dialysis was dehydrated to give 1.5% or 2.5% concentration of lactate dialysate, the volume of the solution was 2000 ml/ times. At least 4 peritoneal dialysis fluids were replaced during dialysis every day, and 24 h uninterrupted dialysis.3. clinical blood samples were collected by chemiluminescent immunoassay for detection of hs-CRP and parathyroid glands. Serum creatinine, urea nitrogen, total cholesterol, high density lipoprotein cholesterol, low density lipoprotein cholesterol, triglyceride, blood calcium, blood phosphorus and other.4. statistical methods were used to analyze the various observation indexes by the total automatic biochemical analyzer. The difference of P0.05 was statistically significant. [results of group]1.HD, the standard rate of blood calcium in group]1.HD was 45.2%, group PD patients. The rate of blood calcium standard was 16.1%, the standard rate of blood calcium in HD patients was higher than that in PD group, and the difference was statistically significant (P0.05), while in group PD, the standard rate of blood phosphorus was (45.2%), parathyroid hormone standard rate (51.6%) was higher than that of HD group (32.3%) and parathyroid hormone (32.3%), but the difference was not statistically significant (P0.05) the total cholesterol of.2.HD group. The standard rate (96.8%), low density lipoprotein cholesterol standard rate (93.5%), triglyceride standard rate (80.6%) higher than the PD group total cholesterol standard rate (90.3%), low density lipoprotein cholesterol standard rate (90.3%), triglyceride standard rate (71%), high density lipoprotein cholesterol level (38.7%) lower than the PD group of high density lipoprotein cholesterol The standard rate (54.8%), but the difference was not statistically significant (P0.05).3. compared with the normal control group, the blood hs-CRP of the patients in group HD and PD was higher, the difference was statistically significant (P0.05), but there was no statistically significant difference between the HD group and the PD group (P0.05).4.HD group (P0.05).4.HD group, total cholesterol, blood calcium, blood phosphorus, and parathyroid hormone and parathyroid hormone. The product of calcium and phosphorus was higher than that in the normal control group, and the high density lipoprotein cholesterol was lower than that of the normal group. The difference was statistically significant (P0.05), while the difference of the glycerol three fat and low density lipoprotein cholesterol was not statistically significant (P0.05) the total cholesterol, blood phosphorus, parathyroid hormone and calcium phosphorus in the group.5.PD group were more than that of the normal group. The blood calcium was lower in the normal control group than in the normal control group. The difference was statistically significant (P0.05). There was no significant difference between the high density lipoprotein cholesterol, glycerin three fat and low density lipoprotein cholesterol (P0.05) the total cholesterol, triglyceride, low density lipoprotein, and high density in group.6.HD and PD patients. There was no significant statistical significance in the product of DHA, blood calcium, blood phosphorus, calcium and phosphorus (P0.05) in group.7.PD, and there was a positive correlation between glycerol three and hs-CRP (r=0.36, P0.05), and there was no significant correlation between the other blood lipids and calcium and phosphorus metabolism index (P0.05), and there was no significant difference in blood lipid metabolism, calcium and phosphorus metabolism index and hs-CRP in HD group. Correlation (P0.05). [Conclusion] there is a state of microinflammation in long-term dialysis patients, accompanied by metabolic disorders of blood lipids and abnormal calcium and phosphorus metabolism, but there is no significant correlation between the microinflammatory response and the metabolism of blood lipids and calcium and phosphorus in dialysis patients.

【学位授予单位】：昆明医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R692.5

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