慢性肾脏病各分期患者矿物质骨代谢指标变化特征研究

发布时间：2018-07-10 14:04

  本文选题：肾病 + 慢性病　； 参考：《中国全科医学》2017年12期

【摘要】：目的分析慢性肾脏病(CKD)1~5期患者矿物质骨代谢指标变化特征,为早期CKD患者矿物质骨代谢的治疗提供依据。方法回顾性选取2013年在南昌大学第二附属医院肾内科住院且符合纳入标准的391例CKD患者的临床资料,依据肾脏病预后质量倡议(KDOQI)指南推荐的CKD分期标准将患者分为CKD 1~2期32例(CKD1~2期组)、CKD 3期67例(CKD 3期组)、CKD 4期79例(CKD 4期组)、CKD 5期213例(CKD 5期组)。比较4组患者一般资料(性别、年龄、糖尿病发生率)、血肌酐、估算肾小球滤过率(eGFR)、矿物质骨代谢指标{血钙、血磷、血钙磷乘积、全段甲状旁腺激素(iPTH)、25羟维生素D-3(25(OH)D_3]、骨型碱性磷酸酶(BSALP)、骨钙素};分析CICD患者eGFR、部分矿物质骨代谢指标〔iPTH、25(OH)D_3、BSALP,骨钙素)的相关性;并计算CKD3、4、5期组患者血钙、血磷、血钙磷乘积、iPTH达标率(达标率均参照KDOQI指南推荐的CKD患者矿物质骨代谢指标参考范围)。结果CKD 3期组患者25(OH)D_3低于CKD1~2期组(P0.05);CKD 4期组患者血磷、血钙磷乘积、iPTH、BSALP高于CICD 1~2期组,25(OH)D_3低于CICD 1~2期组和CICD 3期组,骨钙素高于CKD 1~2期组和CKD 3期组(P0.05);CKD 5期组患者血钙低于CKD 1~2期组、CKD 3期组、CKD 4期组,血磷、血钙磷乘积、iPTH、骨钙素高于CKD 1~2期组、CKD 3期组、CKD 4期组,25(OH)D_3低于CKD 1~2期组和CKD 3期组,BSALP高于CKD1~2期组、CKD 3期组(P0.05)。eGFR与iPTH、BSALP,骨钙素呈负相关(r值分别为-0.49、-0.18、-0.43,P0.05),与25(OH)D_3呈正相关(r=0.34,P0.05);iPTH与25(OH)D_3呈负相关(r=-0.17,P0.05),与BSALP、骨钙素呈正相关(r值分别为0.34、0.60,P0.05);25(OH)D_3与骨钙素呈负相关(r=-0.11,P0.05),25(OH)D_3与BSALP无直线相关关系(r=0.10,P0.05);BSALP与骨钙素呈正相关(r=0.25,P0.05)。CKD 3、4、5期组患者血钙达标率分别为86.6%(58/67)79.7%(63/79)和37.6%(80/213);CKD 3、4、5期组患者血磷达标率分别为82.1%(55/67)69.6%(55/79)、46.0%(98/213);CKD 3、4、5期组患者血钙磷乘积达标率分别为100.0%(67/67)、97.5%(77/79)、76.5%(163/213);CKD 3、4、5期组患者iPTH达标率分别为43.3%(29/67)、26.6%(21/79)、39.0%(83/213)。CKD_3、4、5期组患者各项指标均达标的达标率分别为31.3%(21/67)、19.0%(15/79)、11.7%(25/213)。结论早、中期CKD患者已存在矿物质骨代谢指标异常,且随着肾功能的恶化,iPTH、BSALP,骨钙素均有不同程度的升高;血钙、血磷在CKD 4~5期变化明显;CKD 1~5期患者普遍存在25(OH)D_3不足和缺乏现象,CKD 3~5期患者矿物质骨代谢指标符合KDOQI指南推荐参考范围的达标率很低,特别是iPTH。
[Abstract]:Objective to analyze the characteristics of mineral bone metabolism in patients with chronic kidney disease (CKD) stage 1 and 5, and to provide evidence for the treatment of mineral bone metabolism in early CKD patients. Methods the clinical data of 391 patients with CKD who were hospitalized in Department of Renal Medicine, second affiliated Hospital of Nanchang University in 2013 were retrospectively selected. According to the CKD staging criteria recommended by the prognosis quality Initiative (KDOQI) guidelines, the patients were divided into 32 cases of CKD 1 / 2 (CKD 1 / 2) and 67 cases of CKD 3 (CKD 3). 79 cases of CKD 4 (CKD 4) and 213 cases of CKD 5 (CKD 5) were divided into two groups. General data (sex, age, incidence of diabetes), serum creatinine, estimated glomerular filtration rate (eGFR), mineral bone metabolism index {blood calcium, blood phosphorus, blood calcium and phosphorus product] were compared among the four groups. Total parathyroid hormone (iPTH) 25 hydroxyvitamin D-3 (25 (OH) D3], bone type alkaline phosphatase (BSALP), osteocalcin}; Analysis of the correlation of some mineral bone metabolism indexes (iPTH25 (OH) D3BSALP, osteocalcin) in CICD patients; The serum calcium and phosphorus product and iPTH reached the standard rate (all according to the reference range of mineral bone metabolism index of CKD patients recommended by KDOQI guidelines). Results 25 (OH) D3 in CKD3 group was lower than that in CKD1 / 2 stage 2 group (P0.05). The serum calcium and phosphorus product of IPTHD BSALP was significantly higher than that of CICD 1 / 2 stage 2 group and CICD 1 / 2 stage 2 group and CICD 3 stage group, respectively. Osteocalcin was higher than that in CKD 1 stage 2 and CKD 3 stage group (P0.05) the level of serum calcium in CKD 5 stage group was lower than that in CKD 1 stage 2 group and CKD 3 stage group. The BSALP of serum calcium phosphate product was higher than that of CKD stage 3 group (P 0.05). The osteocalcin level was negatively correlated with 25 (OH) D3 (r = -0.49- 0.18) -0.43P, and positively correlated with 25 (OH) D3 (r = -0.49) D3 (r = -0.49) and 25 (OH) D3 P (r = -0.49 ~ -0.18 ~ (-0.18) D3 (r = -0. 49) D3 (r = -0. 49) and 25 (OH) D3 (r = 0. 34, P < 0. 05). The BSALP of BSALP was higher than that of CKD 3 (P0.05). EGFR was negatively correlated with IPTHBSALP (r = -0. 49-0. 18) -0. 43 respectively. 鍛堣礋鐩稿叧(r=-0.17,P0.05),涓嶣SALP,楠ㄩ挋绱犲憟姝ｇ浉鍏，

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