慢性肾脏

发布时间：2018-08-22 14:25

【摘要】：[目的]1.分析CKD-MBD的发生率,包括血钙、血磷、甲状旁腺激素(Parathyroid Hormone,PTH)、25-羟维生素 D(25-Hydroxy VitaminD,25(OH)D)异常、达标率,心血管钙化的发生率及CKD2-5期其发生率有无差异分析;2.探讨CKD患者心脏重构、心血管钙化、继发性甲状旁腺功能亢进症(Secondary Hyperparathyroidism,SHPT)的危险因素。[方法]收集2015年6月至2015年12月期间,昆明医科大学第一附属医院肾内科住院治疗的CKD2-5期患者238例资料,收集患者性别、年龄、体重、实验室检查资料、碳酸钙用药、活性维生素D用药等信息,分析CKD-MBD发生率,CKD四期MBD发生率有无差异,探讨CKD患者心脏重构、心血管钙化、SHPT的危险因素。[结果]1.本研究共计238例研究对象,男性153例(64.3%),女性85例(35.7%),平均年龄 50.47±15.60 岁,平均 BMI 值 23.33±3.53Kg/mm2,平均CKD病程24.00±57.00月。CKD患者原发病所占比例:慢性肾炎35%,糖尿病肾病33%,高血压肾病12%,痛风性肾病5%,多囊肾4%,梗阻性肾病2%,过敏性紫癜性肾炎2%,ANCA相关性小血管炎1%,多发性骨髓瘤1%,膜性肾病1%。2.CKD患者血钙正常,偏低,偏高发生率:43.2%,47.9%,8.9%;CKD患者血磷正常,偏低,偏高发生率:53.9%,11.7%,34.3%;CKD患者PTH正常,偏低,偏高发生率:37.6%,48.1%,14.3%;CKD患者25(0H)D偏低,不足,均衡发生率:29.8%,63.2%,7.0%;CKD患者血管钙化发生率:29.5%。3.不同 CKD 分期患者血钙(x2=13.705,P=0.018),血磷(x2=28.806 P=0.000),PTH(x2 =17.068,P=0.004)偏低、正常、偏高发生率差异有统计学意义;不同CKD分期患者25(0H)D偏低、不足、均衡发生率(x 2=8.476,P=0.150),心血管钙化(x2=4.358,P=0.200)发生率差异无统计学意义。4.CKD心脏重构发生患者临床指标多因素Logistic回归分析:性别(男性)(P=0.049,0R=0.428,95%CI=0.176-0.944)、糖尿病史(P=0.004,0R=10.306,95%CI=2.148-49.461)、舒张压高(P=0.005,0R=4.58,95%CI=1.577-13.298)、高血磷(P=0.032,0R=3.077,95%CI=0.111-0.955)是CKD患者发生心脏重构的独立危险因素。5.CKD患者心血管钙化相关临床指标多因素Logistic回归分析:高龄(P=0.001,0R=1.085,95%CI=1.033-1.139)、有糖尿病史(P=0.031,0R=4.537,95%CI=1.152-17.872)、高碱性磷酸(P=0.024,0R=8.660,95%CI=1.332-56.301)、高血钙(P=0.029,0R=9.934,95%CI=1.265-77.982)是心血管钙化的独立危险因素。6.CKD患者SHPT相关临床指标的单因素Logistic回归分析:eGFR水平是SHPT 的影响因素(P=0.009,0R=0.587,CI=0.394-0.877)。[结论]1.CKD-MBD发生率高,临床上MBD达标率并不高:血钙、血磷、PTH、25(OH)D达标率分别为43.2%、53.9%、37.6%、25%,心血管钙化发生率29.5%;CKD-MBD自CKD早期(CKD2期)即出现。2.性别(男性)、糖尿病史、高舒张压、高血磷是CKD患者发生心脏重构的独立危险因素。3.高龄、有糖尿病史、高碱性磷酸酶、高血钙是心血管钙化的独立危险因素。4.eGFR水平是SHPT的影响因素。
[Abstract]:[objective] 1. To analyze the incidence of CKD-MBD, including blood calcium, serum phosphorus, 25-Hydroxy vitamin D 25 (OH) D) abnormality, cardiovascular calcification and CKD2-5 stage. To investigate the risk factors of cardiac remodeling, cardiovascular calcification and secondary Secondary hyperparathyroidism in CKD patients. [methods] from June 2015 to December 2015, 238 CKD2-5 patients in Department of Nephrology, the first affiliated Hospital of Kunming Medical University, were collected. The data of sex, age, weight, laboratory examination, calcium carbonate medication were collected. To investigate the risk factors of cardiac remodeling and cardiovascular calcification in patients with CKD-MBD, we analyzed whether there was any difference in the incidence of MBD in the fourth phase of CKD by using active vitamin D and other information, and to explore the risk factors of cardiac remodeling and cardiovascular calcification in patients with CKD. [result] 1. A total of 238 subjects were studied, including 153 males (64.3%) and 85 females (35.7%), with an average age of 50.47 卤15.60 years. Average BMI value 23.33 卤3.53kg / m2, mean course of CKD 24.00 卤57.00 months. Proportion of primary disease in patients with CKD: chronic nephritis 35g, diabetic nephropathy 33cm, hypertension nephropathy 12, gouty nephropathy 5cm, polycystic kidney 4, obstructive nephropathy 2and anaphylactoid purpura nephritis 2and ANCA correlation Small vasculitis 1, multiple myeloma 1, membranous nephropathy 1%.2.CKD patients with normal blood calcium, The incidence of blood phosphorus in patients with CKD was normal and low, and the incidence was higher than that in patients with CKD: 53.9% 11.73.34%. The incidence of PTH in patients with CKD was normal, low, and high. The incidence of PTH in patients with CKD was normal, low, and high. The incidence of 25 (0H) D in patients with CKD was lower than that in patients with 14.3CKD, and the incidence of balanced incidence was 29.83.27.00.The incidence of vascular calcification was 29.5.30.The rate of blood vessel calcification in patients with CKD was lower than that in patients with CKD, and the proportion of blood vessels in patients with CKD was lower than that in patients with CKD. In patients with different CKD stages, the levels of serum calcium (x2n 13.705) and phosphorus (x228.806 Pu 0.000) were low, normal and high, while 25 (0H) D in patients with different CKD stages was lower than that in patients with different CKD stages. 鍧囪　鍙戠敓鐜，

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