维持性血液透析合并难治性继发性甲状旁腺功能亢进患者腹主动脉钙化相关因素分析

发布时间：2019-01-07 20:32

【摘要】：目的:探讨维持性血液透析(MHD)合并难治性继发性甲状旁腺功能亢进(r SHPT)患者腹主动脉钙化(AAC)的相关因素。方法:选取2014年5月至2016年1月间于中日友好医院就诊拟行甲状旁腺切除术的r SHPT患者,记录患者一般情况,血清全段甲状旁腺激素(i PTH)、血清钙(Ca)、血清磷(P)及骨转化标志物等实验室指标,测量骨密度(BMD),根据AAC评分分为无钙化、轻度钙化、中重度钙化三组,比较三组之间的差异。结果:82例r SHPT患者纳入研究,年龄50.99±12.98岁,透析龄88.42±50.15月,男性40例占48.8%。AAC发生率为63.4%,其中腰椎L1~L4对应的四段血管壁均受累20例(24.4%)。男性AAC积分更高(P=0.016)。与无钙化组相比,发生钙化的两组年龄更大(P0.001),透析龄更长(P0.05);轻度及中重度钙化组的I型胶原羧基端肽(CTX)明显低于无钙化组(P0.05)。多重线性回归分析发现:AAC与年龄(r=0.042,P0.001)、血清磷(r=0.438,P=0.045)呈正相关,与CTX(r=-0.100,P=0.035)呈负相关。结论:MHD合并r SHPT患者AAC发生率高,高龄、男性、高血磷及CTX低是血管钙化的易感因素。
[Abstract]:Objective: to investigate the risk factors of abdominal aortic calcification (AAC) in patients with maintenance hemodialysis (MHD) combined with refractory secondary hyperparathyroidism (r SHPT). Methods: from May 2014 to January 2016, r SHPT patients undergoing parathyroidectomy in China-Japan Friendship Hospital were selected. The general status of the patients was recorded, and the serum total parathyroid hormone (i PTH), serum calcium (Ca), was recorded. Serum phosphorus (P) and bone transformation markers were measured. Bone mineral density (BMD),) was measured and divided into three groups according to AAC score: no calcification, mild calcification and moderate and severe calcification. The difference between the three groups was compared. Results: 82 patients with r SHPT were enrolled in the study. The age was 50.99 卤12.98 years old and the dialysis age was 88.42 卤50.15 months. The incidence of 48.8%.AAC was 63.4% in 40 male patients. Of them, 20 cases (24.4%) were involved in the four segments of L1~L4. Male AAC score was higher (P0. 016). Compared with the non-calcification group, the two groups with calcification were older (P0.001) and longer dialysis age (P0.05); the type I collagen carboxyl terminal peptide (CTX) of mild and moderate calcification group was significantly lower than that of non-calcified group (P0.05). Multiple linear regression analysis showed that AAC was positively correlated with age (r = 0.042), serum phosphorus (r = 0.438), and negatively correlated with CTX (r = 0.100). Conclusion: the incidence of AAC in patients with MHD and r SHPT is high. The elderly, male, high blood phosphorus and low CTX are the risk factors of vascular calcification.
【作者单位】：山西医科大学;中日友好医院肾内科;中日友好医院放射科;山西省人民医院肾内科;
【基金】：首都临床特色应用研究与成果推广(Z151100004015112)
【分类号】：R581.1;R692

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