基层血液透析患者骨与矿物质代谢现状调查

蒋易; 陆晓青; 梁献慧; 乔颖进; 王沛

doi:10.3969/j.issn.1671-4091.2020.04.003

中国血液净化 >

2020 , Vol. 19 >Issue 04: 225 - 229

DOI: https://doi.org/10.3969/j.issn.1671-4091.2020.04.003

临床研究

基层血液透析患者骨与矿物质代谢现状调查

蒋易 ,
陆晓青 ,
梁献慧 ,
乔颖进 ,
王沛

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1郑州大学第一附属医院血液净化中心

收稿日期: 2019-12-23

修回日期: 2020-01-13

网络出版日期: 2020-04-12

基金资助

国家自然科学基金面上项目(编号81873612)

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Investigation of bone and mineral metabolism in hemodialysis patients treated in primary hospitals

JIANG Yi ,
LU Xiao-Qing ,
LIANG Xian-Hui ,
QIAO Ying-Jin ,
WANG Pei

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1Blood Purification Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, China

Received date: 2019-12-23

Revised date: 2020-01-13

Online published: 2020-04-12

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摘要

【摘要】目的调查河南省部分基层维持性血液透析患者骨及矿物质代谢现状。方法选取河南省13 个区县级血液透析中心，共纳入932 例患者，了解患者近3 个月的钙、磷、全段甲状旁腺激素(intact parathyroid hormone，iPTH)水平；以肾脏病预后质量倡议(kidney disease outcomes quality initiative,KDOQI)指南为标准，评估患者钙、磷、iPTH 达标率并与国际透析预后与实践模式研究4(dialysis outcomes and practice patients study 4,DOPPS4)相比较；将患者以性别、年龄、透析龄、血管通路通畅情况、原发病、周透析总时长分组，比较不同分组间的达标率差异。结果参与调研的透析中心患者血钙水平为(2.23±0.25)mmol/L，血磷水平为(1.96±0.65)mmol/L，iPTH 水平为362(165,647)pg/ml，3 者检测率分别为38.4%、50.0%、49.4%；3 者达标率分别为33.5%、29.6%、21.8%，综合达标率为3.9%；低钙、高磷、高iPTH 现象较DOPPS4 更为突出(29.0% 比12.4% 、χ2=224.648，P＜0.001；61.4% 比34.2% 、χ2=303.262、，P＜0.001；59.2%比35.4%，χ2=308.165，P＜0.001)。老年患者的磷及iPTH 较低[(1.8±0.5)比(2.0±0.7)mmol/L，t=2.845，P=0.005；291.9(173.8,500.0)比439.9(200.0,701.0)pg/ml，Z=3.404,P=0.001)]、磷及iPTH 达标率较高(42.0% 比24.8% ，χ2=5.110，P=0.024；70.0% 比48.1% ，χ2=6.986，P=0.008)、钙达标率较低(44.0%比65.9%，χ2=7.182，P=0.007)；通路功能不良的患者iPTH 达标率更低(59.0% 比34.3% ，χ2=6.943，P=0.008)；糖尿病患者的iPTH 水平更低[(318.6(79.0,593.0) 比417.9(216.0,694.7)pg/ml，Z=2.246,P=0.025]、血磷达标率更高(39.7%比21.8%，χ2=6.812, P=0.009)；长透析龄的患者iPTH 更高[510.2(181.3, 869.6)比355.0(188.6, 543.0)pg/ml, Z=3.130, P= 0.003]、达标率较低(35.7%比62.6%，χ2=11.206,P=0.001)，周透析时长＜10h 的患者血磷水平更高[(2.1±0.7)比(1.9±0.6)
mmol/L，t=2.004,P=0.047]，血钙达标率更低(49.3%比63.2%，χ2=7.875,P=0.005)。结论基层血液透析患者普遍存在钙磷检测率低、达标率低、药物应用不规范等现象，需进一步加强宣教。

关键词： 慢性肾脏病-矿物质及骨代谢异常; 血液透析; 基层

本文引用格式

蒋易 , 陆晓青 , 梁献慧 , 乔颖进 , 王沛 . 基层血液透析患者骨与矿物质代谢现状调查[J]. 中国血液净化, 2020 , 19(04) : 225 -229 . DOI: 10.3969/j.issn.1671-4091.2020.04.003

Abstract

【Abstract】Objective To investigate the bone and mineral metabolism status in maintenance hemodialysis (MHD) patients treated in primary hospitals in He’nan Province. Methods A total of 932 patients in 13 hemodialysis centers in He’nan province were enrolled in this study to understand their calcium, phosphorus, and intact parathyroid hormone (iPTH) levels in the recent 3 months. KDOQI (Kidney Disease Outcomes Quality Initiative) guidelines were used as the standards to evaluate their calcium, phosphorus, iPTH levels and compliance rates then to compare them with the Dialysis Outcomes and Practice Patients Study 4

(DOPPS4 study). The patients were grouped according to gender, age, dialysis age, vascular access, primary disease, and total dialysis duration per week. The compliance rates were compared among the groups. Results Serum calcium was 2.23±0.25 mmol/L, phosphorus was 1.96±0.65 mmol/L and iPTH was 362(165, 647) pg/ml in the participants in these hemodialysis centers,with detection rates of 38.4%,50% and 49.4% respectively, compliance rates of 33.5%,29.6%, 21.8% respectively, and overall compliance rate of 3.9%. Hypocalcemia, hyperphosphatemia and higher iPTH level were more prominent than those in DOPPS4(29.0% vs. 12.4% , χ2=224.648, P＜0.001; 61.4% vs. 34.2% , χ2=303.262, P＜0.001; 59.2% vs. 35.4%, χ2=308.165, P＜0.001). In elderly patients, serum phosphorus and iPTH were lower [1.8±0.5 vs. 2.0±0.7 mmol/L, t=2.845, P=0.005; 291.9(173.8,500.0) vs. 439.9(200.0, 701.0) pg/ml, Z=3.404, P=0.001)] with the higher phosphorus and iPTH compliance rates(42.0% vs. 24.8%,χ2=5.110, P=0.024; 70.0% vs. 48.1%,χ2=6.986,P=0.008), but the compliance rate of calcium was lower (44.0% vs. 65.9%, χ2=7.182, P=0.007). Patients with poor blood access function had lower iPTH compliance rate (59% vs. 34.3%,χ2=6.943, P=0.008). Diabetic patients had lower iPTH level [318.6(79.0, 593.0) vs. 417.9 (216.0,694.7) pg/ml, Z=2.246, P=0.025] and higher serum phosphorus compliance rate (39.7% vs. 21.8%,χ2=6.812, P=0.009). Patients with long dialysis age had higher iPTH level [510.2(181.3, 869.6)vs. 355.0 (188.6, 543.0)pg/ml, Z=3.130, P=0.003] and lower iPTH compliance rate(35.7% vs. 62.6%,χ2=11.206, P=0.001). Patients with a weekly dialysis duration of＜10h had higher serum phosphorus (2.1±0.7 vs.1.9±0.6mmol/L,t=2.004,P=0.047) and lower blood calcium compliance rate (49.3% vs. 63.2%,χ2=7.875, P=0.005). Conclusion Disorders of calcium and phosphorus metabolism were common in MHD patients treated in the primary hospitals, which need to be changed in no time.

Key words： Chronic kidney disease-mineral and bone disorder; Hemodialysis; Primary hospitals

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