【摘要】 目的 了解湖北地区慢性肾脏疾病(chronic kidney diseases,CKD)3~5期患者矿物质代谢异常的现状及影响因素,为非透析CKD 3~5期矿物质及骨代谢紊乱的患者提供诊治依据。方法 将湖北省中医院肾内科门诊及住院的123例CKD 3~5期患者分为3组(根据肾小球滤过率分组:CKD3组、CKD 4组、CKD 5组),比较CKD患者的血钙、血磷、钙磷乘积、碱性磷酸酶(alka--line phosphatase,ALP)、全段甲状旁腺素(immunoreaetive parathyroid hormone,iPTH)水平,并评估继发性甲状旁腺功能亢进的发病率及其相关影响因素。结果 患者血钙、血磷、钙磷乘积、ALP及iPTH水平在CKD 3~5期之间比较均有统计学差异(P<0.01,P<0.001)。随着CKD病程的进展,血钙逐渐下降,血清磷、钙磷乘积及iPTH水平逐渐上升。根据统计结果,CKD 5期血钙水平较CKD3、4期明显下降(P<0.05,P<0.001),CKD 5期患者的钙磷乘积、ALP水平比CKD3、4期明显升高(P<0.01,P<0.001),CKD 3期患者血清磷、钙磷乘积及iPTH水平与CKD 4期相比有显著统计学差异(P<0.05,P<0.001),而CKD 3期和CKD 4期患者的血钙、ALP水平无显著差异(P>0.05)。以iPTH为因变量,性别、年龄、病程、血钙、血磷、钙磷乘积、ALP和肾小球滤过率(glomerular filtration rate,GFR)为自变量线性相关分析,结果提示iPTH水平与血钙、GFR成负相关(P<0.001)、与血磷、ALP成正相关(P<0.01),与钙磷乘积无相关性,再次基础上做多元相关回归分析,结果显示相关回归系数R=0.51,血钙、ALP、GFR是iPTH升高的独立相关因素(P<0.01和P<0.0(01)。结论CKD)患者的钙磷代谢紊乱在疾病的早期即存在,且随疾病的进展而不断加重。继发性甲状旁腺功能亢进的发病与CKD进程、血钙及ALP有密切关系。更多还原

【Abstract】 Objective To understand the status and influencing factors of abnormal mineral metabolism in chronic kidney disease(CKD) in Hubei Province in patients with stage 3-5 to provide a basis for diagnosis and treatment of non-dialysis CKD patients with mineral and bone metabolism.Methods123 cases of CKDfrom Hubei Provincial Hospital of Traditional Chinese Medicine were divided into three groups according to CKD stage.By comparing serum calcium,serum phosphorus,calcium-phosphorus product,alkaline phosphatase(ALP) and parathyroid hormone levels in CKD patients,the incidence of secondary hyperparathyroidism and its related factors were assessed.Results There was no significant difference in age,gender,disease duration and body mass index(BMI) among CKD stage 3,4 and 5groups(P<0.05).Serum calcium,serum phosphorus,calcium-phosphorus product,ALP and immunoreactive parathyroid hormone(iPTH) levels showed significant difference among CKD stage 3,4 and 5groups(P<0.01,or P<0.001).With the progression of CKD,serum calcium was gradually decreased,and serum phosphorus,calcium-phosphorus product and parathyroid hormone levels were gradually increased.Statistically,serum calcium levels at CKD state 5 was significantly decreased as compared with those at CKD stage 3 and 4(P<0.05,or P<0.01).Calcium-phosphorus product levels and ALP levels at CKD stage 5 were significantly increased as compared with those at CKD stage 3 and 4(P<0.01,or P<0.001),and there was significant difference in serum phosphorus,calcium-phosphorus product and iPTH levels between CKD stage 3 and CKD stage 4(P<0.05,or P<0.01),but there was no significant difference in the level of ALP and serum calcium level between CKD stage 3 and 4(P>0.05).For linear correlation analysis,iPTH was used as the dependent variable,and gender,age,disease duration,calcium,phosphorus,calcium-phosphorus product,ALP and GFR as independent variables.The result showed that iPTH levels were negatively correlated with serum calcium(R=-0.465,P <0.001),positively correlated with serum phosphorus(R = 0.358,P<0.01),negatively correlated with GFR(R =-0.55,P<0.001),and positively correlated with ALP(R= 0.406,P<0.001),but not correlated with calcium-phosphorus product.Multiple regression analysis revealed that calcium,ALP and GFR were independently associated with elevated iPTH(P<0.01,or P<0.001).Conclusions Calcium and phosphorus metabolism disorder in early CKD patients exists,and is worsened with the progression of the disease.The incidence of secondary parathyroid hormone hyperparathyroidism is closely associated with CKD process,serum calcium and ALP.更多还原