【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(P<0.001),透析龄更长(P<0.05);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(P<0.05)。多重线性回归分析发现:AAC与年龄(r=0.042,P<0.001)、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。更多还原

【Abstract】 Objective: To investigate correlation factors of abdominal aortic calcification( AAC) in maintenance hemodialysis( MHD) patients with refractory secondary hyperparathyroidism( r SHPT). Methodology: From May 2014 to January 2016, r SHPT patients without parathyroidectomy, in China-Japan Friendship Hospital were enrolled. The demographic data and biochemical data were collected,including intact parathyroid hormone( i PTH),calcium( Ca),phosphorus( P),Bone mineral density( BMD) were measured using dual X-ray absorptiometry( DXA),AAC was evaluated using lateral X-ray plain films of abdomen. AAC severity was classified as absent( AAC = 0),mild( 1≤ AAC score≤5),and moderate to severe( AAC score>6). Results: Eighty-two r SHPT patients were included,63.4% of them had AAC. Compared with absent calcification group,patients in the other two groups were elder( P<0. 001),the dialysis time was longer( P<0. 05),and C-telopeptide of type I collagen( CTX) level in the absent calcification group was higher than the other groups( P<0. 05). AAC was more severe in males( P<0. 05). Multiple linear regression analysis shows that AAC was positively correlated with age( r = 0. 042,P < 0. 001) and serum phosphorus( r = 0. 438,P = 0. 045),and negatively with CTX( r =-0. 100,P = 0. 035). Conclusion: 63. 4% of MHD patients with r SHPT presented with AAC, and AAC may correlate with age,male,serum phosphorus and CTX.更多还原