摘要
目的通过对老年2型糖尿病肾脏病和非糖尿病肾脏病维持性血液透析患者不同治疗年限骨代谢和钙磷代谢变化比较,了解他们各自的特点。方法 2006年至2010年期间,随机观察90例老年2型糖尿病肾病和120例老年非糖尿病肾病终末期肾脏病患者,分为血液透析前和血液透析1年、3年、>5年4组,抽取外周血,进行骨钙素、β胶原蛋白、全段甲状旁腺激素、血清钙、磷以及钙磷乘积的观察。结果与血液透析前组相比,老年2型糖尿病肾脏病和非糖尿病肾脏病患者骨钙素、β胶原蛋白、全段甲状旁腺激素在血液透析1年、3年、>5年组中皆降低,且以血液透析1年组最低(P<0.05);血钙在血液透析1年、3年、>5年组中皆升高(P<0.01);血磷在血液透析1年组中皆下降,在3年组中2型糖尿病肾病患者血磷仍下降,非糖尿病肾病患者却升高。与老年非糖尿病肾脏病患者比较,老年2型糖尿病肾病患者在血液透析前、血液透析1年和3年组中骨钙素、β胶原蛋白、全段甲状旁腺激素、血磷皆较低,以血液透析前和血液透析3年组差异明显(P<0.05);血钙2者无明显差异。结论老年2型糖尿病肾病患者随着维持性血液透析治疗年限变化,对骨代谢、钙磷代谢有其独特的临床表现和发生机制,应区别对待。
Objective To explore the characteristics of bone and calcium-phosphorus metabolism in elderly maintenance hemodialysis（MHD） patients with type II diabetes kidney disease（DKD） or non-DKD.Methods During the period of 2006 to 2010,peripheral blood samples were taken from 90 elderly end-stage renal disease（ESRD） patients due to type II DKD and 120 elderly ESRD patients of non-DKD to measure their plasma levels of osteocalcin（OT）,？crosslaps,parathyroid hormone（iPTH）,calcium（Ca）,phosphorus（P） and Ca×P before MHD,and on MHD for 1 year,3 years and 5 years.Results When comparisons were made for the laboratory parameters taken before MHD,and on MHD for 1 year,3 years and 5 years,plasma levels of OT,？crosslaps and iPTH were found to be lower in patients on MHD for 1 year,3 years and 5 years,especially in those on MHD for 1 year（P〈0.05）,than those before MHD;plasma Ca was higher in those on MHD for 1,3 and 5 years（P〈0.01）;plasma P was lower in the patients with DKD and on MHD for 1 year,but was higher in the patients with non-DKD and on MHD for 3 years.When comparisons were conducted between the laboratory parameters from MHD patients with DKD and those with non-DKD,plasma levels of OT,β-crosslaps,iPTH and P were found to be lower in the patients with DKD before MHD and on MHD for 1 and 3 years,especially in those before MHD and on MHD for 3 years（P〈0.05）;plasma Ca was indifferent in MHD patients with DKD and those with non-DKD.Conclusions As MHD lasted longer in elderly patients with DKD,they exhibited distinct clinical manifestations and pathogenesis in bone and calcium-phosphorus metabolism.Specific management to these clinical features is usually required.
出处
《中国血液净化》
2011年第8期440-443,共4页
Chinese Journal of Blood Purification
基金
上海市卫生局青年科研项目(2008Y035)
