摘要
目的探讨糖尿病肾病与非糖尿病肾病的血液透析患者在CKD-MBD患病和治疗情况上的差别。方法采用单中心、回顾性横断面研究设计。选取哈尔滨医科大学附属第一医院血液净化中心维持血液透析患者336例作为研究对象,依照其原发病将入选患者分为糖尿病肾病组(DN组)123例和非糖尿病肾病组(Non-DN组)213例。收集患者的一般资料,并检测甲状旁腺素、血钙、血磷和碱性磷酸酶等钙磷代谢指标,比较分析两组患者CKD-MBD的患病及治疗情况,并对继发性甲状旁腺功能亢进的相关因素进行多元回归分析。结果两组的全段甲状旁腺激素水平分别为:DN组为(283.08±187.01)pg/m L、Non-DN组为(415.96±482.49)pg/m L,差异有统计学意义(t=-3.58,P<0.01);DN组与NonDN组血钙水平分别为:(8.74±0.87)mg/d L vs(9.13±1.01)mg/d L(t=-3.63,P<0.01);血磷水平分别为:(6.08±1.88)mg/d L vs(6.41±1.96)mg/d L(t=-1.50,P=0.13)。DN组SHPT的发生率为33.33%,显著低于Non-DN组的53.05%;DN组与Non-DN组低钙血症的发生率分别为34.96%和24.41%,高磷血症的发生率分别为53.66%和68.08%。对影响i PTH升高的因素进行逐步Logistic回归分析结果显示:透析龄增加(OR=1.90,P=0.02)和钙磷乘积水平(OR=2.36,P<0.01)为血i PTH进一步升高的独立危险因素,而非糖尿病患者并发高IPTH危险是糖尿病患者的0.56倍(OR=0.56,P=0.01)。结论糖尿病可能为继发性甲状旁腺功能亢进的抑制因素。
Objective To investigate the differences in the prevalence and treatment of CKDMBD in diabetic nephropathy and non-diabetic nephropathy patients on maintenance hemodialysis. Methods Single-center, retrospective, cross-sectional study design was used in this clinical investigation. A total of 336 patients on maintenance hemodialysis in the Blood Purification Center of the First Affiliated Hospital of Harbin Medical University were selected and divided into two groups according to their primary disease： 123 with diabetic nephropathy （DN） and 213 with non-diabetic nephropathy （Non-DN）. General information of patients was collected, and indices of calcium and phosphorus metabolism, such as levels of parathyroid hormone, serum calcium, phosphorus, and alkaline phosphatase were determined. The prevalence and treatment of CKD-MBD in the two groups were compared, and muhiple regression analysis was conducted on the related factors of secondary hyperparathyroidism. Results Intact parathyroid hormone （iPTH） concentration in the DN group was （283.08 ± 187.01 ） pg/mL and （415.96 ± 482.49 ） pg/mL in the Non-DN group, with a statistically significant difference （t = - 3.58, P 〈0. 01 ）. The serum calcium levels in the DN and Non-DN group were （8.74 ± 0. 87） mg/dL and （9. 13 ± 1.01 ） mg/dL （ t = - 3.63, P 〈 0.01 ）, respectively. The serum phosphorus content was lower in the DN group （6.08 ± 1.88） mg/dL than that in the Non-DN group （6. 41± 1.96） mg/dL （t = - 1.50, P = 0. 13 ）. The incidence of SHPT in the DN group （33.33%） was significantly lower than the one in the Non-DN group （53.05%）, and the incidence of hypocalcemia in the DN group and Non-DN group was 34.96% and 24.41%, respectively, while the incidence of hyperphosphatemia was 53.66% and 68.08% , correspond- ingly. The stepwise logistic regression analysis of the influence factors of elevated iPTH showed that the increased term of dialysis （ OR = 1.90, P = 0. 02） and the value of the calcium and phos
出处
《哈尔滨医科大学学报》
CAS
2017年第2期143-147,共5页
Journal of Harbin Medical University
基金
黑龙江省卫生计生委课题(2014-274)
关键词
糖尿病肾病
继发性甲状旁腺功能亢进
维持性血液透析
矿物质和骨代谢异常
diabetic nephropathy
secondary hyperparathyroidism
maintenance hemodialysis
chronic kidney disease-mineral and bone disorder
