本文關(guān)鍵詞：維持性血液透析患者冠狀動(dòng)脈鈣化危險(xiǎn)因素分析及硫代硫酸鈉的干預(yù)作用　出處：《福建醫(yī)科大學(xué)》2015年碩士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 硫代硫酸鈉 冠狀動(dòng)脈鈣化 血液透析 危險(xiǎn)因素

【摘要】：目的:分析維持性血液透析(Maintenance hemodialysis,MHD)患者冠狀動(dòng)脈鈣化(Coronary artery calcification,CAC)及其與相應(yīng)臨床指標(biāo)的關(guān)系,探討影響CAC的相關(guān)危險(xiǎn)因素。進(jìn)一步觀察硫代硫酸鈉(Sodium Thiosulfate,STS)對冠狀動(dòng)脈鈣化進(jìn)展的干預(yù)作用及其安全性。方法:通過菲利普256層螺旋CT對38例MHD患者胸部進(jìn)行平掃,行CAC評分。依據(jù)CAC評分結(jié)果分為冠狀動(dòng)脈鈣化組(CAC積分10分)和無鈣化組,透析前抽血檢測血鈣、血磷、甲狀旁腺激素、C反應(yīng)蛋白、血清白蛋白、血脂及血紅蛋白等指標(biāo),并計(jì)算鈣磷乘積。比較兩組年齡、透析時(shí)間、血壓和血清學(xué)指標(biāo)的差異。另外將CAC積分大于50分的患者隨機(jī)分為兩組,一組患者(n=10)常規(guī)治療3個(gè)月,另一組患者(n=17,15例患者完成STS治療)在血液透析結(jié)束后接受STS(0.18g/kg體重,溶于100ml生理鹽水)靜脈滴注治療,滴注時(shí)間30分鐘,每周3次,為期3個(gè)月。STS治療前患者行肝腎功能、電解質(zhì)、血脂、血常規(guī)、甲狀旁腺激素、C反應(yīng)蛋白、25羥維生素D、骨源性堿性磷酸酶、成纖維細(xì)胞生長因子23及骨密度等相關(guān)檢查,治療結(jié)束后再次復(fù)查上述指標(biāo)。分析影響血管鈣化的相關(guān)因素,比較兩組血管鈣化患者治療前后影像學(xué)、生化及骨密度等相關(guān)指標(biāo)的改變情況,以及觀察STS治療過程中出現(xiàn)的不良反應(yīng)。結(jié)果:1.38例MHD患者中有27例(71.05%)患者冠狀動(dòng)脈發(fā)生鈣化,冠狀動(dòng)脈鈣化組的年齡、透析時(shí)間、血磷、鈣磷乘積、甲狀旁腺激素和C反應(yīng)蛋白水平顯著高于無鈣化組(p=0.017,0.037,0.038,0.037,0.013,0.006);而白蛋白水平前者低于后者(p=0.026)。其它指標(biāo)差異均無統(tǒng)計(jì)學(xué)意義。2.在治療前兩組相關(guān)指標(biāo)基線值基本一致的情況下,STS治療組CAC積分治療前后無明顯差異(p=0.053),而常規(guī)治療組CAC積分顯著增加(p=0.021)。兩組治療前后CAC積分差值有顯著差異(p=0.004)。STS治療后C反應(yīng)蛋白水平降低(p=0.016),HCO3-水平降低(p=0.020),血鈣水平升高(p=0.005)。其它指標(biāo)如甲狀旁腺激素、25羥維生素D、骨源性堿性磷酸酶、成纖維細(xì)胞生長因子23在STS治療組治療前后均無明顯變化(p0.05)。3.硫代硫酸鈉不良反應(yīng):惡心、嘔吐3例,乏力1例,口渴2例、打噴嚏1例,骨密度降低5例。常規(guī)治療組骨密度下降發(fā)生1例,而兩組間骨密度下降例數(shù)做卡方檢驗(yàn),χ2=1.791,P=0.345,無統(tǒng)計(jì)學(xué)差異。結(jié)論:1.維持性血液透析患者普遍存在冠狀動(dòng)脈鈣化,其發(fā)生主要與年齡、透析時(shí)間、鈣磷代謝異常、炎癥反應(yīng)、營養(yǎng)不良等因素有關(guān)。2.硫代硫酸鈉治療可能延緩冠狀動(dòng)脈鈣化進(jìn)展,抑制炎癥反應(yīng),治療過程中無嚴(yán)重不良反應(yīng)發(fā)生,但對骨密度的影響還需進(jìn)一步研究。
[Abstract]:Objective: to analyze maintenance maintenance hemodialysis. The relationship between coronary artery calcification and clinical indexes in patients with MHD. To investigate the risk factors affecting CAC and to observe sodium Thiosulfate. Methods: the chest of 38 patients with MHD were examined by Philip 256-slice spiral CT. According to the CAC score, the patients were divided into coronary artery calcification group (10 points) and no calcification group. Blood calcium, serum phosphorus and parathyroid hormone C reactive protein were measured before dialysis. Serum albumin, serum lipids and hemoglobin were calculated and calcium and phosphorus products were calculated. Age and dialysis time were compared between the two groups. The difference of blood pressure and serological indexes. Patients with CAC score greater than 50 were randomly divided into two groups: one group (n = 10) was treated with routine therapy for 3 months and the other group (n = 17). After hemodialysis, 15 patients received STS(0.18g/kg body weight, dissolved in 100ml of normal saline) and received intravenous drip for 30 minutes. Patients were given liver and kidney function, electrolyte, blood lipid, blood routine, parathyroid hormone C-reactive protein 25 hydroxyvitamin D and osteogenic alkaline phosphatase before treatment for 3 months. Fibroblast growth factor 23 (FGF23) and bone mineral density (BMD) were examined again after treatment. The factors affecting vascular calcification were analyzed and compared between the two groups before and after treatment. Changes of biochemical and bone mineral density. Results 27 out of 1.38 patients with MHD had coronary artery calcification and the age of coronary artery calcification group was 71.05%. Dialysis time, serum phosphorus, calcium and phosphorus product, parathyroid hormone and C-reactive protein levels were significantly higher than those in non-calcified group. 0.006; The albumin level in the former group was lower than that in the latter group (0.026%). There was no significant difference in other indexes. 2. Under the condition that the baseline values of the two groups were basically the same before treatment. There was no significant difference in CAC score before and after treatment in STS group. However, the CAC score in the routine treatment group increased significantly (P < 0.05). The difference of CAC score between the two groups before and after treatment was significantly different (P < 0.05). The level of C-reactive protein decreased (P < 0.05). P0. 016). The level of HCO3- was decreased by 0.020%, and the level of serum calcium was increased (P 0.005). Other indexes such as parathyroid hormone 25 hydroxyvitamin D and osteogenic alkaline phosphatase were found. There was no significant change of fibroblast growth factor 23 in STS group before and after treatment. Adverse reactions of sodium thiosulfate were nausea and vomiting in 3 cases, fatigue in 1 case and thirst in 2 cases. 1 case sneezed and 5 cases decreased BMD. In routine treatment group, BMD decreased in 1 case, but the number of BMD decrease between two groups was chi-square test, 蠂 ~ 2 ~ (2) ~ (1) 791U ~ (-1) P ~ (-1) P ~ (-1) P ~ (0.345). There is no statistical difference. Conclusion 1. Coronary artery calcification is common in maintenance hemodialysis patients, which is mainly associated with age, dialysis time, abnormal calcium and phosphorus metabolism, inflammatory reaction. 2. Sodium thiosulfate treatment may delay the progress of coronary artery calcification and inhibit inflammatory reaction. There is no serious adverse reaction in the course of treatment, but the effect of sodium thiosulfate on bone mineral density needs further study.
【學(xué)位授予單位】：福建醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R459.5

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相關(guān)期刊論文 前1條

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本文編號：1404397