本文選題：腎病 + 慢性病��； 參考：《中國全科醫(yī)學》2017年12期

【摘要】：目的分析慢性腎臟病(CKD)1~5期患者礦物質(zhì)骨代謝指標變化特征,為早期CKD患者礦物質(zhì)骨代謝的治療提供依據(jù)。方法回顧性選取2013年在南昌大學第二附屬醫(yī)院腎內(nèi)科住院且符合納入標準的391例CKD患者的臨床資料,依據(jù)腎臟病預后質(zhì)量倡議(KDOQI)指南推薦的CKD分期標準將患者分為CKD 1~2期32例(CKD1~2期組)、CKD 3期67例(CKD 3期組)、CKD 4期79例(CKD 4期組)、CKD 5期213例(CKD 5期組)。比較4組患者一般資料(性別、年齡、糖尿病發(fā)生率)、血肌酐、估算腎小球濾過率(eGFR)、礦物質(zhì)骨代謝指標{血鈣、血磷、血鈣磷乘積、全段甲狀旁腺激素(iPTH)、25羥維生素D-3(25(OH)D_3]、骨型堿性磷酸酶(BSALP)、骨鈣素};分析CICD患者eGFR、部分礦物質(zhì)骨代謝指標〔iPTH、25(OH)D_3、BSALP,骨鈣素)的相關(guān)性;并計算CKD3、4、5期組患者血鈣、血磷、血鈣磷乘積、iPTH達標率(達標率均參照KDOQI指南推薦的CKD患者礦物質(zhì)骨代謝指標參考范圍)。結(jié)果CKD 3期組患者25(OH)D_3低于CKD1~2期組(P0.05);CKD 4期組患者血磷、血鈣磷乘積、iPTH、BSALP高于CICD 1~2期組,25(OH)D_3低于CICD 1~2期組和CICD 3期組,骨鈣素高于CKD 1~2期組和CKD 3期組(P0.05);CKD 5期組患者血鈣低于CKD 1~2期組、CKD 3期組、CKD 4期組,血磷、血鈣磷乘積、iPTH、骨鈣素高于CKD 1~2期組、CKD 3期組、CKD 4期組,25(OH)D_3低于CKD 1~2期組和CKD 3期組,BSALP高于CKD1~2期組、CKD 3期組(P0.05)。eGFR與iPTH、BSALP,骨鈣素呈負相關(guān)(r值分別為-0.49、-0.18、-0.43,P0.05),與25(OH)D_3呈正相關(guān)(r=0.34,P0.05);iPTH與25(OH)D_3呈負相關(guān)(r=-0.17,P0.05),與BSALP、骨鈣素呈正相關(guān)(r值分別為0.34、0.60,P0.05);25(OH)D_3與骨鈣素呈負相關(guān)(r=-0.11,P0.05),25(OH)D_3與BSALP無直線相關(guān)關(guān)系(r=0.10,P0.05);BSALP與骨鈣素呈正相關(guān)(r=0.25,P0.05)。CKD 3、4、5期組患者血鈣達標率分別為86.6%(58/67)79.7%(63/79)和37.6%(80/213);CKD 3、4、5期組患者血磷達標率分別為82.1%(55/67)69.6%(55/79)、46.0%(98/213);CKD 3、4、5期組患者血鈣磷乘積達標率分別為100.0%(67/67)、97.5%(77/79)、76.5%(163/213);CKD 3、4、5期組患者iPTH達標率分別為43.3%(29/67)、26.6%(21/79)、39.0%(83/213)。CKD_3、4、5期組患者各項指標均達標的達標率分別為31.3%(21/67)、19.0%(15/79)、11.7%(25/213)。結(jié)論早、中期CKD患者已存在礦物質(zhì)骨代謝指標異常,且隨著腎功能的惡化,iPTH、BSALP,骨鈣素均有不同程度的升高;血鈣、血磷在CKD 4~5期變化明顯;CKD 1~5期患者普遍存在25(OH)D_3不足和缺乏現(xiàn)象,CKD 3~5期患者礦物質(zhì)骨代謝指標符合KDOQI指南推薦參考范圍的達標率很低,特別是iPTH。
[Abstract]:Objective to analyze the characteristics of mineral bone metabolism in patients with chronic kidney disease (CKD) stage 1 and 5, and to provide evidence for the treatment of mineral bone metabolism in early CKD patients. Methods the clinical data of 391 patients with CKD who were hospitalized in Department of Renal Medicine, second affiliated Hospital of Nanchang University in 2013 were retrospectively selected. According to the CKD staging criteria recommended by the prognosis quality Initiative (KDOQI) guidelines, the patients were divided into 32 cases of CKD 1 / 2 (CKD 1 / 2) and 67 cases of CKD 3 (CKD 3). 79 cases of CKD 4 (CKD 4) and 213 cases of CKD 5 (CKD 5) were divided into two groups. General data (sex, age, incidence of diabetes), serum creatinine, estimated glomerular filtration rate (eGFR), mineral bone metabolism index {blood calcium, blood phosphorus, blood calcium and phosphorus product] were compared among the four groups. Total parathyroid hormone (iPTH) 25 hydroxyvitamin D-3 (25 (OH) D3], bone type alkaline phosphatase (BSALP), osteocalcin}; Analysis of the correlation of some mineral bone metabolism indexes (iPTH25 (OH) D3BSALP, osteocalcin) in CICD patients; The serum calcium and phosphorus product and iPTH reached the standard rate (all according to the reference range of mineral bone metabolism index of CKD patients recommended by KDOQI guidelines). Results 25 (OH) D3 in CKD3 group was lower than that in CKD1 / 2 stage 2 group (P0.05). The serum calcium and phosphorus product of IPTHD BSALP was significantly higher than that of CICD 1 / 2 stage 2 group and CICD 1 / 2 stage 2 group and CICD 3 stage group, respectively. Osteocalcin was higher than that in CKD 1 stage 2 and CKD 3 stage group (P0.05) the level of serum calcium in CKD 5 stage group was lower than that in CKD 1 stage 2 group and CKD 3 stage group. The BSALP of serum calcium phosphate product was higher than that of CKD stage 3 group (P 0.05). The osteocalcin level was negatively correlated with 25 (OH) D3 (r = -0.49- 0.18) -0.43P, and positively correlated with 25 (OH) D3 (r = -0.49) D3 (r = -0.49) and 25 (OH) D3 P (r = -0.49 ~ -0.18 ~ (-0.18) D3 (r = -0. 49) D3 (r = -0. 49) and 25 (OH) D3 (r = 0. 34, P < 0. 05). The BSALP of BSALP was higher than that of CKD 3 (P0.05). EGFR was negatively correlated with IPTHBSALP (r = -0. 49-0. 18) -0. 43 respectively. 鍛堣礋鐩稿叧(r=-0.17,P0.05),涓嶣SALP,楠ㄩ挋绱犲憟姝ｇ浉鍏，

本文編號：2113604