【摘要】：[目的]1.分析CKD-MBD的發(fā)生率,包括血鈣、血磷、甲狀旁腺激素(Parathyroid Hormone,PTH)、25-羥維生素 D(25-Hydroxy VitaminD,25(OH)D)異常、達(dá)標(biāo)率,心血管鈣化的發(fā)生率及CKD2-5期其發(fā)生率有無差異分析;2.探討CKD患者心臟重構(gòu)、心血管鈣化、繼發(fā)性甲狀旁腺功能亢進(jìn)癥(Secondary Hyperparathyroidism,SHPT)的危險(xiǎn)因素。[方法]收集2015年6月至2015年12月期間,昆明醫(yī)科大學(xué)第一附屬醫(yī)院腎內(nèi)科住院治療的CKD2-5期患者238例資料,收集患者性別、年齡、體重、實(shí)驗(yàn)室檢查資料、碳酸鈣用藥、活性維生素D用藥等信息,分析CKD-MBD發(fā)生率,CKD四期MBD發(fā)生率有無差異,探討CKD患者心臟重構(gòu)、心血管鈣化、SHPT的危險(xiǎn)因素。[結(jié)果]1.本研究共計(jì)238例研究對(duì)象,男性153例(64.3%),女性85例(35.7%),平均年齡 50.47±15.60 歲,平均 BMI 值 23.33±3.53Kg/mm2,平均CKD病程24.00±57.00月。CKD患者原發(fā)病所占比例:慢性腎炎35%,糖尿病腎病33%,高血壓腎病12%,痛風(fēng)性腎病5%,多囊腎4%,梗阻性腎病2%,過敏性紫癜性腎炎2%,ANCA相關(guān)性小血管炎1%,多發(fā)性骨髓瘤1%,膜性腎病1%。2.CKD患者血鈣正常,偏低,偏高發(fā)生率:43.2%,47.9%,8.9%;CKD患者血磷正常,偏低,偏高發(fā)生率:53.9%,11.7%,34.3%;CKD患者PTH正常,偏低,偏高發(fā)生率:37.6%,48.1%,14.3%;CKD患者25(0H)D偏低,不足,均衡發(fā)生率:29.8%,63.2%,7.0%;CKD患者血管鈣化發(fā)生率:29.5%。3.不同 CKD 分期患者血鈣(x2=13.705,P=0.018),血磷(x2=28.806 P=0.000),PTH(x2 =17.068,P=0.004)偏低、正常、偏高發(fā)生率差異有統(tǒng)計(jì)學(xué)意義;不同CKD分期患者25(0H)D偏低、不足、均衡發(fā)生率(x 2=8.476,P=0.150),心血管鈣化(x2=4.358,P=0.200)發(fā)生率差異無統(tǒng)計(jì)學(xué)意義。4.CKD心臟重構(gòu)發(fā)生患者臨床指標(biāo)多因素Logistic回歸分析:性別(男性)(P=0.049,0R=0.428,95%CI=0.176-0.944)、糖尿病史(P=0.004,0R=10.306,95%CI=2.148-49.461)、舒張壓高(P=0.005,0R=4.58,95%CI=1.577-13.298)、高血磷(P=0.032,0R=3.077,95%CI=0.111-0.955)是CKD患者發(fā)生心臟重構(gòu)的獨(dú)立危險(xiǎn)因素。5.CKD患者心血管鈣化相關(guān)臨床指標(biāo)多因素Logistic回歸分析:高齡(P=0.001,0R=1.085,95%CI=1.033-1.139)、有糖尿病史(P=0.031,0R=4.537,95%CI=1.152-17.872)、高堿性磷酸(P=0.024,0R=8.660,95%CI=1.332-56.301)、高血鈣(P=0.029,0R=9.934,95%CI=1.265-77.982)是心血管鈣化的獨(dú)立危險(xiǎn)因素。6.CKD患者SHPT相關(guān)臨床指標(biāo)的單因素Logistic回歸分析:eGFR水平是SHPT 的影響因素(P=0.009,0R=0.587,CI=0.394-0.877)。[結(jié)論]1.CKD-MBD發(fā)生率高,臨床上MBD達(dá)標(biāo)率并不高:血鈣、血磷、PTH、25(OH)D達(dá)標(biāo)率分別為43.2%、53.9%、37.6%、25%,心血管鈣化發(fā)生率29.5%;CKD-MBD自CKD早期(CKD2期)即出現(xiàn)。2.性別(男性)、糖尿病史、高舒張壓、高血磷是CKD患者發(fā)生心臟重構(gòu)的獨(dú)立危險(xiǎn)因素。3.高齡、有糖尿病史、高堿性磷酸酶、高血鈣是心血管鈣化的獨(dú)立危險(xiǎn)因素。4.eGFR水平是SHPT的影響因素。
[Abstract]:[objective] 1. To analyze the incidence of CKD-MBD, including blood calcium, serum phosphorus, 25-Hydroxy vitamin D 25 (OH) D) abnormality, cardiovascular calcification and CKD2-5 stage. To investigate the risk factors of cardiac remodeling, cardiovascular calcification and secondary Secondary hyperparathyroidism in CKD patients. [methods] from June 2015 to December 2015, 238 CKD2-5 patients in Department of Nephrology, the first affiliated Hospital of Kunming Medical University, were collected. The data of sex, age, weight, laboratory examination, calcium carbonate medication were collected. To investigate the risk factors of cardiac remodeling and cardiovascular calcification in patients with CKD-MBD, we analyzed whether there was any difference in the incidence of MBD in the fourth phase of CKD by using active vitamin D and other information, and to explore the risk factors of cardiac remodeling and cardiovascular calcification in patients with CKD. [result] 1. A total of 238 subjects were studied, including 153 males (64.3%) and 85 females (35.7%), with an average age of 50.47 鹵15.60 years. Average BMI value 23.33 鹵3.53kg / m2, mean course of CKD 24.00 鹵57.00 months. Proportion of primary disease in patients with CKD: chronic nephritis 35g, diabetic nephropathy 33cm, hypertension nephropathy 12, gouty nephropathy 5cm, polycystic kidney 4, obstructive nephropathy 2and anaphylactoid purpura nephritis 2and ANCA correlation Small vasculitis 1, multiple myeloma 1, membranous nephropathy 1%.2.CKD patients with normal blood calcium, The incidence of blood phosphorus in patients with CKD was normal and low, and the incidence was higher than that in patients with CKD: 53.9% 11.73.34%. The incidence of PTH in patients with CKD was normal, low, and high. The incidence of PTH in patients with CKD was normal, low, and high. The incidence of 25 (0H) D in patients with CKD was lower than that in patients with 14.3CKD, and the incidence of balanced incidence was 29.83.27.00.The incidence of vascular calcification was 29.5.30.The rate of blood vessel calcification in patients with CKD was lower than that in patients with CKD, and the proportion of blood vessels in patients with CKD was lower than that in patients with CKD. In patients with different CKD stages, the levels of serum calcium (x2n 13.705) and phosphorus (x228.806 Pu 0.000) were low, normal and high, while 25 (0H) D in patients with different CKD stages was lower than that in patients with different CKD stages. 鍧囪　鍙戠敓鐜，

本文編號(hào)：2197364