【摘要】：目的:探討維持性血液透析(MHD)合并難治性繼發(fā)性甲狀旁腺功能亢進(jìn)(r SHPT)患者腹主動脈鈣化(AAC)的相關(guān)因素。方法:選取2014年5月至2016年1月間于中日友好醫(yī)院就診擬行甲狀旁腺切除術(shù)的r SHPT患者,記錄患者一般情況,血清全段甲狀旁腺激素(i PTH)、血清鈣(Ca)、血清磷(P)及骨轉(zhuǎn)化標(biāo)志物等實(shí)驗(yàn)室指標(biāo),測量骨密度(BMD),根據(jù)AAC評分分為無鈣化、輕度鈣化、中重度鈣化三組,比較三組之間的差異。結(jié)果:82例r SHPT患者納入研究,年齡50.99±12.98歲,透析齡88.42±50.15月,男性40例占48.8%。AAC發(fā)生率為63.4%,其中腰椎L1~L4對應(yīng)的四段血管壁均受累20例(24.4%)。男性AAC積分更高(P=0.016)。與無鈣化組相比,發(fā)生鈣化的兩組年齡更大(P0.001),透析齡更長(P0.05);輕度及中重度鈣化組的I型膠原羧基端肽(CTX)明顯低于無鈣化組(P0.05)。多重線性回歸分析發(fā)現(xiàn):AAC與年齡(r=0.042,P0.001)、血清磷(r=0.438,P=0.045)呈正相關(guān),與CTX(r=-0.100,P=0.035)呈負(fù)相關(guān)。結(jié)論:MHD合并r SHPT患者AAC發(fā)生率高,高齡、男性、高血磷及CTX低是血管鈣化的易感因素。
[Abstract]:Objective: to investigate the risk factors of abdominal aortic calcification (AAC) in patients with maintenance hemodialysis (MHD) combined with refractory secondary hyperparathyroidism (r SHPT). Methods: from May 2014 to January 2016, r SHPT patients undergoing parathyroidectomy in China-Japan Friendship Hospital were selected. The general status of the patients was recorded, and the serum total parathyroid hormone (i PTH), serum calcium (Ca), was recorded. Serum phosphorus (P) and bone transformation markers were measured. Bone mineral density (BMD),) was measured and divided into three groups according to AAC score: no calcification, mild calcification and moderate and severe calcification. The difference between the three groups was compared. Results: 82 patients with r SHPT were enrolled in the study. The age was 50.99 鹵12.98 years old and the dialysis age was 88.42 鹵50.15 months. The incidence of 48.8%.AAC was 63.4% in 40 male patients. Of them, 20 cases (24.4%) were involved in the four segments of L1~L4. Male AAC score was higher (P0. 016). Compared with the non-calcification group, the two groups with calcification were older (P0.001) and longer dialysis age (P0.05); the type I collagen carboxyl terminal peptide (CTX) of mild and moderate calcification group was significantly lower than that of non-calcified group (P0.05). Multiple linear regression analysis showed that AAC was positively correlated with age (r = 0.042), serum phosphorus (r = 0.438), and negatively correlated with CTX (r = 0.100). Conclusion: the incidence of AAC in patients with MHD and r SHPT is high. The elderly, male, high blood phosphorus and low CTX are the risk factors of vascular calcification.
【作者單位】： 山西醫(yī)科大學(xué);中日友好醫(yī)院腎內(nèi)科;中日友好醫(yī)院放射科;山西省人民醫(yī)院腎內(nèi)科;
【基金】：首都臨床特色應(yīng)用研究與成果推廣(Z151100004015112)
【分類號】：R581.1;R692

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