维持性血液透析患者矿物质代谢异常与血管钙化的相关性研究

摘要

Objective To study the relationship between minerals disorders and vascular calcification of maintenance hemodialysis (MHD) patients. Methods 91 MHD patients in our dialysis center were enrolled,whose sereum calcium, phosphorous, intact PTH (iPTH), 1-84PTH,25 (OH)D and ALP were measured. X-ray examinations of hands, pelvis and lateral lumbar spine were applied to evaluate vascular calcification One-way ANOVA and S-N-K was used to compare the difference of quantitative data, pearson correlation was applied to study correlation between two parameters. Results There were 22 patients scored 0 without vascular calcification,38 patients scored 1～3with mild degree vascular calcification, 20 patients scored 4～6 with moderate degree vascular calcification and 11 patients scored 7～10 with severe degree vascular calcification. The prevalence of vascular calcification was 75.8％. Serum iPTH in severe calcification group was higher than in other 3 groups (P＜0.05) and Serum ALP in severe calcification group is the highest. There was a positive correlation between iPTH and calcification score (r=0.323, P=0.003), a positive correlation between ALP and calcification score (r=0.359, P=0.007),a negative correlation between 25(OH)D and iPTH (r -0.207, P=0.012), a positive correlation between PTH (1-84) and iPTH, and a positive correlation between PTH and ALP (r = 0.729, P=0.000/r=0.215, P=0.041).There was no difference in calcium, phosphorus, calcium×phosphorus product, 25(OH)D or PTH (1-84) among the 4 groups. Conclusions Minerals disorders are common in MHD patients, and they may contribute to vascular calcification. Further study may help to find out whether good control of minerral disorder can improve or delay the process of the vascular calcification.%目的 研究维持性血液透析(maintenance hemodialysis,MHD)患者矿物质代谢异常与血管钙化的关系.方法 纳入四川省人民医院血液透析中心的MHD患者91例,检测其血钙、血磷、全段甲状旁腺激素(intact parathyroid hormone,iPTH)、甲状旁腺激素(parathyroid hormone,PTH)(卜84)、25-羟维生素D[25(OH)D]和血清碱性磷酸酶(alkaline phosphatase,ALP)水平,并完善腰椎侧位、骨盆和双手X光片检查进行钙化评分.比较不同钙化程度MHD患者骨矿物质代谢异常的特点.计量资料比较采用单向方差分析,两两比较采用SNK法;相关分析采用Pearson检验.结果 根据X线钙化评分将患者分为无钙化(0分,22例)、轻度钙化(1～3分,38例)、中度钙化(4～6分,20例)和重度钙化(7～10分,11例).血管钙化发生率75.8%.重度钙化组的iPTH水平较其余3组水平明显升高,差异有统计学意义(P＜0.05).重度钙化组ALP水平较中度钙化组水平明显升高,差异有统计学意义(P＜0.05).iPTH水平与钙化评分之间呈正相关关系(r=0.323,P=0.003);血ALP水平与钙化评分之间呈正相关关系(r=0.359,P=0.007);25(OH)D水平与血iPTH水平呈负相关关系(r=-0.207,P=0.012):血PTH(1-84)与血iPTH正相关(r=0.729,P＜0.01),与ALP水平正相关(r=0.215,P=0.041).不同组之间的血钙、血磷、钙磷乘积、25(OH)D和PTH(1-84)差异无统计学意义(P＞0.05).25(OH)D水平与血钙、血磷、ALP和钙磷乘积无相关性.结论 矿物质代谢异常是MHD患者的常见并发症,且与血管钙化程度有一定相关性,控制矿物质代谢异常能否改善或延缓血管钙化进程值得进一步研究.