低钙透析对低甲状旁腺激素血液透析患者矿物质及骨代谢的影响

摘要

Objective To observe the effect of dialysate with lowering calcium concentration on mineral metabolism and bone turnover in patients with low level of parathyroid hormone on hemodialysis. Methods Total 70 patients with iPTH<100 pg/mL were treated with DCa-1. 25mmol/l dialysate for 1 year. Serum calcium, phosphorus, alkaline phosphatase ( ALP) levels were determined by standard method. Their levels of serum intact parathyroid ( iPTH) , osteocalcin ( OC) , procollagen type I amino-terminal propeptide ( PINP) , β-crosslaps (β-CTX) were measured by Chemiluminescence. iPTH, OC, PINP,β-CTX, serum calcium, phosphorus, ALP were measured before and 1,3,6,12 months after the change of dialysate. Results After lowering D-Ca, serum iPTH levels progressively increased at 3 months(P<0. 001), and serum OC, PINP, β-CTX levels increased at 1 months(P<0. 001). In correlation analyses, the changes in OC and β-CTX correlated positively with baseline iPTH (OC :r =0. 673,P =0. 037;β-CTX:r =0. 651,P =0. 020), and correlated negatively with age (OC :r= -0. 816,P<0. 001;β-CTX:r= -0. 718,P<0. 001). In Logistic regression analysis, baseline iPTH, diabetes were independent factors of the improvement of iPTH level. Conclusion Dialysate with lowering calcium concentration can improve PTH levels and stimulate bone metabolism.%目的：低钙透析对低甲状旁腺激素血液透析患者甲状旁腺激素及骨代谢的影响。方法选取70例血清全段甲状旁腺激素( intact parathyroid,iPTH)<100 pg/ mL的维持性血液透析患者。应用1．25 mmol/L钙浓度透析液进行血液透析治疗,随访1年。常规检测生化指标———血钙、血磷、血清碱性磷酸酶( alkaline phosphatase, ALP ),化学发光法检测 iPTH、骨钙素(osteocalcin, OC)、I型前胶原氨基末端前肽(procollagen type I amino-terminal propeptide, PINP)、β胶原蛋白(β-crosslaps,β-CTX),观察患者应用1．25 mmol/L钙浓度透析液前及应用后1、3、6、12个月时血钙、血磷、ALP、iPTH变化以及OC、PINP、β-CTX等骨代谢指标的变化。结果1)血清iPTH浓度于应用1．25 mmol/L钙浓度透析液3个月后显著升高(P<0．001)；2)更换透析液后各时间点与更换前比较,血清OC浓度、PINP浓度及β-CTX浓度于更换1个月后显著升高,差异有统计学意义( P<0．001)；3)OC浓度变化与年龄呈负相关(r=-0．816,P<0．001)、与基线iPTH浓度呈正相关(r=0．673,P=0．037)；β-CTX浓度变化与年龄呈负相关(r=-0．718,P<0．001)、与基线iPTH浓度吴正相关(r=0．651,P=0．020)；4)更换透析液前基线血清iPTH浓度(P<0．001)、糖尿病史(P=0．012)是iPTH改善的独立影响因素。结论低钙透析可以改善低甲状旁腺激素患者iPTH浓度,升高OC、PINP及β-CTX浓度,增加骨代谢,是治疗低转运骨病的有效方法。