目的 探讨高磷血症在糖尿病肾病(DN)和IgA肾病(IgAN)中患病率的差异,探讨合并高磷血症的DN和IgAN患者的血磷水平与动脉钙化和心肾功能等预后因素的相关性.方法 比较所有入组的DN和IgAN的临床资料,并根据慢性肾脏病(CKD)分期,比较两种疾病及CKD各期高磷血症发生率;筛选DN和IgAN组中高磷血症患者,分成高磷血症DN组和高磷血症IgAN组,比较各自血清磷浓度与动脉钙化和心肾功能等指标的相关性.结果 DN组患者的年龄、BMI、高血压患病率、血磷、尿素氮、血糖、24h尿蛋白水平显著高于IgAN组患者,血钙、血清白蛋白、血清总蛋白、eGFR、血红蛋白水平显著低于IgAN组患者.DN组高磷血症的发病率高于IgAN组(P<0.05),且DN在CKD2-4期的血磷亦高于IgAN组(P<0.05).相关性分析发现:合并高磷血症的DN和IgAN的患者,其血磷浓度与血肌酐、血尿素氮、血管钙化严重程度均呈正相关(P<0.05);与eGFR、血红蛋白、左室射血分数均呈负相关(P<0.05).高磷血症的DN血管钙化发生率高于高磷血症的IgAN(P<0.05),血磷增高的程度与动脉钙化的评分呈正比.结论 DN患者血磷水平及CKD各期高磷血症的患病率均高于IgAN组患者,随着肾功能下降这两种疾病高磷血症的患病率逐渐上升;高磷血症的DN和高磷血症的IgAN患者的肾功能指标、动脉钙化和心脏泵射血分数与血磷浓度相关,控制血磷有助于延缓血管钙化和心肾功能恶化.DN患者的血磷控制意义更大.%Objective To investigate the differences of the hyperphosphatemia prevalence between the groups who have diabetic nephropathy (DN)and IgA nephropathy(IgAN)and to find the relevance of serum phosphate level and prognostic factors such as arteriosteogenesis or heart-kidney function in DN and IgAN patients who also have hyperphosphatemia.Methods The clinical data of all the DN and IgAN patients who meet the standard were collected and the hyperphosphatemia prevalence were compared based on the chronic kidney disease(CKD)stage.Then the patients who had hyperphosphatemia in each group were chosen and the arteriosteogenesis level and heart-kidney function with serum phosphate were compared to figure out if they had relationships.ResultsThe age,body mass index(BMI),the prevalence of hypertension,phosphorus,blood urea nitrogen, glucose,24h urine protein levels of DN patients were significantly up-regulated compared to those in IgAN group.Serum calcium,serum albumin, serum total protein,eGFR,hemoglobin levels were significantly down-regulated compared to the IgAN patients. The prevalence of hyperphosphatemia in DN group was significantly higher compared with that in IgAN group(P<0.05),so as the serum phosphate level in CKD2-4 stage of DN patients (P<0.05).The relevance shows that no matter which type nephropathy the patients belonged to,as long as they had hyperphosphatemia,the serum phosphate level was positively correlated with serum creatinine,blood urea nitrogen,the severity of arteriosteogenesis(P<0.05)and negatively correlated with eGFR,hemoglobin,left ventricular ejection fraction(P<0.05). The incidence of arteriosteogenesis level among DN patients who had hyperphosphatemia was higher than that in IgAN group(P<0.05).Conclusion With the decline of renal function,the prevalence of hyperphosphatemia in two diseases gradually increases and the prevalence of hyperphosphatemia of different CKD stages and serum phosphate level in DN patients are higher than those of IgAN group.The renal function index,arteriosteogenesis,and cardiac pump fraction are associated with serum phosphate level in patients who have hyperphosphatemia with DN or IgAN.The control of the serum phosphate level can defer the calcification of blood vessels and the deterioration of heart-kidney function. To strictly control the serum phosphate level in DN patients is more meaningful clinically.
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