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目的调查慢性肾脏病(CKD)3~5期未透析治疗患者的血钙、磷及甲状旁腺素现状,为透析治疗前CKD患者诊治钙磷代谢紊乱提供参考。方法回顾性分析159例CKD 3~5期未透析治疗患者的血钙、磷、全段甲状旁腺素(i PTH)水平,评估低钙、高磷及继发性甲状旁腺功能亢进的发生率。结果追踪患者1年内血钙、磷、i PTH检测情况,血钙、磷、i PTH三项指标均未检测的患者有12例。CKD 3、4、5期患者血钙水平分别为(2.23±0.13)、(2.15±0.13)、(1.95±0.31)mmol/L,逐期递降(P<0.01);血磷水平分别为(1.24±0.27)、(1.36±0.31)、(1.97±0.72)mmol/L,逐期递升(P<0.01);i PTH水平分别为(76.56±33.96)、(220.49±244.56)、(319.00±178.81)pg/ml,逐期递升(P<0.05)。低钙血症发生率分别为16.67%、31.81%、60.47%(P<0.01);高磷血症发生率分别为13.33%、27.27%、41.86%(P<0.01);继发性甲状旁腺功能亢进发生率分别为33.33%、43.47%、66.67%(P<0.05)。两两比较显示,CKD 5期患者的血钙、磷、i PTH水平和CKD 3期、4期分别相比差异均有统计学意义(P均<0.01)。结论 CKD患者的钙磷代谢紊乱在CKD 3期即存在,且随着肾功能的下降而加重,临床上对透析前CKD患者的钙磷代谢紊乱重视不足,应加强早期监测及干预,改善预后。
Objective To investigate the status of serum calcium, phosphorus and parathyroid hormone in patients with chronic kidney disease (CKD) stage 3 ~ 5 without dialysis and to provide a reference for diagnosis and treatment of disorders of calcium and phosphorus metabolism in patients with CKD before dialysis. Methods The levels of serum calcium, phosphorus and whole-body parathyroid hormone (i PTH) in 159 patients with CKD stage 3-5 were retrospectively analyzed to evaluate the occurrence of hypocalcemia, hyperphosphatemia and secondary hyperparathyroidism rate. Results The follow-up of patients with calcium, phosphorus, i PTH detection within 1 year, 12 cases of patients without serum calcium, phosphorus, i PTH three indicators were not detected. The levels of serum calcium were (2.23 ± 0.13), (2.15 ± 0.13) and (1.95 ± 0.31) mmol / L in CKD stage 3, 4, (P <0.01). The levels of i PTH were (76.56 ± 33.96), (220.49 ± 244.56), (319.00 ± 178.81) and pg / ml, gradually increased (P <0.05). The incidence of hypocalcemia was 16.67%, 31.81%, 60.47% respectively (P <0.01). The incidences of hyperphosphatemia were 13.33%, 27.27%, 41.86% (P <0.01) The incidence of hyperthyroidism were 33.33%, 43.47%, 66.67% (P <0.05). The comparison between the two groups showed that the levels of serum calcium, phosphorus and i PTH in CKD stage 5 patients were significantly different from those in stage 3 and stage 4 CKD patients (all P <0.01). Conclusions The disorder of calcium and phosphorus metabolism in patients with CKD exists in CKD stage 3 and aggravates with the decline of renal function. In clinic, the disorder of calcium and phosphorus metabolism in patients with CKD before dialysis lays little emphasis. Early monitoring and intervention should be strengthened to improve prognosis.