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目的了解滁州地区维持性血液透析(maintenance hemodialysis,MHD)患者的矿物质和骨异常(mineral and bone disorder,MBD)现状。方法调查2014年4~6月滁州地区7家医院血液透析中心的MHD患者情况。调查内容包括患者一般人口学特征、实验室检查、临床表现及用药情况等。分别以肾脏疾病患者生存质量指导(Kidney Disease Outcomes Quality Initiative,KDOQI)和改善全球肾脏病预后组织(Kidney Disease:Improving Global Outcomes,KDIGO)指南为标准,观察血校正钙、血磷、全段甲状旁腺素(immunoreactive parathyroid hormone,iPTH)达标情况,将其达标率与透析预后和实践模式研究(the dialysis outcomes and practice patterns study,DOPPS)4比较;并比较三级医院与二级医院MHD者血校正钙、血磷、iPTH达标率。结果①入选病例1 021例,平均透析时间(46.6±37.3)月。原发病前3位是慢性肾小球肾炎(512例,占50.1%)、糖尿病肾脏疾病(206例,占20.2%)、高血压肾病(144例,占14.1%)。②以KDOQI指南为标准,滁州市MHD者血校正钙、磷、iPTH达标率分别为40.5%、37.4%、21.3%,低于DOPPS4的56.7%、52.6%、29.6%(均P<0.01)。③以KDIGO指南为标准,上述指标达标率分别为51.5%、19.8%、46.2%。④以KDOQI指南为标准,三级医院患者血磷、血iPTH达标率高于二级医院(P<0.05),而血校正钙达标率两者差异无统计学意义。⑤MBD治疗状况:以KDIGO指南为标准,低钙、高磷和继发性甲状旁腺功能亢进的不当治疗分别占47.5%、47.6%、32.5%。结论滁州地区MHD者血钙、血磷及iPTH达标率低。三级医院MHD患者MBD控制情况较二级医院好,加强检测和管理有望提高相关指标的达标率。
Objective To understand the status of mineral and bone disorder (MBD) in maintenance hemodialysis (MHD) patients in Chuzhou area. Methods The MHD patients from hemodialysis center of 7 hospitals in Chuzhou from April to June of 2014 were investigated. The survey includes general demographic characteristics of patients, laboratory tests, clinical manifestations and medication situation. The Kidney Disease Outcomes Quality Initiative (KDOQI) and the Guide to Improving Global Outcomes (KDIGO) were used as the standard to observe the changes of blood calcium, (IPTH) were compared with those of the dialysis outcomes and practice patterns study (DOPPS) 4 and compared with those of MHD in tertiary hospitals and secondary hospitals Calcium, phosphorus, iPTH compliance rate. Results ① 1 021 cases were selected and the average dialysis time was 46.6 ± 37.3 months. The first three cases were chronic glomerulonephritis (512 cases, accounting for 50.1%), diabetic nephropathy (206 cases, 20.2%) and hypertensive nephropathy (144 cases, 14.1%). ② According to the KDOQI guidelines, the compliance rates of calcium, phosphorus and iPTH in blood of Chuzhou MHD patients were 40.5%, 37.4% and 21.3% respectively, which were lower than 56.7%, 52.6% and 29.6% of DOPPS4 (all P <0.01). ③ The KDIGO guidelines as the standard, the above indicators were 51.5% compliance rate, 19.8%, 46.2%. ④ According to the KDOQI guidelines, the attainment rates of serum phosphorus and blood iPTH in tertiary hospitals were higher than those in secondary hospitals (P <0.05), but there was no significant difference between the two groups in blood calibration calcium. ⑤ MBD treatment: According to the guidelines of KDIGO, improper treatment of low calcium, high phosphorus and secondary hyperparathyroidism accounted for 47.5%, 47.6% and 32.5% respectively. Conclusion The level of calcium, phosphorus and iPTH in MHD in Chuzhou area is low. The MBD control of patients with MHD in tertiary hospitals is better than that of secondary hospitals, and it is expected that the detection and management of MBD will improve the compliance rate of related indicators.