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目的:了解四川地区维持性血液透析(MHD)患者慢性肾脏病矿物质与骨异常(CKD-MBD)的患病率、各个指标达标率及其发病危险因素。方法:纳入四川地区15个血液透析中心MHD患者1 150例,搜集患者一般临床资料及实验室检查结果,以超声心动图、骨盆正位片、腹部侧位片评价血管钙化。检测血清25羟维生素D[25(OH)D]、25(OH)D3、成纤维细胞生长因子23(FGF-23)和血清可溶性klotho蛋白(s KL)。以K/DOQI指南建议的目标值为标准,分析CKD-MBD患病率、各项指标达标情况及相关危险因素。结果:1 150例MHD中诊断为CKD-MBD的患者1 113例(96.78%)。其中低血磷7.80%、高血磷55.90%;低血钙31.40%、高血钙28.30%、低甲状旁腺激素(PTH)17.20%、高PTH 58.30%;心脏瓣膜钙化的患者169例(30.02%);腹主动脉钙化患者168例(45.41%);髂股动脉钙化106例(27.46%)。患者血钙、血磷、血i PTH达标率分别为36.78%、36.30%、24.50%。收缩压、血清肌酐、血尿素氮、高密度脂蛋白、血i PTH与高磷血症独立相关。透析龄、血i PTH、血清FGF-23与高血钙独立相关。血磷、白蛋白、碱性磷酸酶(ALP)与高血i PTH独立相关。结论:四川地区的MHD患者的CKDMBD的患病率高,达标率低,受多种因素影响。
Objective: To investigate the prevalence of CKD-MBD, the compliance rate of each index and the risk factors of CKD in maintenance hemodialysis (MHD) patients in Sichuan province. Methods: A total of 1 150 MHD patients from 15 hemodialysis centers in Sichuan province were enrolled in this study. The clinical data and laboratory findings of the patients were collected. Vascular calcification was evaluated by echocardiography, pelvis and abdominal lateral radiographs. Serum 25 hydroxyvitamin D [25 (OH) D], 25 (OH) D3, fibroblast growth factor 23 (FGF-23) and serum soluble klotho protein (s KL) were measured. Based on the target values recommended by the K / DOQI guidelines, the prevalence of CKD-MBD, the compliance of various indicators and the related risk factors were analyzed. Results: 1 113 cases (96.78%) of the 1 150 MHD patients diagnosed as CKD-MBD. Among them, hypophosphatemia 7.80%, hyperphosphatemia 55.90%; hypocalcemia 31.40%, hypercalcemia 28.30%, low parathyroid hormone (PTH) 17.20%, high PTH 58.30%; 169 cases of heart valve calcification (30.02 %); 168 patients (45.41%) had abdominal aortic calcification; 106 patients (27.46%) had iliac artery calcification. Patients calcium, phosphorus, blood i PTH compliance rates were 36.78%, 36.30%, 24.50%. Systolic blood pressure, serum creatinine, blood urea nitrogen, high density lipoprotein, blood i PTH independently associated with hyperphosphatemia. Dialysis age, blood i PTH, serum FGF-23 and hypercalcemia independently. Phosphorus, albumin, alkaline phosphatase (ALP) and high blood i PTH independent. Conclusion: The prevalence of CKDMBD in MHD patients in Sichuan Province is high, and the rate of compliance is low, which is affected by many factors.