维持性血液透析患者血清钙磷及PTH水平与心脏结构功能的相关性
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摘要
目的分析维持性血液透析患者血清钙磷及甲状旁腺素(PTH)水平与心脏结构、功能的关系。方法选取2013年4月至2015年1月行血液透析超过12个月的88例患者作为研究对象,均测定其血清钙磷代谢水平及PTH水平,且维持性血液透析前后均测定患者心脏结构及功能,记录左心室收缩末期内径(LVDs)、左心室舒张末期内径(LVDd)、左室内径(LAD)、左室后壁厚度(LVPWT)、室间隔厚度(IVST)、左室射血分数(LVEF),并计算左室心肌质量指数(LVMI);并按照不同钙磷代谢、PTH水平进行分组,分析患者血清钙磷代谢、PTH水平与心脏结构及功能的关系。结果 (1)按检测结果分组:血钙(Ca~(2+))正常39例(44.32%),Ca~(2+)低水平49例(55.68%);血磷(P~(3-))正常33例(37.50%),P~(3-)高水平55例(62.50%);钙磷乘积正常40例(45.45%),钙磷乘积高水平48例(54.55%);PTH正常42例(47.73%),PTH高水平46例(52.27%)。(2)不同钙磷代谢、PTH水平组的心脏结构及功能指标比较:低水平Ca~(2+)组以及高水平的P~(3-)、钙磷乘积和PTH组其LVds、LVDd、LVMI分别高于正常水平的Ca~(2+)、P~(3-)、钙磷乘积和PTH组(P均<0.05);此外,高水平PTH组的LAD高于PTH正常组。(3)相关性分析结果:Ca~(2+)水平与LVDd、LVMI呈负相关,与LVEF呈正相关;血清P~(3-)、钙磷乘积、PTH水平分别与LVds、LVDd、LVMI呈正相关,与LVEF呈负相关,同时PTH还与LAD呈正相关,差异均有统计学意义(P<0.05,P<0.01)。结论维持性血液透析患者常伴钙磷代谢紊乱及高PTH表现,且与患者左室肥厚及左室收缩能力受损有关。
Objective To analyze the relationship of serum calcium(Ca~(2+)),phosphorus(P~(3-)) and parathyroid hormone(PTH) levels with cardiac structure and function in maintenance hemodialysis patients.Methods A total of 88 patients who received hemodialysis for more than 12 months from April 2013 to January 2015 were selected as study subjects.Serum calcium-phosphorus(Ca-P) metabolism levels and PTH levels were measured. Cardiac structure and function were measured before and after maintenance hemodialysis. Left ventricular end systolic diameter(LVDs),left ventricular end diastolic diameter(LVDd),left ventricular internal diameter(LAD),left ventricular posterior wall thickness(LVPWT),ventricular septal thickness(IVST),left ventricular ejection fraction(LVEF) were recorded and left ventricular mass index(LVMI) was calculated. All the patients were divided into different groups according to different levels of Ca-P metabolism and PTH,and the relationship with serum Ca-P metabolism,PTH level between cardiac structure and function was analyzed.Results According to the test results,39 cases(44.32%) were normal Ca~(2+),49 cases(55.68%) were low Ca~(2+),33 cases(37.50%) were normal P~(3-),55 cases(62.50%) were high P~(3-),40 cases(45.45%) were normal Ca-P product,48 cases(54.55%) were high Ca-P product,42 cases(47.73%) were normal PTH and 46 cases(52.27%) were high PTH. LVds,LVDd and LVMI in low Ca~(2+) group and high P~(3-),Ca-P product and PTH group were higher than those in normal Ca~(2+),P~(3-),Ca-P product and PTH group(all P< 0.05),and LAD in high level PTH group was higher than that in normal PTH group. Relevance analysis results show that Ca~(2+) levels were negatively correlated with LVDd and LVMI,and positively correlated with LVEF(all P<0.01). Serum levels of P~(3-),Ca-P product and PTH were positively correlated with LVds,LVDd and LVMI,and negatively correlated with LVEF,while PTH was positively correlated with LAD(P<0.05,P<0.01).Conclusion Maintenance hemodialysis patients often have disorders of Ca-P metabolism and high PTH manifestations,which are related to left ventricular hypertrophy and impaired left ventricular systolic function.
Objective To analyze the relationship of serum calcium(Ca~(2+)),phosphorus(P~(3-)) and parathyroid hormone(PTH) levels with cardiac structure and function in maintenance hemodialysis patients.Methods A total of 88 patients who received hemodialysis for more than 12 months from April 2013 to January 2015 were selected as study subjects.Serum calcium-phosphorus(Ca-P) metabolism levels and PTH levels were measured. Cardiac structure and function were measured before and after maintenance hemodialysis. Left ventricular end systolic diameter(LVDs),left ventricular end diastolic diameter(LVDd),left ventricular internal diameter(LAD),left ventricular posterior wall thickness(LVPWT),ventricular septal thickness(IVST),left ventricular ejection fraction(LVEF) were recorded and left ventricular mass index(LVMI) was calculated. All the patients were divided into different groups according to different levels of Ca-P metabolism and PTH,and the relationship with serum Ca-P metabolism,PTH level between cardiac structure and function was analyzed.Results According to the test results,39 cases(44.32%) were normal Ca~(2+),49 cases(55.68%) were low Ca~(2+),33 cases(37.50%) were normal P~(3-),55 cases(62.50%) were high P~(3-),40 cases(45.45%) were normal Ca-P product,48 cases(54.55%) were high Ca-P product,42 cases(47.73%) were normal PTH and 46 cases(52.27%) were high PTH. LVds,LVDd and LVMI in low Ca~(2+) group and high P~(3-),Ca-P product and PTH group were higher than those in normal Ca~(2+),P~(3-),Ca-P product and PTH group(all P< 0.05),and LAD in high level PTH group was higher than that in normal PTH group. Relevance analysis results show that Ca~(2+) levels were negatively correlated with LVDd and LVMI,and positively correlated with LVEF(all P<0.01). Serum levels of P~(3-),Ca-P product and PTH were positively correlated with LVds,LVDd and LVMI,and negatively correlated with LVEF,while PTH was positively correlated with LAD(P<0.05,P<0.01).Conclusion Maintenance hemodialysis patients often have disorders of Ca-P metabolism and high PTH manifestations,which are related to left ventricular hypertrophy and impaired left ventricular systolic function.
引文
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[3] 李晴,高琳,王巍,等.维持性血液透析患者血清成纤维细胞生长因子23水平与血清钙、磷水平及左心室功能的关系研究[J].中国全科医学,2013,15(41):4173-4175.
[4] 张磊,王志奎,马金玲,等.维持性血液透析及腹膜透析患者心脏瓣膜钙化的评估[J].实用医学杂志,2016,32(7):1130-1132.
[5] 赖玮婧,刘芳,付平.慢性肾脏病评估及管理临床实践指南解读——从K/DOQI到KDIGO[J].中国实用内科杂志,2013,33(6):448-453.
[6] 彭斌,许涛,盛晓华,等.糖尿病肾病致终末期维持性血液透析患者的心脏结构及功能特点分析[J].中国中西医结合肾病杂志,2014,15(1):20-23.
[7] 杜亚琴,李怡,王莉.炎症、氧化应激与终末期肾病血管钙化[J].实用医院临床杂志,2016,13(5):218-221.
[8] 肖晓芬,王小琴,韩四萍,等.2～4期慢性肾脏病患者左心室肥厚的相关因素分析[J].广东医学,2016,37(4):528-531.
[9] 陈少敏,陈宝霞,聂颖,等.动态血压水平和血压变异性与心肌做功指数的关系[J].中华心血管病杂志,2015,43(4):304-307.
[10] 李英.慢性肾脏病并发急性心肌梗死的危险因素及对策[J].肾脏病与透析肾移植杂志,2014,23(4):349-350.
[11] Ylmaz H,Bilgic MA,Gurel OM,et al.OP-122 Ca 125 Levels and LV function in patients with ESRD treated with maintenance hemodialysis patients[J].Am J Cardiol,2014,113(7):S36.
[12] 涂曦文,彭佑铭,唐东兴,等.维持性血液透析患者血管钙化及相关因素分析[J].中国动脉硬化杂志,2015,23(6):613-616.
[13] 任闯,姚丽,樊星,等.维持性血液透析患者生活质量与矿物质代谢指标的相关性分析[J].中华肾脏病杂志,2016,32(12):893-898.
[14] 王金宝,张金玉,周健美,等.维持性血液透析患者钙、磷、iPTH代谢异常的调查分析[J].实用医学杂志,2016,32(2):333.
[15] 廖琳,路建饶,王新华,等.血液透析患者钙磷代谢和血管钙化及其危险因素[J].中国综合临床,2014,30(5):453-457.
[16] Sezer S,Tutal E,Bal Z,et al.Differential influence of vitamin D analogs on left ventricular mass index in maintenance hemodialysis patients[J].Int J Artif Organs,2014,37(2):118-125.