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中华肾病研究电子杂志 ›› 2014, Vol. 03 ›› Issue (03) : 137 -142. doi: 10.3877/cma.j.issn.2095-3216.2014.03.005

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肾脏病磷代谢紊乱的机制和防治
陈靖1,(), 王梦婧1   
  1. 1.200040 上海,复旦大学附属华山医院肾病科,复旦大学肾脏病研究所
  • 出版日期:2014-06-15
  • 通信作者: 陈靖
  • 基金资助:
    国家自然科学基金面上项目(30971373,881170684)

Pathogenesis and control of phosphorus metabolic disorders in patients with kidney diseases

Jing Chen1,(), Mengjing Wang1   

  1. 1.Division of Nephrology, Huashan Hospital Affiliated to Fudan University,Shanghai 200040, China
  • Published:2014-06-15
  • Corresponding author: Jing Chen
引用本文:

陈靖, 王梦婧. 肾脏病磷代谢紊乱的机制和防治[J/OL]. 中华肾病研究电子杂志, 2014, 03(03): 137-142.

Jing Chen, Mengjing Wang. Pathogenesis and control of phosphorus metabolic disorders in patients with kidney diseases[J/OL]. Chinese Journal of Kidney Disease Investigation(Electronic Edition), 2014, 03(03): 137-142.

人体磷平衡主要决定于饮食摄入、体内利用及肾脏排泄。 饮食中的磷含量、甲状旁腺素及活性维生素D 可通过调节肠道及肾脏钠磷转运子表达维持血磷在恒定的水平。 慢性肾功能不全患者在肾功能减退初期,甲状旁腺素及成纤维细胞生长因子23(FGF-23)升高可促进磷从肾脏排泄不表现出高磷,后期由于肾单位进一步减少而呈现高磷状态,高磷血症已被证明与心血管事件的发生和死亡率有着密切的关系。 目前高磷血症在国内透析患者中的发生率居高不下,同时由于国内缺乏透析营养师、透析剂量相对不足、新型磷结合剂未普及等诸多原因,致使高磷血症的治疗效果较差。传统降磷治疗手段包括限磷饮食、应用磷结合剂和透析清除,而量化评估透析患者磷代谢各个环节,有针对性的开展个体化治疗方案将是解决高磷血症难题的关键。 本文将围绕正常磷代谢、慢性肾病患者磷代谢异常以及高磷血症治疗策略的新进展进行讨论。

Normal phosphorus balance mainly depends on the diet intake,body utilzation,and renal excretion. Serum phosphorus is maintained within a physiologic range between 2.5 and 4.5 mg/dl by a series of factors including dietary phosphorus content, parathyroid hormone, and active vitamin D, which can regulate the expression of sodium-phosphate co-transporters that determine phosphate transport in the epithelial cells of both small intestine and renal proximal tubules. At the early stage of renal insufficiency,phosphorus balance is maintained by a compensatory decrease of renal tubular reabsorption of phosphorus which is mediated by elevated parathyroid hormone and fibroblast growth factor-23. As the late stage of renal insufficiency when nephrons are further reduced, total phosphorus excretion cannot keep pace with phosphorus increasing and hyperphosphatemia occurs. Hyperphosphatemia has proved to be closely related to cardiovascular events incidence and mortality. Currently, the incidence of hyperphosphatemia remains high among hemodialysis patients in China, even though the recommended treatments such as phosphorus restricted diet, phosphate binders, and dialysis have been used widely. No guidance from the dietitian,relatively low dose of dialysis, and lack of new type phosphate-binders might be the main reasons.Personalized treatment based on assessment of phosphorus balance by quantification of dietary intake, urinary excretion, dialysis removal, and absorption by phosphorus binders, etc, might be the key to achieve adequate control of hyperphosphatemia. This review is focussed on phosphorus metabolism in both healthy persons and CKD patients, and on progress in the treatment strategy of hyperphosphatemia.

图1 正常成人每天磷代谢示意图
图2 慢性肾脏病患者磷代谢示意图
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