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中华肾病研究电子杂志

中华肾病研究电子杂志 ›› 2015, Vol. 04 ›› Issue (05) : 246 -250. doi: 10.3877/cma.j.issn.2095-3216.2015.05.006

所属专题： 文献；

论著

不同钙浓度腹膜透析液对长期CAPD患者矿物质和骨代谢影响的分析
杨杰1, 杨聚荣1, 霍本刚1, 蔡明玉1, 张建国1, 龚文江1, 余燕1, 何娅妮1,†()   
  1. 1. 400016　重庆，第三军医大学大坪医院野战外科研究所肾内科
  • 出版日期:2015-10-28
  • 通信作者: 何娅妮

Analysis of the effects of dialysate calcium concentrations on mineral and bone metabolism in patients with long-term CAPD

Jie Yang1, Jurong Yang1, Bengang Huo1, Mingyu Cai1, Jianguo Zhang1, Wenjiang Gong1, Yan Yu1, Yani He1,†()   

  1. 1. Department of Nephrology, Daping Hospital, Research Institute of Surgery, Third Military Medical University, Chongqing 400016, China
  • Published:2015-10-28
  • Corresponding author: Yani He
  • About author:
    Corresponding author: He Yani, Email:
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引用本文：

杨杰, 杨聚荣, 霍本刚, 蔡明玉, 张建国, 龚文江, 余燕, 何娅妮. 不同钙浓度腹膜透析液对长期CAPD患者矿物质和骨代谢影响的分析[J]. 中华肾病研究电子杂志, 2015, 04(05): 246-250.

Jie Yang, Jurong Yang, Bengang Huo, Mingyu Cai, Jianguo Zhang, Wenjiang Gong, Yan Yu, Yani He. Analysis of the effects of dialysate calcium concentrations on mineral and bone metabolism in patients with long-term CAPD[J]. Chinese Journal of Kidney Disease Investigation(Electronic Edition), 2015, 04(05): 246-250.

目的

观察腹膜透析液钙离子浓度对持续性不卧床腹膜透析(CAPD)患者矿物质和骨代谢的影响。

方法

回顾性分析我院腹膜透析中心行CAPD治疗2年以上的123例患者，根据腹膜透析液钙离子浓度分为低钙腹膜透析液组(LCD组，钙离子浓度为1.25 mmol/L)和标准钙腹膜透析液组(SCD组，钙离子浓度为1.75 mmol/L)，观察不同钙浓度腹膜透析液对患者血清钙、磷、全段甲状旁腺激素(iPTH)、颈动脉厚度、心脏瓣膜钙化及骨痛、皮肤瘙痒等情况的影响。使用SPSS 18.0统计软件包进行数据处理。

结果

2组患者治疗前人口学特征、腹膜转运特性、钙磷代谢等指标的基线水平差异无统计学意义(P>0.05)。治疗2年后，2组患者血钙浓度及达标率较治疗前均显著增高(P<0.05)，SCD组血钙浓度增幅高于LCD组，但差异无统计学意义(0.26±0.31 mmol/L与0.17±0.29 mmol/L, t＝1.621，P＝0.108)；2组间治疗后血清钙、磷、iPTH平均水平及其达标率、颈动脉厚度、心脏瓣膜钙化比例、骨痛及皮肤瘙痒累计发生率差异均无统计学意义(P>0.05)；LCD组活性维生素D使用比例显著高于SCD组(χ2 ＝6.373，P<0.05)。

结论

采用低钙与标准钙腹透液治疗2年，对CAPD患者矿物质和骨代谢的影响无显著性差异。

关键词: 腹膜透析, 腹膜透析液, 甲状旁腺激素, 钙磷代谢
Objective

To investigate the effects of dialysate calcium concentrations on on mineral and bone metabolism in patients with continuous ambulatory peritoneal dialysis (CAPD).

Methods

A retrospective analysis was made in our hospital for more than two years in 123 patients with CAPD treatment, who were divided into low calcium dialysate (LCD) group (calcium concentration 1.25 mmol/L) and standard calcium dialysate (SCD) group (calcium concentration 1.75 mmol/L) to observe their effects on serum calcium, phosphorus, intact parathyroid hormone (iPTH), bone pain, pruritus, thickness of carotid arteries, and heart valve calcification.

Results

There were no differences in baseline levels of demographic characteristics, peritoneal transport characteristics, and calcium phosphorus metabolism between the two groups (P>0.05). After 2 years of treatment, serum calcium concentration and the target-reaching rate significantly increased in the two groups compared with those before treatment (P<0.05), and the calcium concentration of SCD group was higher than that of the LCD group but without statistical significance (0.26±0.31 mmol/L vs 0.17±0.29 mmol/L, t=1.621, P=0.108); and the differences between the two groups after treatment were not statistically significant in the serum calcium, phosphorus, the average level of iPTH and its target-reaching rate, carotid artery thickness, cardiac valve calcification proportion, bone pain, and cumulative incidence rate of skin itching (P>0.05); but the proportion of active vitamin D use in LCD group was significantly higher than that in the SCD group (χ2=6.373, P<0.05).

Conclusion

The treatment of CAPD with different dialysate calcium concentrations for 2 years did not have any significant effects on the mineral and bone metabolism of patients.

Key words: Peritoneal dialysis, Peritoneal dialysis solution, Parathyroid hormone, Calcium and phosphorus metabolism
表1 低钙透析液组与标准钙透析液组患者临床及相关实验室检查基线水平
分组 例数 年龄(岁) 性别(男/女) 体质量指数(kg/m2) 尿量(ml/24 h) 腹膜转运特性[例(%)]
高转运 高平均转运 低转运 低平均转运
LCD组 66 50.50±16.75 43/23 21.72±2.92 889.39±462.81 9(13.64) 34(51.52) 1(1.52) 22(33.33)
SCD组 57 49.28±18.51 37/20 21.70±3.13 869.30±414.23 10(17.54) 24(42.11) 3(5.26) 20(35.09)
检验值 ? t＝0.443 χ2＝0.001 t＝0.051 t＝0.252 χ2＝0.358 χ2＝1.087 χ2＝0.434 χ2＝0.042
P值 0.702 0.978 0.959 0.801 0.550 0.297 0.510 0.838
分组 ? 估算的肾小球滤过率(ml/min) 总KT/V 总肌酐清除率(L/周) 超滤量(ml/d) Hb(g/L) 血清白蛋白(g/L)
LCD组 66 3.56(1.70，5.90) 1.81(1.46，2.47) 66.53(49.59，93.18) 303.79±453.73 83.92±18.75 32.34±5.06
SCD组 57 2.79(1.83，6.33) 1.69(1.40，2.13) 53.90(39.25，85.08) 429.82±397.07 87.38±19.11 33.42±5.4
检验值 ? U＝0.109 t＝1.481 U＝1.407 t＝1.627 t＝1.154 t＝1.148
P值 ? 0.913 0.139 0.162 0.106 0.317 0.253
表2 低钙透析液组与标准钙透析液组患者治疗前后血清钙磷的变化
组别 例数 治疗前
血清钙(mmol/L) 低钙患者[例数(%)] 高钙患者[例数(%)] 血清钙达标率(%) 血清磷(mmol/L) 低磷患者[例数(%)] 高磷患者[例数(%)] 血清磷达标率(%)
LCD组 66 2.02±0.25 38(57.58%) 0(0%) 42.42% 1.84±0.53 3(4.55%) 34(51.52%) 43.94%
SCD组 57 1.99±0.25 37(64.91%) 1(1.75%) 33.33% 1.95±0.64 4(7.02%) 32(56.14%) 36.84%
检验值 ? t＝0.705 χ2＝0.692 χ2＝0.005 χ2＝1.071 t＝1.085 χ2＝0.04 χ2＝0.263 χ2＝0.639
P值 ? 0.089 0.154 0.842 0.342 0.151 0.809 0.148 0.205
组别 例数 治疗后
血清钙(mmol/L) 低钙患者[例数(%)] 高钙患者[例数(%)] 血清钙达标率(%) 血清磷(mmol/L) 低磷患者[例数(%)] 高磷患者[例数(%)] 血清磷达标率(%)
LCD组 66 2.19±0.17 16(24.24%) 3(4.55%) 71.21% 1.79±0.58 5(7.58%) 28(42.42%) 50.00%
SCD组 57 2.25±0.19 8(14.04%) 4(7.02%) 78.95% 1.65±0.49 5(8.77%) 17(29.82%) 61.40%
检验值 ? t＝1.716 χ2＝2.029 χ2＝0.04 χ2＝0.971 t＝1.444 χ2＝0.059 χ2＝2.093 χ2＝1.609
P值 0.089 0.154 0.842 0.342 0.151 0.809 0.148 0.205
检验值1 ? t＝5.03 χ2＝15.168 χ2＝1.364 χ2＝11.147 t＝0.488 χ2＝0.133 χ2＝1.095 χ2＝0.487
P值1 0 0 0.243 0.001 0.627 0.715 0.295 0.485
检验值2 ? t＝6.289 2＝30.877 χ2＝0.837 χ2＝24.083 t＝3.15 χ2＝0 χ2＝8.053 χ2＝6.879
P值2 0 0 0.36 0 0.003 1 0.005 0.009
表3 低钙透析液组与标准钙透析液组患者治疗前后血清全段甲状旁腺激素的变化
组别 例数 治疗前
iPTH (ng/L) 低iPTH患者[例数(%)] 高iPTH[例数(%)] iPTH达标率(%)
LCD组 66 278.08(146.66，418.76) 13(19.7%) 7(10.61%) 69.70%
SCD组 57 312.48(204.20，533.06) 4(7.02%) 10(17.54%) 75.44%
检验值 ? U＝3.097 χ2＝3.132 χ2＝1.236 χ2＝0.504
P值 0.078 0.077 0.266 0.478
组别 例数 治疗后
iPTH (ng/L) 低iPTH患者[例数(%)] 高iPTH[例数(%)] iPTH达标率(%)
LCD组 66 256.81(173.55，356.80) 12(18.18%) 5(7.58%) 74.24%
SCD组 57 241.60(124.40，362.65) 15(26.32%) 5(8.77%) 64.91%
检验值 ? U＝0.587 χ2＝0.996 χ2＝0.059 χ2＝1.266
P值 0.444 0.318 0.809 0.261
检验值1 ? U＝0.501 χ2＝0.019 χ2＝0.367 χ2＝0.338
P值1 0.616 0.891 0.545 0.561
检验值2 ? U＝2.968 χ2＝6.316 χ2＝1.919 χ2＝1.509
P值2 0.003 0.012 0.166 0.219
表4 低钙透析液组与标准钙透析液组患者治疗前后临床相关指标的变化
组别 例数 治疗前
颈动脉厚度(mm) 心脏瓣膜钙化[例(%)] 骨痛[例(%)] 皮肤瘙痒[例(%)] 使用含钙磷结合剂[例(%)] 使用非钙磷结合剂[例(%)] 使用活性维生素D[例(%)]
LCD组 66 0.65±0.15 2(3.03%) 2(3.03%) 4(6.06%) 46(69.7%) 2(3.03%) 54(81.82%)
SCD组 57 0.64±0.13 3(5.26%) 5(8.77%) 6(10.52%) 37(64.91%) 2(3.51%) 35(61.4%)
检验值 ? t＝0.298 χ2＝0.028 χ2＝0.961 χ2＝0.328 χ2＝0.319 χ2＝0 χ2＝6.373
P值 0.766 0.532 0.327 0.567 0.572 1 0.012
组别 例数 治疗后
颈动脉厚度(mm) 心脏瓣膜钙化[例(%)] 骨痛[例(%)] 皮肤瘙痒[例(%)] 使用含钙磷结合剂[例(%)] 使用非钙磷结合剂[例(%)] 使用活性维生素D[例(%)]
LCD组 66 0.76±0.17 4(6.06%) 4(6.06%) 17(25.76%) 22(33.33%) 3(4.55%) 39(59.09%)
SCD组 57 0.72±0.16 4(7.02%) 6(10.53%) 13(22.81%) 25(43.86%) 3(5.26%) 17(29.82%)
检验值 ? t＝1.458 χ2＝0 χ2＝0.328 χ2＝0.144 χ2＝1.435 χ2＝0 χ2＝10.563
P值 0.147 1 0.366 0.704 0.231 1 0.001
检验值1 ? t＝4.636 χ2＝0.175 χ2＝0.175 χ2＝8.154 χ2＝17.471 χ2＝0 χ2＝8.189
P值1 0 0.676 0.676 0.004 0 1 0.004
检验值2 ? t＝3.464 χ2＝0 χ2＝0.101 χ2＝3.095 χ2＝5.092 χ2＝0 χ2＝11.457
P值2 0.001 1 0.751 0.079 0.024 1 0.001
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