摘要
磷是生命体中重要的元素之一,在细胞代谢和组织结构上起关键作用。磷以磷酸根形式存在,在细胞内组成细胞膜和遗传物质,参与细胞能量代谢及信号传导;在细胞外是骨无机质和牙结构的主要成分之一,部分则存在于血液循环,即临床可检出的血磷。血磷是机体磷代谢状况的直接反应,肠道吸收、肾脏排泄、组织利用以及一系列调节因子共同作用决定血磷的平衡。在慢性肾衰竭患者中,由于肾功能减退及身体内分泌功能的变化,这种平衡被打破而呈现高磷状态,已证实高磷血症除与骨代谢相关外,与心血管事件的发生和死亡率关系也甚密切。本文将围绕正常磷代谢、慢性肾脏病患者磷代谢异常以及高磷血症治疗的新进展进行综述。
Phosphorus is an important element in the life of the body in cellular metabolism and structurc maintenance. Serum phosphorus is a direct reflection of phosphorus metabolism. The balanc, e of phosphorus is decided by intestine absorption,kidney excretion,and body usage as well as a series of regulatory factors. In patients with chronic renal failure,this balance is broken. Patients often show high phosphorus status due to renal dysfunction and pilysical changes in endocrine function. Hyperphosphatemia has been proved to be related with renal osteodystrophy, vascular calcification, cardiovascular events incidence and mortality. Sodium phosphate co-transporter is the common chamlel to determiue Ihe phosphate transport in small intestine and renal tubular epithelial cells. It is divided into three subtypes. The impact factors of sodium phosphate co-transporter include diet, PTH, VitD3, FGF-23 and so on. The current means of control of hyperphosphatemia primarily are dialysis, diet restrietion, and usage of phosphate binders. At the same time, the levels of serum calcium,PTH,and 1,25 （OH）2 D3 are required to control. The latest K/DIGO guidelines recommend that in C KD3 4,serum calcium and phosphorus levels should be eonttvlled within the normal range （caleimn： 8.5 - 10. 5 mg/dl, phosphorus 2. 5 -4. 5 mg/dl） ,while to CKD5 patients,serum phosphate should be as c, lose to normal range. All treatmem programs are determined according to the dynamic changes of oatients＇ conditions,rather than a oartictdar monitorinb data.
出处
《肾脏病与透析肾移植杂志》
CAS
CSCD
北大核心
2011年第6期548-553,共6页
Chinese Journal of Nephrology,Dialysis & Transplantation
关键词
慢性肾脏病
磷代谢
高磷血症
chronic kidney disease
phosphorus metabolism
hyperphosphatemia
