摘要
目的 探讨慢性肾脏病（CKD）不同病期患者的骨密度及骨矿盐代谢指标的变化情况.方法 非透析CKD患者345例,根据2002年美国肾脏病基金会（NKF）K/DOQI专家组CKD分期以及我国慢性肾衰竭分期方法按血清肌酐（SCr）、肾小球滤过率（GFR）水平分为CKD 1 ～5期,CKD 1期75例,CKD 2期65例,CKD 3期65例,CKD4期65例,CKD 5期75例,抽取受试者静脉血,分离血清,用离子选择电极法测定血钙、磷和SCr;用苦味酸法测定血尿素氮（BUN）；用化学发光法测定血全段甲状旁腺激素（iPTH）及1,25羟基维生素D3[1,25（OH）2 VitD3].结果 CKD患者随着肾功能下降,血iPTH、磷水平逐渐升高,以CKD4期和CKD 5期升高明显,与CKD1期比较差异有统计学意义[（289.6578±187.7945）、（482.0667±232.2065）μg/L比（77.8431±52.9760） μg/L,（1.6938±0.1960）、（2.6034±0.5986） mmol/L比（1.3833±0.4068） mmol/L,P＜ 0.05]；血钙、1,25（OH）2VitD3水平逐渐下降,以CKD 4期和CKD5期下降明显,与CKD 1期比较差异有统计学意义[（1.9185±0.4633）、（1.8293±0.3075） mmol/L比（2.0893±0.2245） mmol/L,（10.0892±0.2638）、（7.6058±0.4356） ng/L比（18.0036±0.3218） ng/L,P＜ 0.05].随着肾功能减退,骨质疏松的比例也逐渐升高,且以CKD5期最显著,与CKD 1期和CKD 2期比较差异有统计学意义[60.00％（45/75）比20.00％（15/75）、23.08％（15/65）,P＜0.05].结论 随着肾功能减退,血iPT-H、磷水平逐渐升高,血钙、1,25 （OH）2 VitD3水平以及骨密度逐渐下降,尤其以CKD4期和CKD5期最明显.
Objective To discuss the relationship between bone mineral salt metabolism index change and bone density in different stage of chronic kidney disease （CKD）.Methods Three hundred and forty-five non-dialysis patients with CKD were enrolled in this study.According to the serum creatinine （SCr）,glomerular filtration rate （GFR）,they were divided into stage 1-5.CKD 1 had 75 cases,CKD 2 had 65 cases,CKD 3 had 65 cases,CKD 4 had 65 casès,CKD 5 had 75 cases.The level of blood calcium （Ca）,phosphorus （P） and SCr were detected by ion selective electrode method.The level of urea nitrogen （BUN） was detected by picric acid method.The level of intact parathyroid hormone （iPTH） and 1,25 （OH）2VitD3 were detected by chemiluminescence.Results With the decline of renal function,the level of iPTH and blood P increased gradually,especially in stage CKD 4 and CKD 5,and compared with stage CKD 1,there were significantly differences [（289.6578 ± 187.7945）,（482.0667 ± 232.2065） μ g/L vs.（77.8431 ± 52.9760） μ g/L and （1.6938 ± 0.1960）,（2.6034 ± 0.5986） mmol/L vs.（1.3833 ± 0.4068） mmol/L,P 〈 0.05].The level of blood Ca and 1,25 （OH）2VitD3 decreased gradually,especially in stage CKD 4 and CKD 5,and compared with stage CKD 1,there were significantly differences [（1.9185 ±0.4633）,（1.8293 ± 0.3075） mmol/L vs.（2.0893 ± 0.2245） mmoi/L and （10.0892 ± 0.2638）,（7.6058 ±0.4356） ng/L vs.（18.0036 ± 0.3218） ng/L,P 〈 0.05].With the decline of renal function,the proportion of osteoporosis also gradually increased,especially in stage CKDS,and compared with stage CKD 1 and CKD 2,there was significantly difference [60.00% （45/75） vs.20.00% （15/75）,23.08% （15/65）,P 〈 0.05].Conclusion With the decline of renal function,the level of blood P and iPTH increase,and blood Ca,1,25（OH）2VitD3,bone density decrease,especially in stage CKD 4 and CKD 5 patients.
出处
《中国医师进修杂志》
2013年第18期4-6,共3页
Chinese Journal of Postgraduates of Medicine
关键词
肾功能不全
慢性
骨矿盐代谢
骨密度
Kidney failure, chronic
Bone mineral salt metabolism
Bone density
