糖尿病慢性肾脏病早期患者继发性甲状旁腺功能亢进症的影响因素分析(1)
[摘要] 目的 分析糖尿病慢性肾脏病(CKD)早期患者继发性甲状旁腺功能亢进(SHPTH)的影响因素，为临床工作提供理论依据。 方法 回顾性分析2012年7月～2014年7月于解放军第九五医院肾脏内科住院糖尿病CKD早期患者的临床资料，依据是否合并SHPTH分为合并SHPTH组和非合并SHPTH组。对两组患者的一般情况进行分析，同时以SHPTH为因变量进行影响糖尿病CKD患者SHPTH的多因素回归分析。 结果 所有纳入患者共481例。合并SHPTH组214例(44.49%)，非合并SHPTH组267例(55.51%)。两组高血压、高脂血症、血磷、25-羟维生素D(25-OH-VitD)、尿微量白蛋白、糖化血红蛋白(HbA1c)比较，差异有统计学意义(P < 0.05或P < 0.01)。多因素分析显示，高血压、高脂血症、高血磷、低25-OH-VitD、高尿微量白蛋白、高HbA1c与SHPTH的发生有一定关系(P < 0.05)。 结论 糖尿病肾病患者是否并发SHPTH受多种因素的影响，可通过降低患者血压、血脂、血磷、尿微量白蛋白、HbA1c水平，提高25-OH-VitD来改善患者的预后。
[关键词] 慢性肾脏病；继发性甲状旁腺功能亢进；糖尿病；高血压
[中图分类号] R692 [文献标识码] A [文章编号] 1673-7210(2017)10(b)-0125-04
Influence factors analysis on secondary hyperparathyroidism in early stage patients with diabetic CKD
YANG Qingbai JI Guoxin▲ CHEN Zhizhong HUANG Yuping CHEN Hong ZHANG Huimin
95th Hospital of PLA， Fujian Province， Putian 351100， China
[Abstract] Objective To analyze the influence factors on secondary hyperparathyroidism (SHPTH) in early stage patients with diabetic CKD， as to provide theoretical basis for clinical work. Methods All data of early stage patients admitted to 95th Hospital of PLA from July 2012 to July 2014 were retrospectively analyzed， and all patients were divided into combined with SHPTH group and not combined with SHPTH group according to whether the merger of SHPTH. General situation of two groups were analyzed， and at the same time， SHPTH was chosen as the dependent variable to analyze the multiple factors regression for patients with diabetic CKD. Results 481 patients were studied， in which， 214 cases (44.49%) was combined with SHPTH， 267 cases (55.51%) were not combined with SHPTH. The levels of hypertension， hyperlipidemia， serum phosphorus， 25-OH-VitD， urinary albumin and HbA1c between two groups were compared， with statistically significant differences (P < 0.05 or P < 0.01). Multivariate analysis showed that hypertension， hyperlipidemia， hyperphosphatemia， low 25-OH-VitD， high urinary microalbumin， high HbA1c and SHPTH had a certain relationship (P < 0.05). Conclusion Diabetic CKD patients whether combined with SHPTH is influenced by many factors， it can through reduce the patients' blood pressure， blood lipid， blood phosphorus， urine trace albumin， HbA1c level， improve 25-OH-VitD to improve the prognosis of patients.
[Key words] Chronic kidney disease； Secondary hyperparathyroidism； Diabetes millitus； Hypertension
慢性腎脏病(CKD)患者肾功能往往在数月或数年内逐渐丧失，依据NFK-K/DOQI标准，其在老年人群中患病率呈平稳上升趋势[1-3]。在众多病因中，糖尿病占据了很大比例，被认为是导致终末期肾病的主要原因之一[4]。继发性甲状旁腺功能亢进(SHPTH)是CKD患者的常见并发症，为体内低血钙的一种代偿机制，以1，25-羟维生素D3缺乏、钙磷代谢紊乱、高甲状旁腺激素(iPTH)血症、甲状旁腺增生为主要特征[5]。在CKD进程早期时SHPTH即已经发生，是导致CKD患者心血管事件死亡率增加的一个重要独立危险因素。SHPTH的患病率与相关代谢组分是否具有差异目前仍不知晓。因此对糖尿病合并SHPTH的危险因素进行深入研究有助于我们早期诊断和治疗CKD。基于此背景，本研究通过回顾性分析解放军第九五医院(以下简称“我院”)肾脏内科住院早期患者的临床资料，探讨糖尿病患者在合并与非合并SHPTH中的发生率及其相关指标的影响，以期指导临床诊治。, http://www.100md.com(杨清柏 纪国新 陈志忠 黄玉平 陈红 张慧敏)
[关键词] 慢性肾脏病；继发性甲状旁腺功能亢进；糖尿病；高血压
[中图分类号] R692 [文献标识码] A [文章编号] 1673-7210(2017)10(b)-0125-04
Influence factors analysis on secondary hyperparathyroidism in early stage patients with diabetic CKD
YANG Qingbai JI Guoxin▲ CHEN Zhizhong HUANG Yuping CHEN Hong ZHANG Huimin
95th Hospital of PLA， Fujian Province， Putian 351100， China
[Abstract] Objective To analyze the influence factors on secondary hyperparathyroidism (SHPTH) in early stage patients with diabetic CKD， as to provide theoretical basis for clinical work. Methods All data of early stage patients admitted to 95th Hospital of PLA from July 2012 to July 2014 were retrospectively analyzed， and all patients were divided into combined with SHPTH group and not combined with SHPTH group according to whether the merger of SHPTH. General situation of two groups were analyzed， and at the same time， SHPTH was chosen as the dependent variable to analyze the multiple factors regression for patients with diabetic CKD. Results 481 patients were studied， in which， 214 cases (44.49%) was combined with SHPTH， 267 cases (55.51%) were not combined with SHPTH. The levels of hypertension， hyperlipidemia， serum phosphorus， 25-OH-VitD， urinary albumin and HbA1c between two groups were compared， with statistically significant differences (P < 0.05 or P < 0.01). Multivariate analysis showed that hypertension， hyperlipidemia， hyperphosphatemia， low 25-OH-VitD， high urinary microalbumin， high HbA1c and SHPTH had a certain relationship (P < 0.05). Conclusion Diabetic CKD patients whether combined with SHPTH is influenced by many factors， it can through reduce the patients' blood pressure， blood lipid， blood phosphorus， urine trace albumin， HbA1c level， improve 25-OH-VitD to improve the prognosis of patients.
[Key words] Chronic kidney disease； Secondary hyperparathyroidism； Diabetes millitus； Hypertension
慢性腎脏病(CKD)患者肾功能往往在数月或数年内逐渐丧失，依据NFK-K/DOQI标准，其在老年人群中患病率呈平稳上升趋势[1-3]。在众多病因中，糖尿病占据了很大比例，被认为是导致终末期肾病的主要原因之一[4]。继发性甲状旁腺功能亢进(SHPTH)是CKD患者的常见并发症，为体内低血钙的一种代偿机制，以1，25-羟维生素D3缺乏、钙磷代谢紊乱、高甲状旁腺激素(iPTH)血症、甲状旁腺增生为主要特征[5]。在CKD进程早期时SHPTH即已经发生，是导致CKD患者心血管事件死亡率增加的一个重要独立危险因素。SHPTH的患病率与相关代谢组分是否具有差异目前仍不知晓。因此对糖尿病合并SHPTH的危险因素进行深入研究有助于我们早期诊断和治疗CKD。基于此背景，本研究通过回顾性分析解放军第九五医院(以下简称“我院”)肾脏内科住院早期患者的临床资料，探讨糖尿病患者在合并与非合并SHPTH中的发生率及其相关指标的影响，以期指导临床诊治。, http://www.100md.com(杨清柏 纪国新 陈志忠 黄玉平 陈红 张慧敏)