文摘目的调查河南省部分基层维持性血液透析患者骨及矿物质代谢现状。方法选取河南省13个区县级血液透析中心,共纳入932例患者,了解患者近3个月的钙、磷、全段甲状旁腺激素(intact parathyroid hormone,iPTH)水平;以肾脏病预后质量倡议(kidney disease outcomes quality initiative,KDOQI)指南为标准,评估患者钙、磷、iPTH达标率并与国际透析预后与实践模式研究4(dialysis outcomes and practice patients study 4,DOPPS4)相比较;将患者以性别、年龄、透析龄、血管通路通畅情况、原发病、周透析总时长分组,比较不同分组间的达标率差异。结果参与调研的透析中心患者血钙水平为(2.23±0.25)mmol/L,血磷水平为(1.96±0.65)mmol/L,iPTH水平为362(165,647)pg/ml,3者检测率分别为38.4%、50.0%、49.4%;3者达标率分别为33.5%、29.6%、21.8%,综合达标率为3.9%;低钙、高磷、高iPTH现象较DOPPS4更为突出(29.0%比12.4%、χ^2=224.648,P<0.001;61.4%比34.2%、χ^2=303.262、,P<0.001;59.2%比35.4%,χ^2=308.165,P<0.001)。老年患者的磷及iPTH较低[(1.8±0.5)比(2.0±0.7)mmol/L,t=2.845,P=0.005;291.9(173.8,500.0)比439.9(200.0,701.0)pg/ml,Z=3.404,P=0.001)]、磷及iPTH达标率较高(42.0%比24.8%,χ^2=5.110,P=0.024;70.0%比48.1%,χ^2=6.986,P=0.008)、钙达标率较低(44.0%比65.9%,χ^2=7.182,P=0.007);通路功能不良的患者iPTH达标率更低(59.0%比34.3%,χ^2=6.943,P=0.008);糖尿病患者的i PTH水平更低[(318.6(79.0,593.0)比417.9(216.0,694.7)pg/ml,Z=2.246,P=0.025]、血磷达标率更高(39.7%比21.8%,χ^2=6.812,P=0.009);长透析龄的患者iPTH更高[510.2(181.3,869.6)比355.0(188.6,543.0)pg/ml,Z=3.130,P=0.003]、达标率较低(35.7%比62.6%,χ^2=11.206,P=0.001),周透析时长<10h的患者血磷水平更高[(2.1±0.7)比(1.9±0.6)mmol/L,t=2.004,P=0.047],血钙达标率更低(49.3%比63.2%,χ^2=7.875,P=0.005)。结论基层血液透析患者普遍存在钙磷检测率低、达标率低、药物应用不规范等现象,需进一步加强宣教。
