标题：维持性血液透析患者血清钙磷及PTH水平与心脏结构功能的关系

      作者：黄楠，程小丽，余道丽    安康市中心医院血透室，陕西 安康 725000

      卷次： 2019年30卷22期

      【摘要】 目的 分析维持性血液透析患者血清钙磷及甲状旁腺激素 (PTH)水平与心脏结构功能的关系。方法 回顾性分析 2016年 9月至2018年6月在安康市中心医院血透室接受维持性血液透析(MHD)治疗的92例终末期肾病患者。根据患者的血磷水平将其分为血磷正常组42例，高磷组50例；根据钙磷乘积将其分为钙磷乘积正常组44例和高钙磷乘积组48例；根据PTH水平将其分为PTH正常组40例和高PTH组52例。接受MHD治疗6个月后，采用全自动生化分析仪检测所有患者的血清总钙和磷水平，采用化学发光法检测血清PTH水平。采用彩色多普勒超声检测左心室舒张期内径(LVEd)、左心室收缩期内径(LVDs)、左心房前后径(LAD)、左心室舒张期后壁厚度(LVPWT)、室间隔厚度(IVST)、左心室质量指数(LVMI)以及左心室射血分数(LVEF)；采用Pearson相关性分析血磷、钙磷乘积和PTH水平与心脏结构功能之间的相关性。结果 高血磷组、高钙磷乘积组和高PTH组患者的LVDd、LVDs、LAD、LVPWT、IVST和LVMI明显高于血磷正常组、钙磷乘积正常组和PTH正常组，LVEF明显低于血磷正常组、钙磷乘积正常组和PTH正常组，差异均有统计学意义(P<0.05)；Pearson相关性分析结果显示，血磷水平、钙磷乘积以及PTH水平升高均与LVDd、LVDs、LAD、LVPWT、IVST呈显著正相关(P<0.05)，与LVEF呈显著负相关关系(P<0.05)。结论 血磷水平、钙磷乘积以及PTH水平升高均与心脏结构和功能异常具有显著的相关性。
      【关键词】 维持性血液透析；血磷；钙磷乘积；甲状旁腺激素；心脏结构；心功能
      【中图分类号】 R459.5 【文献标识码】 A 【文章编号】 1003—6350（2019）22—2869—04

Relationship between serum calcium, phosphorus, PTH levels, and cardiac structural function in patientsundergoing maintenance hemodialysis.
HUANG Nan, CHENG Xiao-li, YU Dao-li. Hemodialysis Room, Ankang CityCenter Hospital, Ankang 725000, Shaanxi, CHINA
【Abstract】 Objective To analyze the relationship between serum calcium, phosphorus, parathyroid hormone(PTH) levels, and cardiac structural function in patients undergoing maintenance hemodialysis (MHD). Methods A ret-rospective analysis was performed on 92 patients with end-stage renal disease who underwent MHD in HemodialysisRoom of Ankang Central Hospital from September 2016 to June 2018. According to the level of blood phosphorus, thepatients were divided into the normal blood phosphorus group (42 cases) and high phosphorus group (50 cases). Accord-ing to the product of calcium and phosphorus, the patients were divided into the normal calcium and phosphorus productgroup (44 cases) and the high calcium and phosphorus product group (48 cases). According to the level of PTH, the pa-tients were divided into normal PTH group (40 cases) and high PTH group (52 cases). Six months after MHD treatment,serum total calcium and phosphorus levels were measured by automatic biochemical analyzer. Serum PTH levels weremeasured by chemiluminescence method. Left ventricular diastolic diameter (LVEd), left ventricular systolic diameter(LVDs), left atrial diameter (LAD), left ventricular posterior wall thickness (LVPWT), interventricular septal thickness(IVST), left ventricular mass index (LVMI) and left ventricular ejection fraction (LVEF) were measured by color Dopplerultrasound. Pearson correlation was performed to analyze the correlation between serum phosphorus, calcium-phosphorusproduct, PTH level and cardiac structural function. Results LVDd, LVDs, LAD, LVPWT, IVST and LVMI in the high se-rum phosphorus group, high calcium-phosphorus product group and high PTH group were significantly higher than thosein the normal serum phosphorus group, normal calcium-phosphorus product group and normal PTH group (all P<0.05),while LVEF was significantly lower than that in normal serum phosphorus group, normal calcium-phosphorus productgroup and normal PTH group (all P<0.05). Pearson correlation analysis showed that increase of serum phosphorus level,calcium-phosphorus product and PTH level was significantly positively related to LVDd, LVDs, LAD, LVPWT and IVST(all P<0.05), while significantly negatively related to LVEF (P<0.05). Conclusion Increase of serum phosphorus, calci-um-phosphorus product and PTH levels is significantly related to cardiac structural and functional abnormalities.
      【Key words】 Maintenance hemodialysis (MHD); Blood phosphorus; Product of calcium and phosphorus; Para-thyroid hormone; Cardiac structure; Cardiac function