糖尿病肾病与慢性肾小球肾炎血液透析患者甲状旁腺激素水平研究

Study on the level of parathyroid hormone in hemodialysis patients with diabetic nephropathy and chronic glomerulonephritis

关键词:  甲状旁腺激素  糖尿病肾病  慢性肾小球肾炎  血液透析  外周静脉血

Key words:  parathyroid hormone  diabetic nephropathy  chronic glomerulonephritis  hemodialysis  peripheral venous blood

摘要:

目的　分析在糖尿病肾病（diabetic nephropathy,DN）与慢性肾小球肾炎(chroni glomerulonephritis,CGN)的血液透析治疗中，患者血钙、血磷以及甲状旁腺激素（parathyroid hormone,PTH）水平的差别，从而指导血液透析治疗的合理开展。方法　选取2018年1月至2020年12月进行维持性血液透析治疗的患者180例作为研究对象，按照原发疾病的不同进行分组，其中糖尿病肾病60例（DN组），慢性肾小球肾炎120例（CGN组）。进行持续稳定血液透析治疗超过6个月后分别抽取两组患者的外周静脉血进行血清制取，检测血钙、血磷以及甲状旁腺激素水平，并进行对比分析。结果　DN组血钙水平为（2.24±0.16）mmol/L，血磷水平为（2.21±0.21）mmol/L，CGN组血钙水平为（2.29±0.18）mmol/L，血磷水平为（2.33±0.52）mmol/L，两组血钙、血磷水平差异无统计学意义（P＞0.05）。DN组患者的PTH水平为（171.45±53.63）pg/mL，达标31例，总达标率为51.67％；CGN组患者的PTH水平为（308.75±93.11）pg/mL，达标42例，总达标率为35.00％，DN组患者的PTH水平与总达标率均明显优于CGN组，差异有统计学意义（P＜0.05）。结论　接受血液透析治疗的糖尿病肾病与慢性肾小球肾炎患者PTH水平达标率较低，同时慢性肾小球肾炎患者的PTH水平明显高于糖尿病肾病患者，提示在实际的临床治疗中要基于患者实际情况制定个性化的干预方案，以减少并发症的发生。

Abstract:

Objective 　To analyze the differences of blood calcium, blood phosphorus and parathyroid hormone levels in patients with diabetic nephropathy and chronic glomerulonephritis during hemodialysis treatment, in order to guide the rational development of hemodialysis treatment. Methods 　A total of 180 patients receiving maintenance hemodialysis from January 2018 to December 2020 were selected as the research subjects and grouped according to the difference of primary diseases, including 60 cases of diabetic nephropathy (DN group) and 120 cases of chronic glomerulonephritis (CGN group). After continuous and stable hemodialysis treatment for more than six months, the peripheral venous blood of patients in two groups was collected for serum preparation, and the levels of blood calcium, blood phosphorus and parathyroid hormone were measured and compared. Results 　The blood calcium level in the DN group was (2.24±0.16) mmol/L, and the blood phosphorus level was (2.21±0.21) mmol/L. The blood calcium level in the CGN group was (2.29±0.18) mmol/L, and the blood phosphorus level was (2.33±0.52) mmol/L. There were no significant differences in blood calcium and blood phosphorus levels between the two groups (P＜0.05). The level of parathyroid hormone in the DN group was (171.45±53.63) pg/mL, and 31 cases reached the standard. The total rate of reaching the standard was 51.67%. The parathyroid hormone level in the CGN group was (308.75±93.11) pg/mL, and 42 cases reached the standard, with the total reaching rate of 35.00%. The parathyroid hormone level and the overall rate of reaching the standard in the DN group were significantly better than those in the CGN group, respectively (P<0.05). Conclusions 　The rate of reaching the standard of parathyroid hormone level in patients with diabetic nephropathy and chronic glomerulonephritis treated by hemodialysis is low, and the parathyroid hormone level in patients with chronic glomerulonephritis is obviously higher than that in patients with diabetic nephropathy. Thus, personalized intervention plan should be formulated based on the actual situation of patients in actual clinical treatment to reduce the incidence of complications.