单中心维持性血透患者钙磷代谢情况及用药依从性分析

Analysis of Calcium and Phosphorus Metabolism and Medication Compliance in Patients with Single-Center Maintenance Hemodialysis

摘要: 目的：探讨分析单中心维持性血液透析患者钙磷代谢情况，以及钙磷调节药物的用药情况。方法：选取2018年1月在同济大学附属同济医院医院血液净化中心行规律血液透析3个月以上的维持性血液透析患者为研究分析对象，回顾性分析患者透析前血磷、血钙、血白蛋白和全段甲状旁腺激素(iPTH)指标，分析钙、磷及iPTH达标情况，收集患者钙磷调节药物的用药情况，统计患者性别、年龄、透析龄、透析频率、磷结合剂、活性维生素D、钙剂等使用状况并进行统计学分析。结果：1) 患者平均校正血钙值为(2.25 ± 0.19) mmol/L，校正总钙低于目标标准共23例，占比为14.29%，达标者共131例占比为81.37%，7例患者高于标准值，占比为5.34%；平均血磷值为(1.68 ± 0.51) mmol/L，1例血磷指数比目标标准低，占比为0.61%，共52例达标，占比为32.29%，108例高于标准值，占比为67.08%；平均iPTH值为(341.65 ± 351.81) pg/ml，1例比目标标准低，占比为0.61%，共22例达标，占比为13.67，138例高于标准值占比为85.72 %。2) 患者服用钙磷调节药物的比例为68.32% (110/161)，Morisky平均得分为1.11 ± 1.387分。3) 单因素方差分析显示：不同年龄组患者血钙水平存在统计学差异，不同透析龄组患者的血iPTH水平存在统计学差异，Morisky评分得分不同的患者的血钙水平也存在统计学差异，但是卡方分析显示：在不同年龄组、透析龄组以及Morisky评分组，血钙、血磷和血iPTH的达标率均无统计学差异。4) 方差分析显示：Morisky评分在男性和女性之间以及不同透析龄之间无差别，在不同年龄组间存在差异，其中年龄小于35岁的患者得分明显高于其他年龄组。5) 相关性分析结果显示：iPTH与尿酸、钙、矫正钙、钙磷乘积、白蛋白水平、透析龄之间成正相关，iPTH与磷水平之间成负相关(p < 0.05)。结论：根据KDIGO标准，我院该时期维持性透析患者的血钙达标率较高，而血磷和血iPTH水平未得到更好的控制；血钙水平与年龄和服药依从性相关，血iPTH水平与透析年限相关；年龄小的患者服药依次性低，而服药依从性高的患者血钙和血磷达标率高。临床需给予足够的重视，加强健康宣教。

Abstract: Objective: To investigate and analyze the calcium and phosphorus metabolism in patients with single-center maintenance hemodialysis and the use of calcium and phosphorus regulating drugs. Methods: Maintenance hemodialysis patients who received regular hemodialysis for more than 3 months in the blood purification center of Tongji Hospital Affiliated to Tongji University in January 2018 were selected as the research and analysis objects. The indicators of serum phosphorus, serum calcium, serum albumin and whole parathyroid hormone (iPTH) before dialysis were ret-rospectively analyzed. The standards of calcium, phosphorus and iPTH, the medication status of calcium and phosphorus regulating drugs were collected. Results: 1) The mean corrected blood calcium of the patients was (2.25 ± 0.19) mmol/L, and the corrected total calcium was lower than the target standard in 23 cases, accounting for 14.29%, 131 cases of bidders accounting for 81.37%, and 7 cases of patients higher than the standard value, accounting for 5.34%. The average blood phosphorus was (1.68 ± 0.51) mmol/L. The blood phosphorus index of 1 case was lower than the target standard, accounting for 0.61%. A total of 52 cases reached the standard, accounting for 32.29%. The average iPTH was (341.65 ± 351.81) pg/ml, and 1 case was lower than the target standard, accounting for 0.61%. A total of 22 cases reached the standard, accounting for 13.67%, and 138 cases were higher than the standard value, accounting for 85.72%. 2) The proportion of patients taking calcium and phosphorus regulating drugs was 68.32% (110/161), and the average score of Morisky was 1.11 ± 1.387. 3) The single factor analysis of variance showed that different age group patients’ blood calcium level statistical differences, different dialysis age group of patients with serum iPTH statistical differences, Morisky scale scores in patients with different blood calcium level are statistically significant, but a chi-square analysis showed: in different age groups, dialysis age group and Morisky group, blood calcium, phosphorus and blood iPTH success rate had no statistical difference. 4) Anova showed that there was no difference in Morisky score between male and female and between different dialysis ages. There was difference among different age groups. Patients younger than 35 years old scored significantly higher than other age groups. 5) Correlation analysis showed that there was a positive correlation between iPTH and calcium, urate, correction calcium, calcium phosphorus product, albumin level and a negative correlation between iPTH and phosphorus level. Conclusion: According to the KDIGO standard, the compliance rate of serum calcium of maintenance dialysis patients in our hospital was higher during this period, while the levels of serum phosphorus and blood iPTH were not better controlled. Blood calcium level was correlated with age and medication compliance, and blood iPTH level was correlated with dialysis age. Younger patients were less likely to take medication in turn, while patients with higher compliance had higher compliance rates of blood calcium and phosphorus. Enough attention should be paid to health education in clinic.