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目的观察非透析慢性肾脏病(CKD)患者心瓣膜钙化与甲状旁腺素、钙磷代谢紊乱及动态血压的关系。方法入选2010年6月至2013年6月间在承德市中心医院肾内科就诊的CKD3~5期非透析患者70例,根据超声心动图结果分为有瓣膜钙化组和无瓣膜钙化组,比较两组患者的血钙、磷、甲状旁腺素(i PTH)水平以及动态血压监测指标。结果两组患者血钙、肾小球滤过率差异无统计学意义(P>0.05),有瓣膜钙化组血磷、钙磷乘积和i PTH水平高于无瓣膜钙化组,差异有统计学意义(P<0.05)。有瓣膜钙化组24 h平均脉压偏高、24 h平均舒张压偏低,差异有统计学意义(P<0.05),平均收缩压略高于无瓣膜钙化组,杓型血压比例略低于无瓣膜钙化组,但差异无统计学意义(P>0.05)。结论 血磷浓度、钙磷乘积、血i PTH升高是导致CKD患者心脏瓣膜钙化的重要危险因素,心脏瓣膜钙化的患者可出现动态血压异常。
Objective To investigate the relationship between heart valve calcification and parathyroid hormone, calcium and phosphorus metabolism and ambulatory blood pressure in patients with non-dialysis chronic kidney disease (CKD). Methods 70 patients with stage CKD stage 3-5 non-dialysis treated in Department of Nephrology, Chengde Central Hospital between June 2010 and June 2013 were divided into valvular calcification group and non-valvular calcification group according to echocardiographic results. Group of patients with serum calcium, phosphorus, parathyroid hormone (i PTH) levels and ambulatory blood pressure monitoring indicators. Results There was no significant difference in serum calcium and glomerular filtration rate between the two groups (P> 0.05). The levels of serum phosphorus, calcium and phosphorus, and i PTH in valvular calcification group were significantly higher than those in nonvalvular calcification group (P <0.05). In the valvular calcification group, the mean pulse pressure was high at 24 h, and the average diastolic pressure at 24 h was lower (P <0.05). The mean systolic pressure was slightly higher than that of the non-valvular calcification group, and the ratio of dipper blood pressure was slightly lower than that without Valvular calcification group, but the difference was not statistically significant (P> 0.05). Conclusions The serum phosphorus concentration, the calcium-phosphorus product and the elevated blood i-PTH are important risk factors for heart valve calcification in patients with CKD. Ambulatory blood pressure abnormalities may occur in patients with cardiac valve calcification.