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目的探讨老年腹膜透析患者残余肾功能与钙磷代谢、血清铁调素及心功能的相关性。方法收集2014年1月至2015年12月肾内科收治的60例进行维持性腹膜透析的老年肾病患者,按照根据肾小球滤过率(GFR)的不同分为:A组(GFR<2 ml·min~(-1)·1.73m~(-2)),B组(GFR为2~4 ml·min~(-1)·1.73m~(-2)),C组(GFR>4 ml·min~(-1)·1.73m~(-2))。结果 A组透析时间高于B组和C组,B组高于C组,差异有统计学意义(P均<0.05)。其中有14例出现高钙血症,发生率为23.33%;37例出现高磷血症,发生率为61.67%。A组、B组、C组三组血钙水平比较,差异无统计学意义(P>0.05);A组血磷水平、钙磷乘积高于B组和C组,B组高于C组,差异有统计学意义(P均<0.05)。A组心脏钙化发生率高于B组和C组,B组高于C组,差异有统计学意义(P均<0.05)。A组、B组、C组血清铁调素水平分别是(17.62±3.66)μg/L、(14.98±3.37)μg/L、(11.04±3.29)μg/L,随着残余肾功能的降低,血清铁调素水平不断升高(F=11.281,P=0.000)。GFR与血磷、钙磷乘积、心脏钙化发生率均呈负相关(r=-0.365,P=0.012;r=-0.354,P=0.017;r=-0.350,P=0.020),与EF呈正相关(r=0.359,P=0.015),与铁调素水平呈负相关(r=-0.407,P=0.000)。结论老年腹膜透析患者残余肾功能与腹膜透析时间有关,残余肾功能较差的患者存在钙磷代谢紊乱,且患者心脏钙化发生率增加,患者的心功能异常,血清铁调素水平不断升高。
Objective To investigate the relationship between residual renal function and calcium and phosphorus metabolism, serum hepcidin and cardiac function in elderly peritoneal dialysis patients. Methods A total of 60 elderly patients with nephropathy undergoing maintenance peritoneal dialysis were enrolled in the Department of Nephrology between January 2014 and December 2015. The patients were divided into group A (GFR <2 ml Min -1 -1.73 m -2), group B (GFR 2-4 ml · min -1 · 1.73 m -2), group C (GFR> 4 ml -1) · Min ~ (-1) · 1.73m -2). Results The dialysis time of group A was higher than that of group B and C, while that of group B was higher than that of group C (P <0.05). Among them, 14 cases had hypercalcemia, the incidence was 23.33%; 37 cases had hyperphosphatemia, the incidence was 61.67%. There was no significant difference in serum calcium levels among groups A, B and C (P> 0.05); the levels of serum phosphorus and calcium and phosphorus in group A were higher than those in groups B and C, The difference was statistically significant (P all <0.05). The incidence of heart calcification in group A was higher than that in group B and C, and in group B was higher than that in group C (P <0.05). The levels of serum hepcidin in group A, B and C were (17.62 ± 3.66) μg / L and (14.98 ± 3.37) μg / L and (11.04 ± 3.29) μg / L, respectively. Serum hepcidin levels continue to rise (F = 11.281, P = 0.000). There was a negative correlation between GFR and serum phosphorus, calcium and phosphorus products and the incidence of cardiac calcification (r = -0.365, P = 0.012; r = -0.354, P = 0.017; r = -0.350, P = 0.020) (r = 0.359, P = 0.015), but negatively correlated with hepcidin (r = -0.407, P = 0.000). Conclusion The residual renal function in peritoneal dialysis patients is related to the time of peritoneal dialysis. The patients with poor residual renal function have disorder of calcium and phosphorus metabolism, the incidence of cardiac calcification increases, the patients have abnormal cardiac function and the level of serum hepcidin increases continuously.