淮南地区维持性血液透析患者甲状旁腺激素达标情况及相关影响因素分析

韩姝; 戴荣; 谢伟楠; 王保家; 第加美

doi:10.16766/j.cnki.issn.1674-4152.004119

淮南地区维持性血液透析患者甲状旁腺激素达标情况及相关影响因素分析

doi: 10.16766/j.cnki.issn.1674-4152.004119

韩姝^{1, 2},
戴荣^{1, 2},
谢伟楠²,
王保家^{1, 2},
第加美^2, ,

1.
蚌埠医科大学研究生院, 安徽蚌埠 233000
2.
安徽理工大学第一附属医院肾内科, 安徽淮南 232007

基金项目:

安徽省卫生健康科研项目重点项目 AHWJ2023A10030

蚌埠医学院2023年度研究生创新计划项目 Byycx23142

详细信息

通讯作者:
第加美，E-mail: 2562344375@qq.com

中图分类号: R692.5 R459.5
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- 文章访问数: 7
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- 被引次数: 0
出版历程
- 收稿日期: 2025-01-22
- 网络出版日期: 2025-10-31

Analysis of PTH compliance and related influencing factors in MHD patients in Huainan area

HAN Shu^{1, 2},
DAI Rong^{1, 2},
XIE Weinan²,
WANG Baojia^{1, 2},
DI Jiamei^{2
, ,}

1.
Graduate School of Bengbu Medical University, Bengbu, Anhui 233000, China

摘要

摘要: 目的对2021—2023年淮南地区维持性血液透析(MHD)患者一般临床资料及临床质控数据进行分析，了解淮南地区MHD患者甲状旁腺激素(PTH)质控指标达标情况及相关影响因素，为发现更有效的预防和治疗措施提供依据。方法以2021年1月—2023年12月在淮南地区18个血液透析单位进行MHD的患者为研究对象，收集所有患者的一般临床资料及相关实验室指标。分析淮南地区MHD患者PTH相关临床指标达标情况，并进一步分析影响PTH达标的相关因素。结果本研究共纳入了4 409例MHD患者，其中男性2 740例，女性1 669例，年龄为(58.23±12.71)岁，透析龄为60.00(36.00，97.00)个月。汇总全部研究对象的实验室检查结果，血钙、血磷、ALP和PTH的达标率分别为63.1%、46.7%、75.3%和59.2%。2021年、2022年和2023年血磷达标率及PTH达标率的分布差异有统计学意义(χ²=8.765、10.917，P=0.012、0.004)。不同PTH达标情况MHD患者年龄、原发病、血磷达标率、ALP达标率差异均有统计学意义(P < 0.05)。结论淮南地区MHD患者各项指标达标情况仍需进一步改善，其中血磷及PTH达标率在2021—2023年呈逐年提高的趋势；年龄、原发病、血磷、ALP均是影响PTH达标的相关因素。
- 终末期肾脏病 /
- 维持性血液透析 /
- 甲状旁腺激素 /
- 继发性甲状旁腺功能亢进症 /
- 影响因素
Abstract: Objective To understand the compliance of parathyroid hormone (PTH) quality control indicators and related influencing factors in maintenance hemodialysis (MHD) patients in Huainan area through the analysis of general clinical data and clinical quality control data of MHD patients in Huainan area from 2021 to 2023, so as to provide a basis for finding more effective prevention and treatment measures. Methods The patients who underwent MHD in 18 hemodialysis units in Huainan area from January 2021 to December 2023 were selected as the research objects, and the general clinical data and related laboratory indicators of all patients were collected. The compliance of PTH related clinical indicators in MHD patients in Huainan area was analyzed, and the related factors affecting PTH compliance were explored. Results A total of 4 409 MHD patients from 18 hemodialysis units in Huainan area were included in this study, including 2 740 males and 1 669 females, with an average age of (58.23±12.71) years and an average dialysis age of 60.00 (36.00, 97.00) months. The laboratory test results of all subjects showed that the compliance rates of serum calcium, serum phosphorus, ALP and PTH were 63.1%, 46.7%, 75.3%, and 59.2%, respectively. There were statistically significant differences in the distribution of blood phosphorus compliance rate and PTH compliance rate in 2021, 2022 and 2023 (χ²=8.765, 10.917, P=0.012, 0.004). There were statistically significant differences in the distribution of PTH compliance among subjects with different ages, primary diseases, blood phosphorus compliance rate and ALP compliance rate (P < 0.05). Conclusion The indicators of MHD patients in Huainan area still need to be further improved, and the compliance rate of blood phosphorus and PTH increased year by year from 2021 to 2023. The age, hypertension, serum phosphorus and ALP are all related factors affecting PTH compliance.
- End-stage renal disease /
- Maintenance hemodialysis /
- Parathyroid hormone /
- Secondary hyperparathyroidism /
- Influencing factors

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表 1 4 409例MHD患者的人口学和临床指标

Table 1. Demographic and clinical information of 4 409 subjects

项目	数据
性别[例(%)]
男性	2 740(62.1)
女性	1 669(37.9)
年龄(x±s, 岁)	58.23±12.71
原发病[例(%)]
不详	290(6.6)
多囊肾	259(5.9)
高尿酸血症	76(1.7)
高血压	980(22.2)
梗阻性肾病	69(1.6)
狼疮肾炎	47(1.1)
慢性肾小球肾炎	1 238(28.1)
其他	119(2.7)
肾病综合征	74(1.7)
糖尿病	1 257(28.5)
血管通路[例(%)]
动静脉内瘘	3 684(83.6)
动静脉内瘘+中心静脉导管	16(0.4)
中心静脉导管	709(16.1)
透析龄[M(P₂₅, P₇₅), 月]	60.00(36.00，97.00)
血钙[例(%)]
不达标	1 629(36.9)
达标	2 780(63.1)
血磷[例(%)]
不达标	2 350(53.3)
达标	2 059(46.7)
ALP[例(%)]
不达标	1 090(24.7)
达标	3 319(75.3)
PTH[例(%)]
不达标	1 799(40.8)
达标	2 610(59.2)

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表 2 不同年份MHD患者人口学和临床指标比较

Table 2. Comparison of demographic and clinical indicators of MHD patients in different years

项目	2021(n=1 628)	2022(n=1 275)	2023(n=1 506)	统计量	P值
性别[例(%)]				0.117^a	0.943
男性	1 013(62.2)	796(62.4)	931(61.8)
女性	615(37.8)	479(37.6)	575(38.2)
年龄(x±s, 岁)	57.76±12.35	57.42±12.77	59.42±12.95	10.305^b	< 0.001
原发病[例(%)]				16.145^a	0.582
不详	102(6.3)	90(7.1)	98(6.5)
多囊肾	108(6.6)	74(5.8)	77(5.1)
高尿酸血症	30(1.8)	23(1.8)	23(1.5)
高血压	385(23.6)	284(22.3)	311(20.7)
梗阻性肾病	27(1.7)	17(1.3)	25(1.7)
狼疮肾炎	19(1.2)	14(1.1)	14(0.9)
慢性肾小球肾炎	436(26.8)	350(27.5)	452(30.0)
其他	43(2.6)	39(3.1)	37(2.5)
肾病综合征	26(1.6)	27(2.1)	21(1.4)
糖尿病	452(27.8)	357(28.0)	448(29.7)
血管通路[例(%)]				27.596^a	< 0.001
动静脉内瘘	1 388(85.3)	1 088(85.3)	1 208(80.2)
内瘘+中心静脉导管	1(0.1)	3(0.2)	12(0.8)
中心静脉导管	239(14.7)	184(14.4)	286(19.0)
透析龄[M(P₂₅, P₇₅)，月]	53.00(27.00, 91.00)	54.00(29.00, 89.00)	72.00(48.00, 105.00)	220.011^b	< 0.001
血钙[例(%)]				2.152^a	0.341
不达标	579(35.6)	479(37.6)	571(37.9)
达标	1 049(64.4)	796(62.4)	935(62.1)
血磷[例(%)]				8.765^a	0.012
不达标	912(56.0)	673(52.8)	765(50.8)		.
达标	716(44.0)	602(47.2)	741(49.2)
ALP[例(%)]				8.373^a	0.015
不达标	438(26.9)	314(24.6)	338(22.4)
达标	1 190(73.1)	961(75.4)	1 168(77.6)
PTH[例(%)]				10.917^a	0.004
不达标	714(43.9)	510(40.0)	575(38.2)
达标	914(56.1)	765(60.0)	931(61.8)
注：^a为χ²值，^b为F值。

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表 3 不同PTH达标情况MHD患者人口学和临床指标的比较

Table 3. Comparison of demographic and clinical indicators in MHD patients with different PTH attainment situations

项目	不达标(n=1 799)	达标(n=2 610)	统计量	P值
性别[例(%)]			0.483^a	0.487
男性	1 129(62.8)	1 611(61.7)
女性	670(37.2)	999(38.3)
年龄(x±s, 岁)	56.81±12.91	59.20±12.47	6.177^b	< 0.001
原发病[例(%)]			69.644^a	< 0.001
不详	124(6.9)	166(6.4)
多囊肾	109(6.1)	150(5.7)
高尿酸血症	30(1.7)	46(1.8)
高血压	487(27.1)	493(18.9)
梗阻性肾病	34(1.9)	35(1.3)
狼疮肾炎	15(0.8)	32(1.2)
慢性肾小球肾炎	499(27.7)	739(28.3)
其他	44(2.4)	75(2.9)
肾病综合征	38(2.1)	36(1.4)
糖尿病	419(23.3)	838(32.1)
透析龄[M(P₂₅, P₇₅)，月]	62.00(37.0, 96.0)	58.00(35.0, 98.0)	-1.939^b	0.052
血钙[例(%)]			3.088^a	0.079
不达标	637(35.4)	992(38.0)
达标	1 162(64.6)	1 618(62.0)
血磷[例(%)]			83.091^a	< 0.001
不达标	1 108(61.6)	1 242(47.6)
达标	691(38.4)	1 368(52.4)
ALP[例(%)]			92.295^a	< 0.001
不达标	580(32.2)	510(19.5)
达标	1 219(67.8)	2 100(80.5)
注：^a为χ²值，^b为t值。

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表 4 MHD患者PTH不达标影响因素的logistic回归分析

Table 4. Logistic regression analysis of the influencing factors of non-compliant PTH in MHD patients

变量	B	SE	Waldχ²	P值	OR值	95% CI
性别	0.064	0.068	0.890	0.345	1.065	0.932~1.217
年龄	0.011	0.003	15.043	＜0.001	1.011	1.005~1.016
透析龄	0.000	0.001	0.117	0.732	1.000	0.999~1.002
血钙	-0.118	0.067	3.149	0.076	0.888	0.779~1.012
血磷	0.533	0.067	62.533	＜0.001	1.699	1.489~1.939
ALP	0.767	0.074	107.589	＜0.001	2.150	1.860~2.486
高血压	-0.433	0.141	9.478	0.002	0.648	0.488~0.847
注：性别以男性为参照，血钙、血磷、ALP以不达标为参照。PTH，达标=0, 不达标=1;性别，男性=1, 女性=2;年龄，连续型变量，以实际值赋值; 透析龄，连续型变量，以实际值赋值; 血钙，达标=0, 不达标=1;血磷，达标=0, 不达标=1;ALP，达标=0, 不达标=1;高血压，是=0, 否=1。

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