低钙透析液对低转运性骨病患者PTH和BGP的影响及与骨质疏松及血管钙化的关系

目的探讨低钙透析液对低转运性骨病患者甲状旁腺素(parathyroid hormone,PTH)和骨钙素(osteocalcin,BGP)的影响,并分析其与骨质疏松及血管钙化的关系。方法选取2017年1月至2018年12月在本院使用普钙(1.5 mmol/L)进行维持性血液透析(MHD)6个月以上的180例肾性骨病患者作为研究对象,根据是否为低转运性骨病将其分为低转运性骨病组和非低转运性骨病组,分别为60例和120例,对比两组患者血清PTH、BGP水平、骨密度和冠状动脉血管钙化情况。后对低转运性骨病组中合并冠状动脉血管钙化者改用1.25 mmol/L透析液,观察患者发生低血压、心律失常、肌肉痉挛等不良反应情况以评估其安全性;对比更换前、更换后第1、3、6个月患者血清PTH、BGP水平、骨密度和冠状动脉血管钙化情况。结果与非低转运性骨病比较,低转运性骨病血清PTH、BGP及BMD降低,但CACS则明显升高,差异有统计学意义(P<0.05)。绘制ROC图分析得知,PTH在低转运性骨病和非低转运性骨病鉴别诊断中有一定价值;与之比较,PTH联合检测鉴别诊断效能提高,以PTH、BGP、BMD及CACS四者联合效能最高。更换低钙透析液总不良反应率分别为20.00%和25.00%,两者比较差异无统计学意义(χ^2=0.430,P=0.512)。与更换前比较,更换后低转运性骨病血清PTH、BGP及BMD升高,但CACS则明显降低,差异有统计学意义(P<0.05)。与无心血管事件者比较,心血管事件发生者PTH、BGP和BMD明显降低,但CACS则相对升高,差异有统计学意义(P<0.05)。结论低钙透析液可明显升高低转运性骨病患者血清PTH和BGP水平,改善骨质疏松和血管钙化,从而降低心血管事件发生率。

The Effect of Low Calcium Dialysate on PTH and BGP in Patients with Low-transit Osteopathy and Its Relationship with Osteoporosis and Vascular Calcification

Objective To investigate the effects of low calcium dialysate on parathyroid hormone(PTH)and osteocalcin(BGP)in patients with low-transit osteopathy,and to analyze the relationship between PTH and BGP and osteoporosis and vascular calcification.Methods 180 patients with renal osteopathy who received maintenance hemodialysis(MHD)with calcium(1.5 mmol/L)from January 2017,to December,2018 in our hospital were selected as study subjects.They were divided into the low-transit osteopathy group(60 cases)and the non-low-transit osteopathy group(120 cases)according to whether or not they were low-transit osteopathy.Serum PTH,BGP levels,bone mineral density and coronary artery calcification were compared between the two groups.Also,1.25 mmol/L dialysate was used to evaluate the safety of patients with low-transit osteopathy complicated with coronary artery calcification,and adverse reactions such as hypotension,arrhythmia and muscle spasm were observed to compare the levels of PTH,BGP,BMD and coronary artery before and 1,3 or 6 months after the replacement.Results Compared with the non-low transport osteopathy,serum PTH,BGP and BMD of low transport osteopathy decreased,while CACS increased significantly(P<0.05).The analysis of ROC chart showed that PTH had a certain value in the differential diagnosis of low-transit osteopathy and non-low-transit osteopathy.Compared with individual test of PTH,BGP,BMD or CACS,the combined detection and differential diagnosis efficiency of PTH was improved,among which the combination of PTH,BGP,BMD and CACS was the most effective option.The total adverse reactions of replacement of low calcium dialysate were 20.00%and 25.00%respectively,and there was no significant difference between them(χ^2=0.430,P=0.512).Compared with before the replacement,the serum PTH,BGP and BMD of low-transporting osteopathy increased after the replacement,while CACS decreased significantly(P<0.05).Compared with those without cardiovascular events,PTH,BGP and BMD in patients with cardiovascular events were significantly lower,while CACS was relatively higher(P<0.05).Conclusion Low calcium dialysate can significantly increase serum PTH and BGP levels,improve osteoporosis and vascular calcification,and reduce the incidence of cardiovascular events in patients with low transport osteopathy.