慢性肾脏病患者钙磷代谢与心血管疾病的关系分析

目的 观察慢性肾脏病(CKD)患者钙磷代谢与心血管疾病的关系，探讨钙磷代谢在心脏损害中的作用,为预防CKD患者的心血管事件提供参考。 方法 98例非透析患者根据K/DOQI指南分为CKD 3、CKD 4、CKD 5期，测定血钙(Ca)、血磷(Pi)、甲状旁腺素(iPTH)、β-胶原降解产物(β-CTX)、总I型胶原氨基端延长肽(TPINP)、N端骨钙素(N-MID)；彩超检查左心室舒张末内径(LVDd)、室间隔厚度(IVST)、左心室后壁厚度(LVPTW)、射血分数(EF)，二尖瓣舒张晚期血流速度(A)与二尖瓣舒张早期血流速度(E)的比值(A/E)，两类指标作相关分析。 结果 ①从CKD 3期到CKD 5期β-CTX、N-MID、TP1NP、Pi和iPTH浓度水平表现升高趋势(P＜0.05)。②98例中36例(35.7%)有心肌肥厚，70例(71.4%)有舒张功能异常，27例(27.5%)有收缩功能异常。③β-CTX、N-MID、TP1NP、Pi、iPTH与心脏结构值呈正相关，与心脏收缩(EF)及舒张功能(A/E)值呈负相关。 结论 肾功能不全状态下钙磷代谢紊乱可能引起心脏结构及功能损害，管理钙磷代谢可减少心血管疾病的发生。 

Correlation of abnormal calcium-phosphorus homeostasis and heart malfunction patients with chronic kidney disease

Objective To analyze the relationship between the calcium-phosphorus metabolic profiles and cardiac malfunction characteristics in the chronic kidney disease(CKD) patients,discuss the role of calcium phosphorus metabolism in the heart damage,and provide reference for the privation of cardiovascular events in CKD patients. Methods A total number of 98 inpatients at stages of CKD3,CKD4 and CKD5 were recruited.Fasting venous blood was taken and calcium-phosphorus metabolic indices,including serum calcium,serum phosphate(Pi),intact parathyroid hormone(iPTH),β-collagen-specific sequences,total N-terminal propeptide of type Ⅰ procollagen(TPINP),and N-terminal-midfragment of ostecalcin(N-MID) were measured via electrochemiluminescence.Cardiac damage parameters,including left ventricular end diastolic diameter,interventricular septal thickness,left ventricular posterior wall thickness,ejection fraction(EF),and blood flow velocity at mitral diastolic late phase(A) and at mitral diastolic early phase(E) were obtained from echocardiography. Results There was an escalating trend in deteriorating calcium-phosphorus metabolic indices for patients from stage CKD3 to stage CKD5(P<0.05).Among 98 patients,35.7%(n=36) had myocardial hypertrophy,71.4%(n=70) had the diastolic dysfunction,and 27.5%(n=27) had systolic dysfunction.Correlations between abnormal calcium-phosphorus metabolic indices,such as β-CTX,N-MID,TP1NP,Pi,and iPTH,with myocardial hypertrophy,cardiac systolic indicator EF and the A/E value,diastolic dysfunction index,were evidenced. Conclusion In the context of kidney dysfunction,the abnormalities of calcium-phosphorus homeostasis may contribute to cardiac malfunction in CKD patients.