Relationship between mineral and bone metabolic disorders and prognosis in patients with chronic renal disease

He Xiaolei; Li Ya

doi:10.3760/cma.j.issn.1008-1372.2018.10.019

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慢性肾病患者矿物质、骨代谢紊乱与预后的关系研究

中国医师杂志, 2018,20(10) : 1514-1517. DOI: 10.3760/cma.j.issn.1008-1372.2018.10.019

摘要

目的

探讨慢性肾病(CKD)患者矿物质、骨代谢紊乱与预后的关系。

方法

纳入本院2015年10月至2017年10月收治的CKD患者200例，上门随访6个月，分析患者的预后情况，并根据预后进行分组，分别为预后良好组(无事件生存)、预后不良组(并发症、死亡)。比较两组临床特征，通过绘制ROC曲线分析矿物质、骨代谢指标对预后不良的预测价值，其中矿物质、骨代谢指标包括血钙(Ca)、血磷(P)、血钙×血磷(Ca×P)、骨型碱性磷酸酶(BSALP)、25羟基维生素D3[25(OH)D₃]、骨钙素(OC)、全段甲状旁腺激素(iPTH)。利用Logistic回归分析明确CKD患者预后不良的独立危险因素。

结果

在200例患者中，有164例(82.00%)预后良好，36例(18.00%)预后不良。预后不良组的CKD4期、CKD5期、血糖控制不良、血压控制不良占比(27.78%、16.67%、47.22%、41.67%)高于预后良好组(4.27%、1.22%、18.29%、15.85%)，预后不良组血Ca×P、BSALP、OC水平[(3.46±0.21)mmol²/L²、(98.64±12.67)U/L、(71.19±58.73)μg/L]高于预后良好组[(3.34±0.28)mmol²/L²、(85.43±15.58)U/L、(36.57±23.65)μg/L]，差异有统计学意义(P<0.05)；而血25(OH)D₃水平[(11.39±6.56)μg/L]低于预后良好组[(19.64±8.65)μg/L]，差异有统计学意义(P<0.05)。血Ca×P、BSALP、25(OH)D₃、OC预测CKD预后不良的曲线下面积分别为0.782、0.806、0.815、0.857。经Logistic回归分析发现CKD分期(4～5期)、血糖控制不良、血压控制不良、Ca×P≥3.393 mmol²/L²、BSALP≥92.932 U/L、25(OH)D₃≤14.016 μg/L、OC≥86.339 μg/L均是CKD预后不良的独立危险因素(P<0.05)。

结论

血Ca×P、BSALP、25(OH)D₃、OC水平对CKD预后不良具有一定预测价值，患者的矿物质、骨代谢紊乱越严重，预后不良风险越大。

引用本文: 贺晓蕾, 李亚. 慢性肾病患者矿物质、骨代谢紊乱与预后的关系研究 [J] . 中国医师杂志,2018,20 (10): 1514-1517. DOI: 10.3760/cma.j.issn.1008-1372.2018.10.019

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慢性肾病(chronic kidney disease，CKD)是因各种因素所致的慢性肾损害，具有发病隐匿、病程长、并发症多、死亡率高等特点^[1,2]。近年来，随着我国人口老龄化发展，CKD患病率逐年增高，严重危及患者生命质量^[3]。现已有多项研究证实矿物质、骨代谢紊乱在CKD患者中普遍存在，但关于紊乱程度与预后关系的报道比较少见^[4,5]。本文旨在分析CKD患者矿物质、骨代谢紊乱与预后的关系，便于进一步明确影响CKD预后的相关因素，现报道如下。

贡献者信息

贺晓蕾

518020　深圳市人民医院肾内科　暨南大学第二临床医学院

李亚

518020　深圳市人民医院肾内科　暨南大学第二临床医学院

关键词

肾疾病/代谢; 骨疾病，代谢性; 钙/血液; 磷/血液;

历史

出版日期：2018-10-20

收稿日期：2018-03-28

本文编辑

骆蓉

Original Article

Relationship between mineral and bone metabolic disorders and prognosis in patients with chronic renal disease

He Xiaolei, Li Ya

Published 2018-10-20

Cite as J Chin Physician, 2018,20(10): 1514-1517. DOI: 10.3760/cma.j.issn.1008-1372.2018.10.019

Abstract

Objective

To investigate the relationship between mineral and bone metabolic disorders and prognosis in patients with chronic renal disease (CKD).

Methods

200 patients with CKD admitted to our hospital from October 2015 to October 2017 were included. The prognosis of the patients was analyzed and grouped according to their prognosis.The follow-up was 6 months.They were divided into good prognosis group (no event survival) and poor prognosis group (complication and death). The clinical characteristics of the two groups were compared, and ROC curves were drawn to analyze the predictive value of mineral and bone metabolic indexes for poor prognosis, including serum calcium (Ca), phosphorus (P), calcium × phosphorus (Ca×P), bone alkaline phosphatase (BSALP), 25 hydroxyvitamin D₃ [25(OH)D₃], osteocalcin (OC), total parathyroid hormone (iPTH). Logistic regression analysis was used to determine the independent risk factors of poor prognosis in patients with chronic kidney disease.

Results

Of the 200 patients, 164(82%) had a good prognosis, and 36(18%) had poor prognosis.The ratio of CKD4, CKD5, poor blood glucose control and poor blood pressure control in the poor prognosis group were 27.78%, 16.67%, 47.22%, 41.67%, respectively, better than the prognosis group (4.27%, 1.22%, 18.29%, 15.85%). The levels of Ca×P, BSALP and OC in the poor prognosis group were (3.46±0.21)mmol²/L^2, (98.64±12.67)U/L, (71.19±58.73)μg/L, higher than the good prognosis group [(3.34±0.28)mmol²/L², (85.43±15.58)U/L, (36.57±23.65)μg/L]; The 25(OH)D₃ level in the poor prognosis group was (11.39±6.56)μg/L, which was lower than that in the good prognosis group (19.64±8.65)μg/L; with statistically significant difference (P<0.05). The area under the curve of Ca×P, BSALP, 25 (OH) D₃ and OC was 0.782, 0.806, 0.815 and 0.857, respectively, to predict the poor prognosis of CKD.The logistic regression analysis showed that CKD stage (stage 4-5), poor glycemic control, poor control of blood pressure, Ca×P≥3.393 mmol²/L^2, BSALP≥92.932 U/L, 25 (OH) D₃≤14.016 μg/L, OC≥86.339 μg/L were independent risk factors of poor prognosis of CKD (P< 0.05).

Conclusions

Serum Ca×P, BSALP, 25 (OH) D₃ and OC levels have certain predictive value for the poor prognosis of CKD. The more serious the mineral and bone metabolism disorders are, the greater the risk of poor prognosis.

Key words:

Kidney diseases/ME; Bone diseases, metabolic; Calcium/BL; Phosphorus/BL

Contributor Information

He Xiaolei

Department of Nephrology, the People′s Hospital of Shenzhen, the Second Clinical Medical College of Jinan University, Shenzhen 518020, China

Li Ya

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