通讯作者: 李志燕, lizhiyan68@126.com

DOI：10.12201/bmr.202411.00029

Analysis of Serum Calcium, Phosphate, and Hemoglobin Levels and Their Influencing Factors in Maintenance Hemodialysis Patients

• 摘要：目的：分析维持性血液透析患者血清钙、磷和血红蛋白水平的现状及其相关影响因素。方法：回顾性分析维持性患者的临床资料,包括血清钙、磷、血红蛋白水平及相关临床指标。结果：217例维持性透析患者中男性115例(53.0%),平均年龄(55.88±13.54)岁,身体质量指数(23.30±3.91)kg/m2。不同钙水平组患者在年龄、性别、身体质量指数、血红蛋白、C反应蛋白、血钾、磷、碳酸氢根、肌酐、尿酸、甲状旁腺素、β-2微球蛋白、尿素下降率方面差异无统计学意义,P＞0.05；在尿素、白蛋白、前白蛋白方面差异有统计学意义,P＜0.05。不同磷水平组患者在性别、身体质量指数、血红蛋白、C反应蛋白、血清钙、尿素下降率方面差异无统计学意义,P＞0.05；在年龄、血钾、碳酸氢根、尿素、肌酐、尿酸、白蛋白、前白蛋白、甲状旁腺素、β-2微球蛋白方面差异有统计学意义,P＜0.05。 不同血红蛋白水平组患者在年龄、性别、身体质量指数、血钾、血磷、碳酸氢根、尿素、肌酐、尿酸、白蛋白、甲状旁腺素、β-2微球蛋白、尿素下降率方面差异无统计学意义,P＞0.05；在C反应蛋白、血钙、前白蛋白方面差异有统计学意义,P＜0.05。以校正钙为结果评估血钙达标率为50.70%,血磷达标率为24.00%,血红蛋白达标率为34.10%。多因素线性回归分析发现：只有碳酸氢根(B值 0.014,P=0.003)、血红蛋白(B值 0.002,P=0.024)对血钙的影响有统计学差异(P＜0.05)；只有肌酐(B值0.001,P＜0.01)、碳酸氢根(B值 -0.045,P＜0.01)、尿素(B值 0.019,P＜0.01)、年龄(B值 -0.006,P=0.02)、血钾(B值 0.084,P=0.035)对血磷的影响有统计学差异(P＜0.05)；只有C反应蛋白(B值 -1.098,P＜0.01)、β-2微球蛋白(B值 -0.472,P=0.001)、总蛋白(B值 0.607,P=0.003)、甲状旁腺素(B值 -0.007,P=0.022)、血钙(B值 10.762,P=0.024)对血红蛋白的影响有统计学差异(P＜0.05)。通过血清钙、磷和血红蛋白的残差直方图初步判断回归标准化残差基本符合正态分布。结论：碳酸氢根与血红蛋白对血钙水平有一定独立正相关性；肌酐、尿素、血钾对血磷水平有一定独立正相关性,与年龄呈负相关；总蛋白、血钙水平对血红蛋白有一定独立正相关,与C反应蛋白、β-2微球蛋白、甲状旁腺素呈负相关。为临床疾病管理提供参考。

  关键词： 维持性血液透析; 血清钙; 血清磷; 血红蛋白; 影响因素

   

  Abstract: Objective: To analyze the current status of serum calcium, phosphate, and hemoglobin levels in maintenance hemodialysis (MHD) patients and their associated influencing factors. Methods: A retrospective analysis was conducted on clinical data from MHD patients, including serum calcium, phosphate, hemoglobin levels, and related clinical indicators. Results: Among 217 MHD patients 115 male, (53.0%); mean age( 55.88 ± 13.54) years; mean BMI 23.30 ± 3.91)(kg/m2), no statistically significant differences were found between different calcium level groups regarding age, gender, BMI, hemoglobin, CRP, potassium, phosphate, bicarbonate, creatinine, uric acid, PTH, beta-2 microglobulin, or URR (p > 0.05). Statistically significant differences were observed in urea, albumin, and prealbumin levels (p < 0.05). No statistically significant differences were found between different phosphate level groups regarding gender, BMI, hemoglobin, CRP, serum calcium, or URR (p > 0.05). Statistically significant differences were observed in age, potassium, bicarbonate, urea, creatinine, uric acid, albumin, prealbumin, PTH, beta-2 microglobulin (p < 0.05). No statistically significant differences were found between different hemoglobin level groups regarding age, gender, BMI, potassium, phosphate, bicarbonate, urea, creatinine, uric acid, albumin, PTH, beta-2 microglobulin, or URR (p > 0.05). Statistically significant differences were observed in CRP, serum calcium, and prealbumin (p < 0.05). The corrected calcium target attainment rate was 50.70%, the phosphate target attainment rate was 24.00%, and the hemoglobin target attainment rate was 34.10%. Multivariate linear regression analysis showed that only bicarbonate (B value 0.014, p=0.003) and hemoglobin (B value 0.002, p=0.024) had a statistically significant effect on serum calcium (p < 0.05). Only creatinine (B value 0.001, p < 0.01), bicarbonate (B value -0.045, p < 0.01), urea (B value 0.019, p < 0.01), age (B value -0.006, p=0.02), and potassium (B value 0.084, p=0.035) had a statistically significant effect on serum phosphate (p < 0.05). Only CRP (B value -1.098, p < 0.01), beta-2 microglobulin (B value -0.472, p=0.001), total protein (B value 0.607, p=0.003), PTH (B value -0.007, p=0.022), and serum calcium (B value 10.762, p=0.024) had a statistically significant effect on hemoglobin (p < 0.05). Residual histograms for serum calcium, phosphate, and hemoglobin suggested that standardized residuals generally followed a normal distribution. Conclusion: Bicarbonate and hemoglobin levels have an independent positive correlation with serum calcium. Serum phosphate levels have an independent positive correlation with creatinine, urea, and potassium, and a negative correlation with age. Hemoglobin levels have an independent positive correlation with total protein and serum calcium, and a negative correlation with CRP, beta-2 microglobulin, and PTH. These findings provide reference for clinical disease management.

  Key words: Maintenance Hemodialysis; Serum Calcium; Serum Phosphate; Hemoglobin; Influencing Factors

  提交时间：2024-11-14

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• 序号	提交日期	编号	操作
  1	2024-08-16	bmr.202411.00029V1	下载

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