背景:贫血是与慢性肾脏病(CKD)相关的常见并发症之一,是此类患者发病率和死亡率增加的原因。有几个因素导致了肾性贫血,其中甲状旁腺功能亢进是较少认识的原因之一。大多数研究都是在接受血液透析的CKD患者中进行的。慢性肾脏病早期的PTH水平研究不多。CKD继发的甲状旁腺激素(PTH)过量已被认为是贫血的致病因素。
目的:评估CKD患者血液透析前的血清PTH水平,并研究血红蛋白状态与甲状旁腺激素的关系。
方法:将40例血液透析前年龄在18岁以上的CKD患者和25例年龄和性别相匹配的健康对照者纳入研究。常规生化和血液学参数,如常规血糖(RBS),尿素,肌酐,Na+,K+,Ca2+,进行PTH和Hb%。通过用0.1%至0.9%的不同氯化钠浓度连续稀释全血测量红细胞渗透脆性。
结果:研究显示Hb%显著下降,与对照组相比,CKD患者的中位渗透脆性(MOF)和PTH升高。PTH与Hb%的线性回归显示两个参数之间的显著负相关,R2值为0.677。MOF和其他自变量如Hb%的多元线性回归分析,Na+,K+,Ca2+,尿素,PTH和肌酐使MOF的方差增加了72%,PTH贡献的最大方差。接收器工作曲线(ROC)分析显示,在PTH≥100pg/ml的截止值检测渗透脆性时,曲线下面积为0.980,灵敏度为100%,特异性为87%。
结论:CKD患者在血液透析前应及早发现贫血的根本原因。继发性甲状旁腺功能亢进应被排除为贫血的致病因素,以减缓疾病进程的进展。
BACKGROUND: Anaemia is one of the common complications associated with Chronic Kidney Disease (CKD) responsible for the increase in the morbidity and mortality in such patients. Several factors have been attributed to cause renal anaemia, amongst which hyperparathyroidism is one of the less recognised reasons. Most studies have been conducted in this regard in CKD patients undergoing haemodialysis. The level of PTH in early stages of chronic kidney disease has not been much studied. The excess amount of Parathyroid Hormone (PTH) secondary to CKD has been suggested to be a causative factor for anaemia.
OBJECTIVE: To evaluate the serum PTH level in CKD patients before haemodialysis and to
study the association of the haemoglobin status with the parathyroid hormone.
METHODS: Forty CKD patients above 18 years of age before haemodialysis and 25 age and sex matched healthy controls were included in the
study. Routine biochemical and haematological parameters such as Routine Blood Sugar (RBS), urea, creatinine, Na+, K+, Ca2+, PTH and Hb% were perfomed. Red cell osmotic fragility was measured by serial dilutions of whole blood with varying concentrations of sodium chloride ranging from 0.1% to 0.9%.
RESULTS: The
study revealed a significant fall in Hb%, along with a rise in Median Osmotic Fragility (MOF) and PTH in the CKD patients when compared to the control group. Linear regression of PTH with Hb% revealed significant negative association between both the parameters with a R2 value of 0.677. Multilinear regression analysis of MOF and other independent variables such as Hb%, Na+, K+, Ca2+, urea, PTH and creatinine highlighted the variance of MOF by 72%, maximal variance contributed by PTH. Receiver Operating Curve (ROC) analysis revealed an area under the curve of 0.980 with a sensitivity of 100% and specificity of 87% in detecting osmotic fragility at a cut off value of PTH ≥100 pg/ml.
CONCLUSIONS: The underlying cause of anaemia should be identified early in the CKD patients before haemodialysis. Secondary hyperparathyroidism should be ruled out as a causative factor of anaemia to slow down the progression of the disease process.