中文摘要：

目的分析合并高磷血症的腹膜透析（腹透）患者的临床特征，探讨影响腹透患者发生高磷血症的相关因素。方法人选在上海交通大学医学院附属仁济医院腹透中心接受稳定、规律腹膜透析3个月以上的患者100例，根据血磷水平分为高血磷组（血磷≥1．6mmol／L）和正常血磷组（血磷〈1．6mmol／L）。记录所有入选患者3d的饮食日记，评估饮食中磷、蛋白质、热量的摄人量。检测患者血清白蛋白、血磷、血钙、血清甲状旁腺激素（iPTH）、超敏c反应蛋白（hCRP）、血钾等指标。评估患者腹膜及残肾的磷清除率、残肾功能（RRF）、总肌酐清除率（Ccr）、腹透超滤量等。记录患者降磷药物及活性维生素D的使用情况。采用多元逐步回归法分析影响腹透患者血磷水平的独立相关因素。结果与正常血磷组相比，高血磷组患者的饮食磷摄人量[（13．03±3．39）比（10．65±3．04）mg·kgIBW^-1·d^-1]和蛋白质摄入量[（0．96±0．30）比（0．80±0．27）mg·kgIBW^-1·d^-1较高（均P〈0．05）。腹膜磷清除率【（21．80±9．90）比（27．74±11．23）L·周^-1·（1．73m2）^-1】、残肾磷清除率[1．38（0，12．38）比10．30（0，21．97）L·周^-1·（1．73m2）^-1】和总Ccr[（59．7±18．5）比（68．3±23．1）L·周^-1·（1．73m2）^-1】较低（均P〈0．05）；高血磷组中无尿患者比例（46％比24％）、1．25mmol／L钙浓度透析液的使用比例（66％比40％）、血钾水平[（4．4±0．8）比（3．9±0．6）mmol／L]均较正常血磷组高（均P〈0．05）。两组患者中血清白蛋白、超敏c反应蛋白、血钙等指标以及碳酸钙和活性维生素D使用比例与剂量的差异无统计学意义（均P〉0．05）。多元逐步回归分析结果显示：饮食磷摄入量（β=0．043，P〈0．01）、腹膜磷清除率（β=-0．008，P〈0．05）、残肾功能（β=-0．07，P〈0．01）和log[iPT

英文摘要：

Objective To sort the clinical features associated with hyperphosphatemia in peritoneal dialysis （PD） patients. Methods The patients who had been on stable PD at least three months were eligible to enroll. All patients were instructed to record 3 days food diary in order to obtain the daily dietary phosphorus, protein and calorie intake. The peritoneal and renal clearance of phosphorus, residual renal function （RRF） and total creatinine clearance （Ccr） were calculated.Laboratory parameters, including serum albumin, phosphorus, calcium, intact parathyroid hormone （iPTH）, high sensitivity C reactive protein （hs- CRP）, potassium were measured. Prescription of oral phosphorus binders and active vitamin D were recorded. Results A total of 100 PD patients were enrolled and divided into two groups according to their serum phosphorus levels, including high serum phosphorus group （≥ 1.6 mmol/L, n = 50） and normal serum phosphorus group （ 〈 1.6 mmol/L, n = 50）. Compared to the patients with normal serum phosphorus, hyperphosphatemic PD patients had significantly higher dietary phosphorus [（13.03±3.39） vs （10.65± 3.04） mg. kg IBW d-1] and protein intake [（0.96±0.30） vs （0.80±0.27） mg. kg IBW-1. d-l], while peritoneal phosphorus clearance [（21.8± 9.90） vs （27.74_＋11.23） L. wk-1[（1.73 m2）-1], renal phosphorus clearance [1.38（0, 12.38） vs 10.30（0, 21.97） L. wk-1[ （1.73 m2）-1] and total Cer [（59.7±18.5） vs （68.3±23.1） L. wk-1 （1.73 m2）-1] were lower （all P 〈 0.05）. Patients with hyperphosphatemia showed higher prevalence of anuria （46% vs 24%） and more frequent usage of dialysate with 1.25 mmol/L calcium （66% vs 40% ） compared to their counterparts with normal serum phosphorus （all P 〈 0.05）. In addition, serum potassium levels in patients with hyperphosphatemia were higher [（4.4±0.8） vs （3.9 ± 0.6） mmol/L, P 〈 0.05]. Multiple stepwise regression analysis showed that dietary phosphorus intake （β = 0.04