Zacharias J M, Fontaine B, Fine A
Department of Medicine, University of Manitoba, Winnipeg, Canada.
Perit Dial Int. 1999 May-Jun;19(3):248-52.
To investigate the risk factors for the development of calciphylaxis in renal failure, a poorly understood and often fatal condition characterized by calcium deposition in tissues.
Retrospective case-control study.
University hospital peritoneal dialysis center.
Eight continuous ambulatory peritoneal dialysis (CAPD) patients with calciphylaxis were identified in a 3-year period. We matched up to five controls for dialysis modality and length of time on dialysis with each case.
Multivariate conditional logistic regression analysis for matched case-controls.
Laboratory data and demographics were collected as well as cumulative calcium and vitamin D ingestion over the year prior to disease onset.
All the patients were female, versus only 38% (14/37) of controls (p < 0.0001). While not statistically significant, a majority of the patients were diabetic [62.5% (5/8) vs 32% (12/37)]. Peak and average levels of serum calcium, phosphate, calcium x phosphate product, parathyroid hormone (PTH), albumin, iron, total iron-binding capacity (TIBC), and ferritin were not significantly different in cases compared with controls. The use of calcitriol alone or with calcium carbonate was not found to be a significant risk factor for the development of calciphylaxis. In a multivariate analysis, iron intake seemed to be protective, contrary to previous reports, while the use of calcium carbonate was associated with a strong trend to increased risk of calciphylaxis development (odds ratio = 1.029/g and 1.011/g calcium ingested per month, at 1 and 2 - 3 months prior to calciphylaxis development; p = 0.0556 and 0.0565, respectively).
These data, although limited by the small numbers of index cases, suggest that calcium ingestion is a risk factor for calciphylaxis. The increased use of calcium salts as a phosphate binder in recent years might explain the apparent increased incidence of calciphylaxis in our and other centers. The preponderance of female diabetics among cases reported elsewhere was confirmed in our study.
探讨肾衰竭患者发生钙化防御的危险因素，钙化防御是一种组织中钙沉积的、了解甚少且常致命的病症。
回顾性病例对照研究。
大学医院腹膜透析中心。
在3年期间确定了8例持续性非卧床腹膜透析（CAPD）并发钙化防御的患者。我们为每例患者匹配了多达5名透析方式和透析时间长度的对照。
配对病例对照的多变量条件逻辑回归分析。
收集实验室数据和人口统计学资料以及疾病发作前一年的累积钙和维生素D摄入量。
所有患者均为女性，而对照组中只有38%（14/37）为女性（p<0.0001）。虽然无统计学意义，但大多数患者患有糖尿病[62.5%（5/8）对32%（12/37）]。与对照组相比，病例组的血清钙、磷、钙×磷乘积、甲状旁腺激素（PTH）、白蛋白、铁、总铁结合力（TIBC）和铁蛋白的峰值和平均水平无显著差异。单独使用骨化三醇或与碳酸钙联用未被发现是发生钙化防御的显著危险因素。在多变量分析中，与先前报道相反，铁摄入似乎具有保护作用，而使用碳酸钙与钙化防御发生风险增加的强烈趋势相关（优势比分别为疾病发作前1个月和2 - 3个月时每月摄入钙1.029/g和1.011/g；p分别为0.0556和0.0565）。
这些数据虽因索引病例数量少而受限，但表明钙摄入是钙化防御的危险因素。近年来作为磷结合剂的钙盐使用增加可能解释了我们中心和其他中心钙化防御发病率明显上升。我们的研究证实了其他地方报道的病例中女性糖尿病患者占优势。
