Li Ya, Zhang Wen, Ren Hong, Wang Weiming, Shi Hao, Li Xiao, Chen Xiaonong, Shen Pingyan, Wu Xiaojing, Xie Jingyuan, Chen Nan
Department of Nephrology, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, PR China.
Contrib Nephrol. 2013;181:31-40. doi: 10.1159/000348636. Epub 2013 May 8.
Glomerulonephritis (GN) remains a major cause of morbidity and mortality in chronic kidney disease (CKD). Our study aimed to investigate the prevalence of anemia, abnormal serum intact parathyroid hormone (iPTH), calcium, and phosphorus in a Chinese patient population with primary GN. Medical histories and laboratory test results were collected from 2,924 patients with primary GN hospitalized in Ruijin Hospital of Shanghai between January 2003 and August 2009. The leading cause of CKD was primary glomerular diseases, which were responsible for up to 53.5% of all cases. IgA nephropathy was the most common cause, accounting for 38.7%, followed by focal segmental glomerulosclerosis (FSGS). The anemia rate of GN patients in early stages of CKD (stages 1-2 and 3) was 16-36%, and rapidly accelerated to 65.8 and 80.2% in advanced CKD stage 4 and stage 5, respectively. There was no significant decline observed in the level of serum calcium in patients with CKD stages 1-4 (p > 0.05). However, in patients with CKD stage 5 the prevalence of hypocalcaemia increased significantly (13.7%, p = 0.000). The prevalence of hyperphosphatemia did not significantly increase in patients with CKD stages 1-3 (p < 0.05), but was much higher in patients with CKD stages 4 and 5 (p = 0.001 and p = 0.021, respectively) and showed a negative correlation with renal function. Serum iPTH levels did not increase significantly in GN patients with CKD stages 1-2. The median iPTH levels were 54.7, 88.6, and 289.2 pg/ml (p = 0.000) for CKD stages 3-5, respectively, all of which showed negative correlation with renal function. The proportion of vitamin D insufficiency and deficiency increased to 29.3 and 11.2%, respectively, as the glomerular filtration rate fell below 15 ml/min/1.73 m(2). Primary glomerular disease remains the major cause of CKD in China, and complications such as anemia and metabolic bone disease are frequently present in GN patients.
肾小球肾炎（GN）仍是慢性肾脏病（CKD）发病和死亡的主要原因。我们的研究旨在调查中国原发性GN患者群体中贫血、血清完整甲状旁腺激素（iPTH）异常、钙和磷的患病率。收集了2003年1月至2009年8月期间在上海瑞金医院住院的2924例原发性GN患者的病史和实验室检查结果。CKD的主要病因是原发性肾小球疾病，占所有病例的53.5%。IgA肾病是最常见的病因，占38.7%，其次是局灶节段性肾小球硬化（FSGS）。CKD早期（1-2期和3期）GN患者的贫血率为16%-36%，在CKD晚期4期和5期迅速升至65.8%和80.2%。CKD 1-4期患者的血清钙水平未观察到显著下降（p>0.05）。然而，CKD 5期患者低钙血症的患病率显著增加（13.7%，p=0.000）。CKD 1-3期患者高磷血症的患病率没有显著增加（p<0.05），但在CKD 4期和5期患者中高磷血症的患病率要高得多（分别为p=0.001和p=0.021），并且与肾功能呈负相关。CKD 1-2期GN患者的血清iPTH水平没有显著升高。CKD 3-5期的iPTH中位数水平分别为54.7、88.6和289.2 pg/ml（p=0.000），所有这些均与肾功能呈负相关。当肾小球滤过率低于15 ml/min/1.73 m²时，维生素D不足和缺乏的比例分别增至29.3%和11.2%。原发性肾小球疾病仍是中国CKD的主要病因，贫血和代谢性骨病等并发症在GN患者中很常见。
