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突然变矮 可能是透析惹的祸

2015-9-28 19:22| 发布者: steven| 查看: 13935| 评论: 63|原作者: steven


  专家建议,在开始透析之前就应该进行甲状旁腺激素水平监测。图/Gettyimages
  你可能不知道,个头变矮、骨骼变形等,是透析患者可能出现的症状,类似报道也时常见诸报端。根据相关统计,我国目前在透患者人数为37万左右,但透析质量仍处于相对较低水平,平均透析龄较短。专家表示,随着透析时间的延长,患者出现个头变矮、骨骼变形等,可能与甲状旁腺激素水平升高有关,严重者可能影响患者的心肺功能,甚至生活无法自理。
  透析时间长,容易出现骨疼、骨折及骨骼畸形
  目前,慢性肾脏病以及由其导致的终末期肾病已经成为严重危害我国居民身体健康的重要慢性疾病。据统计,我国慢性肾脏病患者大约有1.2亿,其中,据估计,需要接受肾脏替代治疗的终末期肾病患者为200万左右,然而,根据我国透析登记系统的统计,截至2014年底,我国在透(血透+腹透)患者人数仅37万左右,虽然近年发展速度迅猛,但远远低于预估。
  在透析人数快速增长的同时,我国的透析质量却仍处于相对较低的水平,包括平均透析龄较短,血压达标率较低,营养状况较差等。
  在近日由北京市科委、中日医院和航天中心医院共同举办的第一届慢性肾脏病矿物质与骨异常规范化诊疗国际研讨会上,中日医院肾内科主任医师张凌表示,在透析患者中,慢性肾病-矿物质与骨代谢异常诊治水平相对低下更是成为了较为突出的问题。具体表现在,由于延误治疗导致严重影响患者生命及生活质量的骨骼畸形、心血管钙化等比较常见。
  究其原因,张凌告诉记者,肾脏也是人体的一个内分泌器官,除了常见功能外,肾脏还会分泌产生125-双羟维生素D,产生病变后,后者会刺激甲状旁腺,产生增生。增生初期是代偿性的生理反应,但随着透析时间的延长,甲状旁腺会长得更大一些,甲状旁腺与骨骼相关,患者容易出现骨疼、骨折及骨骼畸形等。肾脏功能受影响,患者会出现高血磷、低血钙症状,容易刺激甲状旁腺腺体增生。通常来说,在没有肾脏疾病的情况下,甲状旁腺激素亢进是一种罕见病,只有肾脏病进展到一定程度,才会出现。
  病人身高可能出现“退缩”
  如果激素水平升高没有及时采取相应措施,后果很严重,“一个非常明显的表现是,病人身高可能会出现’退缩’,我见到过有些病人从1米7退缩到1米5的情况,我们称之为退缩人。”张凌告诉记者,随着病情的进展,患者最后可能无法行走,只能卧床。严重“退缩”甚至会引起脊髓压缩,压缩到一定程度,心脏、肺等脏器积压在一起,影响心肺功能,透析患者甚至会出现呼吸衰竭,甚至可能引起死亡。正是因为知晓情况并不普遍,张凌介绍,很多医护人员甚至一度认为这种“退缩”是透析患者的正常表现。
  这种变化与透析方式关系不大,相反,透析不充分,骨骼畸形等症状反而可能更严重,但透析无法解决肾脏的内分泌功能问题。
  ■ 专家提醒
  手术之外及时监测
  张凌介绍,甲状旁腺激素水平升高是透析患者的高发疾病,发病率在20%-80%之间。
  张凌建议,及时进行监测是知晓甲状旁腺激素水平的唯一方法,关于开始监测的时间,“在开始透析之前就应该进行监测,根据临床情况,有些患者在透析开始前就已经出现‘退缩’。”频率在一月一次左右为宜。“采用药物或手术治疗时,还需更频繁进行监测。”90%的患者能够通过手术将激素水平控制在一定水平,但少数患者激素水平还有升高的可能,因此,手术之后也应定期监测甲状旁腺激素水平,患者因骨骼畸形而变形的面容在术后也能适当得到改善。
  本版采写/新京报记者 张秀兰

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