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词汇介绍
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解析
Hyperphosphatemia 英 /:haipəfɔsfə'ti:mjə/
释 义 n. [医] 血磷酸盐过多；[医] 高磷酸盐血
例 句 Objective: To investigate the clinical characteristics and mechanism of renal failure due to acute hyperphosphatemia following intravenous fructose diphosphate injection. 目的：探讨注射用二磷酸果糖致急性高磷血症的临床特点及诱发急性肾功能衰竭的发病机理。
概述
概述
高磷血症是一种电解质紊乱，血液中有水平升高的磷酸盐，大多数人没有症状，而一些人则在软组织中形成钙沉积。通常，钙含量也很低，但是可能导致肌肉痉挛。原因包括肾衰竭，甲状旁腺功能减退症，糖尿病酮症酸中毒，肿瘤溶解综合征，和横纹肌溶解等。
原因
大多数人每天从红肉，奶制品，鸡肉，鱼和强化谷物等食物中获取约800至1200 mg的磷。在人体中，磷酸盐在骨骼和牙齿，细胞内部以及在血液中的含量要少得多。肾脏有助于去除体内多余的磷酸盐，以保持体内的平衡。当肾脏受损时，身体无法足够快地从血液中去除磷酸盐，这会导致磷酸盐水平长期升高。如果接受含磷的泻药作为结肠镜检查的准备，血磷酸盐水平也可能突然升高。
高磷血症的其他可能原因包括：甲状旁腺激素水平低（甲状旁腺功能低下）；细胞的损害；高维生素D水平；糖尿病性酮症酸中毒-糖尿病人血液中高水平的酮酸；损伤-包括造成肌肉损伤的伤害；严重的全身感染。
诊断方法
高磷酸盐血症的诊断是通过测量血液中磷酸盐的浓度来进行的，磷酸盐浓度高于1.46 mmol/l（4.5 mg/dl）表示高磷酸盐血症，尽管可能还需要进一步测试以确定磷酸盐水平升高的根本原因。当水平大于1.6 mmol/l（5 mg/dl）时，认为是严重高磷酸盐血症。
治疗方法
使用磷酸盐粘合剂和饮食限制磷酸盐可以降低高磷酸盐水平，如果肾脏正常运作，则可诱发盐水利尿作用，以使肾脏消除多余的磷酸盐。在极端情况下，可以通过血液透析过滤血液，去除多余的磷酸盐。如果肾脏受损，可以通过以下三种方法降低高磷酸盐水平：减少饮食中的磷酸盐含量；透析去除多余的磷酸盐；降低用药后肠道吸收的磷酸盐量。
预防
高磷血症通常是慢性肾脏疾病的并发症，降低风险的一种方法是减缓肾脏损害。通过治疗肾脏疾病的原因来保护肾脏。高血压也是肾脏损害的危险因素，服用降压药，例如血管紧张素转换酶（ACE）抑制剂或血管紧张素II受体阻滞剂，可以降低血压并保护肾脏。体内多余的液体会使肾脏受损，服用利尿剂可以帮助恢复体内正确的体液平衡。
Effect of Intradialytic Exercise on Hyperphosphatemia and Malnutrition
复制标题
透析锻炼对高磷血症和营养不良的影响
发表时间：2019-10-15
影响指数：4.2
作者： Nada Salhab
期刊：Nutrients
Hyperphosphatemia, described as the “silent killer” for hemodialysis (HD) patients, is prevalent among almost half of this population and is a determinant to decreased quality of life (QOL). The Kidney Disease Improving Global Outcomes (KDIGO) guidelines (2017) recommend lowering the serum phosphorus (P) levels towards the range that is considered normal for healthy populations. Standard HD regimes of 4-h three times a week cannot remove the entire P load; thus, other serum P controlling interventions are used such as limiting dietary P intake and administration of P-binding medications. However, these techniques provide some risks: the P-restricted diet can lead to protein energy malnutrition, and P-binders can cause gastrointestinal side effects, which may increase the cost of health care. This is a specific concern because there is no conclusive evidence about P-binder cost-effectiveness as first-line intervention for hyperphosphatemia management. All of which raises the need for adjunct novel effective approaches targeting hyperphosphatemia management, such as intradialytic exercise (IDE). Recently, 2 meta-analyses showed that exercise does not appear to have a significant impact on serum P compared to controls; however, most of the studies included in these reviews were relatively short term. IDE has been the focus of many researchers for the last two decades. Orcy et al. (2014) reported an increase in P clearance with IDE among HD patients. Also, other studies showed a decrease in serum P levels with IDE. It is hypothesized that exercise increases blood flow and decreases inter-compartmental resistance leading to increased toxin removal through the dialyzer. Moreover, IDE potentially has a positive effect on patient’s QOL, dialysis adequacy (Kt/V), urea reduction ratio (URR), C-reactive protein (CRP) levels, and functional capacity. Finally, in HD patients, body composition is significantly associated with physical functioning and QOL; thus, any attempt targeting muscle and fat distribution should be encouraged.
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