慢性肾脏病患者血清1,25（OH）2D水平与蛋白尿及尿炎症细胞因子相关性研究

目的：探讨慢性肾脏病（CKD）1～4期患者血清1,25（OH）2D水平与蛋白尿、尿炎症细胞因子的关系。方法：对我科115例CKD1～4期患者及20例健康对照者进行血清1,25（OH）2D、血CRP,尿TGF-β1、MCP-1、TNF、IL-6,24h尿蛋白定量检测;分析血清1,25（OH）2D水平与以上指标相关性。结果：（1）CKD组患者血清1,25（OH）2D水平低于对照组（P〈0.05）;血CRP,尿MCP-1、TGF-β1、IL-6、TNF水平,24h尿蛋白定量高于对照组（P〈0.05）。（2）与GFR≥60ml·min^-1·1.73m^-2患者比较：GFR〈44ml·min^-1·1.73m^-2患者CRP,尿MCP-1、TGF-β1、IL-6、TNF水平、24h尿蛋白定量升高（P〈0.05）;血清1,25（OH）2D水平降低（P〈0.05）;而GFR45～59ml·min^-1·1.73m^-2患者与GFR≥60ml·min^-1·1.73m^-2患者比较,两组间差异无统计学意义（P〉0.05）;（3）单因素相关分析显示CKD患者血清1,25（OH）2D与年龄（r=-0.442）、收缩压（r=-0.464）、舒张压（r=-0.399）、GFR（r=0.902）、Scr（r=-0.430）、PTH（r=-0.341）、UA（r=0.237）、24h尿蛋白定量（r=-0.372）及尿TGF-β1（r=-0.894）、MCP-1（r=-0867）、TNF（r=-0.899）、IL-6（r=-0.934）水平相关（P〈0.05）。多元回归分析显示血清1,25（OH）2D与GFR呈正相关;与24h尿蛋白定量,尿MCP-1、IL-6,血Scr、PTH呈负相关。结论：CKD1～4期患者存在1,25（OH）2D水平降低,并与蛋白尿及尿炎症细胞因子水平密切相关。

Correlation Between Serum 1,25(OH)2D and Urinary Inflammatory Cytokines and Albuminuria in Chronic Kidney Disease Patients

Objective：To study the relationship between serum 1,25（OH）2D levels and albuminuria and urinary inflammatory cytokines in chronic kidney disease（CKD）patients.Methods：Clinical and laboratory data of 115 hospitalized CKD patients and 20 healthy hospital staff as control group were collected.serum 1,25（OH）2D,urinary TGF-β1,MCP-1,TNF,IL-6 levels and the relationship between serum 1,25（OH）2D and these clinical parameters were analysed.Results：（1）The mean levels of,blood pressure,BUN,Scr,serum phosphorus,PTH,24h urinary protein,CRP,TC,TG,LDL,UA,urinary MCP-1,urinary TGF-β1,urinary IL-6,urinary TNF of CKD patients were higher than that of control group,and the mean levels of GFR,serum calcium,HDL,serum 1,25（OH）2D levels were lower than control group（P〈0.05）.（2）Compared with patients of GFR ≥60 ml·min^-1·1.73 m^-2,Serum CRP,The mean levels of urinary TGF-β1,MCP-1,IL-6,TNF and 24 h urinary protein of patients with GFR44 ml·min^-1·1.73 m^-2,were higher（P〈0.05）,serum 1,25（OH）2D was decreased（P〈0.05）,but those difference were not significantly between patients with GFR ≥60 ml·min^-1·1.73 m^-2 and 45-59 ml·min^-1·1.73 m^-2（P〈0.05）.（3）The levels of serum 1,25（OH）2D of CKD patients were related with age（r=-0.442）,systolic blood pressure（r=-0.464）,diastolic blood pressure（r =-0.399）,GFR（r=0.902）,Scr（r=-0.430）,PTH（r=-0.341）,UA（r=0.237）,24 h urinary protein（r=-0.372）and urinary TGF-β1（r=-0.894）,MCP-1（r =-0867）,TNF（r=-0.899）,IL-6（r=-0.934）（P〈0.05）.（4）The levels of serum 1,25（OH）2D of CKD patients were positively correlated with GFR and negative correlated with PTH and 24 h urinary protein urinary TGF-β1,MCP-1,TNF,IL-6.Conclusion：The levels of serum 1,25（OH）2D of CKD patients were closely correlated with proteinuria and the levels of urinary inflammatory cytokines.