血液透析患者血清25-羟维生素D［25(OH)D］水平及相关因素研究

 目的 了解血液透析患者血清25-羟维生素D［25-hydroxy vitamin D,25 (OH)D］水平,并分析相关影响因素。方法 横断面分析2010年6月至7月复旦大学附属中山医院血液净化中心维持性透析患者224例。其中男性132例,女性92例,平均年龄(56.94±14.47)岁,透析龄(54.20±43.39)个月。所有患者均收集临床病史,并于周中透析前检测25(OH)D、甲状旁腺素(parathyaid hormone,iPTH)、血钙、血磷和高敏C反应蛋白(high sensitivity C-reactive protein,hs-CRP)、肌钙蛋白T(cardiac tropoin T,cTnT)和氨基末端脑钠肽前体(N-terminal brain natriuretic peptide,NT-proBNP)。结果 整组患者的血清25(OH)D水平为(58.53±18.33) nmol/L,其中25(OH)D水平正常36例(16.1%)、不足163例(72.8%)、缺乏25例(11.2%)。男性组25(OH)D水平显著高于女性组［(61.94±19.84)nmol/L vs. (55.12±15.37)nmol/L,P<0.05］。 Spearman相关分析显示25(OH)D与年龄因素呈负相关(P<0.05),与cTnT、NT-proBNP、hs-CRP呈显著负相关(P<0.01);与血红蛋白、血清肌酐和白蛋白呈显著正相关(P<0.01)。多元线性逐步回归分析提示血清白蛋白和25(OH)D浓度相关(P<0.05)。结论 血液透析人群中25(OH)D缺乏和不足十分常见,且可能与心脏疾病、炎症、贫血的发生发展相关。年龄增长、女性、营养不良等是导致的25(OH)D缺乏和不足的因素。25(OH)D缺乏和不足在透析人群中的意义以及合理的干预措施值得进一步研究。

Status of serum 25-hydroxy vitamin [25(OH)D] and analysis of related factors in hemodialysis patients

Objective To investigate the serum levels of 25-hydroxy vitamin D 25(OH)D] in hemodialysis patients and to analyze the related factors.Methods This cross-sectional study was carried out in 224 HD patients(132 males and 92 females) with mean age of(56.94±14.47) years and mean dialysis vintage of(54.20±43.39) months from Jun.2010 to Jul.2010.Medical history were collected and parameters such as 25(OH)D,calcium,phosphorus,parathyroid hormone(iPTH),high sensitivity C-reactive protein(hs-CRP),cardiac troponin T(cTnT) and N-terminal brain natriuretic peptide(NT-proBNP) were measured before the mid-week hemodialysis.Results The mean level of 25(OH) D in all patients was(58.53±18.33) nmol/L.Of these patients,36 cases(16.1%) were considered 25(OH)D adequate,163(72.8%) were insufficiency and 25(11.2%) were deficiency.Serum 25(OH)D levels in male group was significantly higher than that in female group (61.94±19.84) nmol/L vs.(5.12±15.37)nmol/L,P<0.05].Spearman correlation analysis showed that serum 25(OH)D was negatively correlated with age(P<0.05) and also with cTnT,NT-proBNP and hs-CRP(P<0.01).Serum 25(OH)D was significantly positively correlated with hemoglobin,creatinine and albumin(P<0.01).Multivariate linear regression model suggested that serum albumin was independly associated with serum 25(OH)D.Conclusions Serum 25(OH)D insufficiency and deficiency is very common in hemodialysis patients,which may be related to heart disease,inflammation and anemia.Age,female and malnutrition may be the causative factors of 25(OH)D insufficiency and deficiency.Further studies are required to estimate the significance and appropriate interventions of 25(OH)D insufficiency and deficiency in hemodialysis patients.