慢性肾脏病1～3期患者25（OH）D水平的影响因素

目的 通过调查慢性肾脏病（CKD）1～3期患者25（OH）D水平,探讨25（OH）D的影响因素,为CKD患者早期进行维生素D缺乏的预防及治疗提供依据.方法 采用放射免疫法检测89例CKD 1 ～3期患者25（OH）D水平,采用自动生化仪测定血钙、磷、碱性磷酸酶、总蛋白、白蛋白、肌酐,24 h尿蛋白定量及微量清蛋白、尿钙等.采用单因素相关分析探讨25 （OH）D的影响因素.25（OH）D的独立影响因素采用多元线性回归分析.结果 89例CKD患者25（OH）D水平中位数11.0 μg/L,全距3.0 ～ 39.0 μg/L,维生素D不足者占28.1％（25/89）,缺乏者占68.5％（61/89）.CKD1～3期各期间25（OH）D比较差异无统计学意义（P＞0.05）.单因素相关分析提示：25（OH）D与激素使用、校正钙、促甲状腺激素、24 h尿蛋白定量、24 h尿微量白蛋白呈负相关,与总蛋白及白蛋白呈正相关.多元线性回归分析提示：校正钙、白蛋白是25（OH）D水平的独立影响因素.结论 CKD 1 ～3期患者普遍存在维生素D缺乏,校正钙、白蛋白是25（OH）D水平的独立影响因素.

Influencing factors of 25-hydroxyvitamin D level in patients with chronic kidney disease at stage 1-3

Objective To observe the level of vitamin D [25 （OH）D] in patients with chronic kidney disease （CKD） at stage 1-3,and explore the influencing factors.Methods Eighty-nine patients with CKD at stage 1-3 were selected.The 25 （OH）D was detected by radioimmunoassay.Using automatic biochemical analyzer,serum calcium,phosphate,alkaline phosphatase,total protein,albumin,creatinine,24 h urine protein quantitation and micro-albumin and urinary calcium,etc were detected.The influencing factors of 25 （OH）D were analyzed by single factor correlation analysis.The independent influencing factors of 25 （OH）D were analyzed by multiple linear regression analyses.Results The median of 25 （OH）D level in 89 patients with CKD at stage 1-3 was 11.0 μg/L,and full range was 3.0-39.0 μg/L.The rate of vitamin D insufficiency was 28.1% （25/89）,and the rate of deficiency was 68.5% （61/89）.There were no significant differences in 25 （OH）D among different CKD stages （P 〉 0.05）.Single factor correlation analysis result showed that 25 （OH）D was negatively correlated with glucocorticoid,corrected calcium,thyroid stimulating hormone,24 h urine protein quantitation,24 h urine micro-albumin,and 25 （OH）D was positively correlated with total protein and albumin.Multiple linear regression analyses result showed that the corrected calcium and albumin were the independent influencing factors of 25 （OH）D.Conclusions Vitamin D insufficiency or deficiency is common in different stage of CKD 1-3 patients.Multiple linear regression analyses shows that albumin and correction calcium are the independent influencing factors of 25（OH）D level.