维持性血液透析患者25羟维生素D3与颈动脉内中膜厚度的关系的研究

目的探讨维持性血液透析(maintenance hemodisysis,MHD)患者25羟维生素D3与颈动脉内中膜厚度(intima-mediathickness,IMT)的关系。方法放射免疫分析法测定25羟维生素D3,超声检查测定颈动脉IMT;ELISA法测定血清淀粉样蛋白A(SAA)、肿瘤环死因子α(TNF-α)浓度;检测血红蛋白、血浆白蛋白、尿素氮、肌酐、血脂、钙磷、甲状旁腺激素等相关指标。结果 63例尿毒症MHD的患者中:①IMT≥1.0mm的19例,IMT<1.0mm的44例;②IMT≥1.0mm与IMT<1.0mm2组之间25羟维生素D3与IMT呈负相关(t=2.91,P<0.05)、血清淀粉样蛋白A、TNF-α、年龄、透析龄、收缩压、脉压、低密度脂蛋白等指标与IMT呈正相关(t值分别为3.25、4.32、2.67、2.78、3.12、3.08、2.66,P<0.05);③Pearson相关分析显示IMT与25羟维生素D3、血清淀粉样蛋白A、TNF-α显著相关(r值分别为-0.268、0.253、0.240,P<0.05)。结论 IMT≥1.0mm占30.2%,25羟维生素D3水平与IMT呈负相关,提示MHD患者25羟维生素D3可能参与了心血管疾病的发生发展。

Relationship between carotid intima-media thickness and 25-hydroxy vitamin D3 in maintenance hemodisysis uremic patients

Objective To explore the relationship between carotid intima-media thickness （IMT） and serum 25-hydroxy vitamin D3 in maintenance hemodisysis （MHD） uremic patients. Methods Serum 25- hydroxy vitamin D3 was determined by radioimmunoassay. Carotid IMT was measured by ultrasonography. Serum amyloid A and tumor necrosis factor-ct were determined by ELISA. Clinical data were also collected. Results Among the 63 MHD uremic patients, IMT ≥ 1.0 mm was found in 19 cases, and IMT 〈1.0 mm in 44 cases. Serum 25-hydroxy vitamin D3 was negatively correlated with IMT （t=2.91, P 〈 0.05）. Serum amy- loid A, tumor necrosis factor-or, age, hemodialysis age, systolic pressure, pulse pressure and low density lipoprotein cholesterol were significantly higher in patients with IMT ≥1.0 mm than in those with IMT 〈 1.0 mm （t 3.25, 4.32, 2.67, 2.78, 3. 12, 3.08, 2.66, P〈 0.05）. Pearson correlation analy- sis showed IMT was closely correlated with 25-hydroxyvitamin D3, serum amyloid A, and tumor necrosis factorax （r -0.268, 0.253, 0.240, P〈 0.05）. Conclusion IMT ≥ 1.0 mm accounted for 30.2% of this group of MHD uremic patients. Serum 25-hydroxyvitamin D3 level and IMT were negatively correlated, suggesting the involvement of 25-hydroxy vitamin D3 in the development of cardiovascular diseases in MHD patients.