慢性肾脏病患者维生素D不足与缺乏

目的 了解慢性肾脏病(CKD)患者维生素D不足与缺乏的患病率，为合理的维生素D治疗提供依据。 方法 对358例住院CKD患者的临床资料进行回顾性分析。用酶标法测定血清25（OH）D3水平，并常规检测血红蛋白（Hb）、Scr、BUN、CO2CP、白蛋白(Alb)、血清钙、磷、全段甲状旁腺激素（iPTH）等。分析25（OH）D3水平与临床指标的关系。 结果 358例患者的25（OH）D3平均水平为（18.58±11.7） µg/L，显著低于正常值（P < 0.01）；CKD1~5期患者25（OH）D3水平分别为（25.84±9.71）、（20.76±6.99）、（20.40±17.02）、（19.49±11.29）和（14.16±7.98） µg/L。维生素D缺乏患病率为39.66%；在CKD1~5期中分别为5.00%、17.50%、37.21%、42.37%和57.14%，患病率随CKD分期逐级增加。维生素D不足患病率为44.97%，在CKD1~5期中分别为72.50%、47.50%、45.35%、33.90%和40.60%。维生素D缺乏及不足患病率为84.63%，在CKD1~5期中分别为77.50%、65.00%、82.56%、76.27%和97.74%，CKD各期间差异无统计学意义。单因素相关分析显示，25（OH）D3与Hb（r = 0.163）、Alb（r = 0.291）、Scr（r = -0.236）、eGFR（r = 0.156）和iPTH（r = -0.178）相关（P < 0.01）。多元线性回归分析显示，25（OH）D3与Alb呈正相关，而和iPTH、Scr呈负相关。CRP、钙磷乘积等与25（OH）D3无相关。按K/DOQI指南，根据25（OH）D3和iPTH水平，CKD3~5期患者符合维生素D治疗指征的比例分别为87.20%、83.05%和26.31%；而仅根据iPTH水平，符合治疗指征的比例仅为16.28%、35.59%和26.31%。 结论 CKD患者维生素D缺乏和不足患病率高。Alb、Scr和iPTH是CKD患者维生素D水平的重要影响因子。应在CKD人群中开展维生素D水平检测，并早期、合理治疗维生素D缺乏和不足。

Vitamin D insufficiency and deficiency in chronic kidney disease patients

Objective To elucidate the prevalence of vitamin D insufficiency and deficiency in chronic kidney diseases (CKD) patients and provide the evidence for treatment of these patients. Methods Clinical data of 358 inpatients with CKD from stage 1 to stage 5 were analyzed retrospectively. Level of 25 (OH)D3 in these inpatients, as well as the levels of intact parathyroid hormone (iPTH), hemoglobin (Hb), serum creatinine (Scr), urea nitrogen (BUN), carbon dioxide combining power (CO2CP), alhumin (Alb), serum calcium (Ca) and blood serum (P) were examined. Correlation between 25 (OH)D3 and parameters was analyzed. Results The mean level of 25 (OH)D3 in these CKD patients was (18.58±11.7) μg/L, which was significantly lower than that of normal reference (P<0.01). The 25(OH )D3 levels of CKD patients from stage 1 to stage 5 were (25.84±9.71) μg/L, (20.76±6.99) μg/L, (20.40±17.02) μg/L, (19.49±11.29) μg/L, and (14.16±7.98) μg/L respectively. The prevalence of vitamin D defieiency was 39.66%, and from CKD stage 1 to stage 5 was 5.00%, 17.50%, 37.21%, 42.37% and 57.14%. The prevalence of vitamin D insufficiency was 44.97%, and from CKD stage 1 to stage 5 was 72,50%, 47.50%, 45.35%, 33.90% and 40.60%. The prevalence of decreased vitamin D level was 84.63%, and from CKD stage 1 to stage 5 was 77.50%, 65.00%, 82.56%, 76.27% and 97.74%. Single factor correlation analysis showed 25 (OH)D3 was correlated with Hb, Alb, Scr, eGRF and iPTH. Regression analysis indicated that 25 (OH)D3 was negatively correlated with iPTH and Scr, and positively correlated with Alb. According to K/DOQI, percentage of CKD patients from stage 3 to stage 5 who were consistent with vitamin D treatment was 87.20%, 83.05% and 26.31% based on 25 (OH)3 and iPTH levels, but such percentage was 16.28%, 35.59% and 26.31% based on iPTH level only. Conclusions The prevalence of vitamin D insufficiency and deficiency in patients with CKD is quite high. Alia, iPTH and Scr are key factors influencing vitamin D level. Vitamin D level should be measured among CKD patients in order to carry out corresponding treatment.