慢性肾脏病患者维生素D缺乏与动脉僵硬度的相关性

目的 探讨慢性肾脏病患者维生素D缺乏与动脉僵硬度的相关性.方法 选取慢性肾脏病(CKD l～5期)患者300例,根据血25(OH)D3浓度分为维生素D缺乏组[25 (OH)D3＜20 μg/L]和维生素D非缺乏组[25(OH)D3≥20 μg/L].采集临床资料数据,测定动脉僵硬度指标肱踝脉搏波传导速度(baPWV).对血25(OH)D3水平与baPWV间的关系进行单因素相关分析及多元线性回归分析. 结果 维生素D缺乏组188例(62.7％),维生素D非缺乏组112例(37.3％).全部CKD患者25(OH)D3平均浓度为(17.62±8.54) μg/L,维生素D缺乏组和非缺乏组分别为(12.38±4.55) μg/L与(26.44±6.05) μg/L(P＜0.01).维生素D缺乏组baPWV值高于非缺乏组[(1 827.34±429.11) cm/s比(1 555.31±353.14) cm/s,P＜0.01].单因素相关分析显示全体CKD患者(r=-0.38,P＜0.01)以及CKD 2～5期患者[r=-0.30,P＜0.05;r=-0.26,P＜0.05;r=-0.46,P＜0.01;r=-0.57,P＜0.01]血25(OH)D3浓度与baPWV均呈负相关.多元线性回归分析显示血25 (OH)D3浓度下降与baPWV的增加独立相关(模型1:β=-0.18,P＜0.01;模型2:β=-0.17,P=0.01),回归模型1与模型2均可解释baPWV变化的50％.结论 CKD患者普遍存在维生素D缺乏,维生素D缺乏与动脉僵硬度增加相关.维生素D替代治疗可能影响CKD患者的心血管预后,但有待未来研究的进一步明确.

Correlation of vitamin D deficiency and arterial stiffness in patients with chronic kidney disease

Objective To evaluate the association between serum 25-hydroxyvitaminD3 [25(OH)D3] and arterial stiffness in patients with chronic kidney disease (CKD). Methods Three hundred patients with CKD were included, and were divided into two groups based on serum 25(OH)D3 levels: vitamin D deficient [25(OH)D3＜20 μg/L] and vitamin D non-deficient [25(OH)D3≥20 μg/L]. Brachial ankle pulse wave velocity (baPWV), which reflected arterial stiffness, was calculated using the single-point method. Clinical data were collected in details. Correlation between serum 25(OH)D3 level and baPWV was assessed by the single factor correlation test and multiple linear regression analysis. Results The prevalence of vitamin D deficiency was 62.7%(188/300). The concentration of 25(OH)D3 was (17.62±8.54) μg/L in total patients, but was (12.38±4.55) μg/L and (26.44±6.05) μg/L in the subgroups of vitamin D deficient and non-deficient, respectively(P＜0.01). There was a higher value of baPWV in the group of vitamin D deficient than that of vitamin D non-deficient (1 827.34±429.11 vs 1 555.31±353.14, P＜0.01). Serum 25(OH)D3 level and baPWV was negatively correlated in total patients(r=-0.38, P＜0.01) and each stage of CKD(stage 2-5)[r=-0.30, P＜0.05; r=-0.26, P＜0.05; r=-0.46, P＜0.01; r=-0.57, P＜0.01]. Multiple linear regression analysis showed that vitamin D level was independently associated with baPWV(Model 1: β =-0.18, P＜0.01; Model 2: β =-0.17, P=0.01). Both models accounted for 50% (R2=0.50) of total variance of baPWV. Conclusions Vitamin D deficiency is common in CKD, and a low 25(OH)D3 level is significantly associated with increased arterial stiffness in these patients. Clinical intervention studies are needed to clarify whether treatment with vitamin D decreases the risk of cardiovascular disease in patients with CKD.