慢性肾脏病患者血清25-羟维生素D水平及其影响因素分析  

The level of serum 25-hydroxyvitamin D and its related factors in patients with chronic kidney disease

作　　者：王菊[1] 王海燕[1] 张桂霞[1] 朱福海[2] 王雪荣[1] 袁亮[1] 王德光[1] 何衡杰[1] 刘桂凌[1] 郝丽[1] 

机构地区：[1]安徽医科大学第二附属医院肾脏内科,合肥230601 [2]安徽医科大学第二附属医院体检中心,合肥230601

出　　处：《安徽医科大学学报》2016年第1期106-109,共4页Acta Universitatis Medicinalis Anhui

基　　金：安徽高校省级自然科学研究项目(编号:KJ2013Z155);安徽医科大学校临床科学研究项目(编号:2015xkj110)

摘　　要：目的了解慢性肾脏病(CKD)患者血清25-羟维生素D[25(OH)D]缺乏的发生率,分析25(OH)D缺乏的影响因素。方法纳入CKD患者213例,176例健康成年人作为对照组,收集研究对象人口学资料、临床及实验室资料,分析CKD组和对照组25(OH)D水平、缺乏率之间的差异,并分析影响CKD患者25(OH)D缺乏的因素。结果 CKD组25(OH)D水平低于对照组[(10.8±8.3)ng/ml vs(14.7±6.5)ng/ml,P<0.01],CKD组25(OH)D缺乏率高于对照组(77.9%vs 54.6%,P<0.01)。单因素相关分析显示25(OH)D与血红蛋白(Hb)、白蛋白(Alb)、全段甲状旁腺激素(i PTH)、碱性磷酸酶(ALP)、估算肾小球率过滤(e GFR)呈正相关性(P<0.05),与收缩压(SBP)、总胆固醇(TC)呈负相关性(P<0.05)。多元线性回归分析显示Alb与ALP水平的下降以及TC水平的增加是25(OH)D缺乏的独立影响因素(β=0.273,P<0.01;β=0.335,P<0.05;β=-0.209,P<0.05)。结论 CKD患者及健康者普遍存在25(OH)D缺乏,CKD患者较健康者更为严重。改善患者的营养状态、骨代谢紊乱和脂质代谢紊乱可能会纠正25(OH)D缺乏状态,延缓慢性肾脏病进展,而能否降低CKD患者死亡率则有待于进一步研究。Objective To detect the deficiency of 25-hydroxyvitamin D [ 25 （OH）D ] and its related factors in pa- tients with chronic kidney disease （CKD）. Methods 213 patients with C KD and 176 healthy adults were recrui- ted. Their clinical examinations were collected for statistical analysis. Results The level of 25 （OH）D in CKD pa- tients was lower than healthy adults[ （10. 79 ± 8.32） ng/ml vs （14. 65 ± 6. 50） ng/ml,P 〈 0. 01 ] ;the prevalence of 25（OH）D deficiency in CKD patients was higher than healthy adults （77.93% vs 54.55% ,P 〈 0.01 ）. 25 （OH）D was positively correlated with Hb, Alb, iPTH, ALP and eGFR. 25 （OH）D was negatively correlated with SBP, TC. Alb, ALP and TC were the independent factors to influence serum 25 （OH）D. Conclusion The prevalence of 25（OH） D deficiency is high in CKD and healthy adults, especially in CKD patients. Improving nu- tritional status, bone metabolic disorder and disorder of lipid metabolism may improve 25 （OH） D deficiency, delay CKD progress, whether reduce the mortality is subject to further study.

关 键 词：慢性肾脏病 25-羟维生素D 骨代谢紊乱 

分 类 号：R692.5[医药卫生—泌尿科学]