慢性肾脏病患者维生素D缺乏与贫血的关系  

The interplay of vitamin D deficiency and anemia in CKD

作　　者：刘烨歆 刘虹[1] LLIU Ye-xin LIU Hong(Nephrology Department and Blood Purification Center, the Second Xiangya Hospital of Central South University, Institute of Nephrology, the Second Xiangya Hospital of Central South University, Key Laboratory of Kidney Disease and Blood Purification of Hunan Province, Changsha 410011, China)

机构地区：[1]中南大学湘雅二医院肾内科中南大学湘雅二医院血液净化中心中南大学(湘雅二医院)肾脏病研究所肾脏疾病与血液净化学湖南省重点实验室,长沙410011

出　　处：《中国血液净化》2016年第11期620-623,共4页Chinese Journal of Blood Purification

基　　金："十二五"国家科技支撑计划项目(No.2011BAI10B08)

摘　　要：慢性肾脏病(chronic kidney disease,CKD)患者在病程中逐渐出现活性维生素D缺乏,红细胞生成素分泌减少,导致继发性甲状旁腺功能亢进以及肾性贫血。贫血及继发性甲状旁腺功能亢进的管理与CKD患者的预后息息相关。不论是对社区人群、CKD患者还是透析患者,目前临床研究均观察到维生素D在红细胞生成方面的积极作用,从而改善贫血。维生素D与贫血的联系部分依赖全段甲状旁腺素(intact parathyroid hormone,i PTH)。除此之外,非甲状旁腺素依赖的炎性反应、铁调素等也起到重要作用,其均有维生素D受体(vitamin D receptor,VDR)激活这一共同途径。本文旨在探讨维生素D与贫血的相互作用以及维生素D缺乏与贫血相关性的可能机制,并从改善贫血的角度为CKD患者,包括透析患者补充维生素D提供一些参考。Patients of chronic kidney disease usually suffer from anemia and hyperparathyroidism secondary to deficiency of EPO and vitamin D as CKD progresses. The outcome of CKD is significantly influenced by the management of anemia and secondary hyperparathyroidism. Recently the association of vitamin D and anemia has been found in many researches no matter the population, the CKD patients and the patients on dialysis, but the mechanism is undefined. The relevance of vitamin D deficiency and anemia is partially dependent on parathyroid hormone （PTH）. Besides, hepcidin and inflammation independent of PTH also play a significant role. The above possible aspects contribute to anemia via a common VDR pathway. This review fo- cuses on current situation and probable mechanism of the interplay between vitamin D and anemia in order to provide a suggestion that administration of vitamin D or its analogues may improve the anemia state in CKD patients.

关 键 词：慢性肾脏病 维生素D 肾性贫血 甲状旁腺素 炎性反应 铁调素 维生素D受体 

分 类 号：R692.5[医药卫生—泌尿科学]