慢性肾脏病3~5期患者血清维生素K_(2)检测的临床意义  

Clinical significance of serum vitamin K_(2) detection in patients with stage 3-5 chronic kidney disease

作　　者：陈天浩[1] 黄正 Chen Tianhao;Huang Zheng(Department of Nephrology,Tianchang City People’s Hospital,Tianchang 239300,China;Department of Infectious Diseases,Tianchang City People’s Hospital,Tianchang 239300,China)

机构地区：[1]天长市人民医院肾内科,安徽天长239300 [2]天长市人民医院感染科,安徽天长239300

出　　处：《临床荟萃》2025年第2期122-127,共6页Clinical Focus

基　　金：滁州市卫生健康委科研项目——维生素K_(2)、肠道微生态与慢性肾脏病血管钙化的相关性(CZWJ2022C001)。

摘　　要：目的探讨慢性肾脏病(chronic kidney disease,CKD)3~5期患者血清维生素K 2(vitamin K_(2),VitK_(2))检测的临床意义。方法选取2020年9月-2023年5月在天长市人民医院肾内科住院诊治的CKD 3~5期患者193例。根据估算肾小球滤过率(estimated glomerular filtration rate,eGFR)分期标准,分为G3期组(n=30)、G4期组(n=47)和G5期组(n=116)。比较3组VitK_(2)及其相关指标的差异,用多因素线性回归分析分析影响VitK_(2)的独立危险因素。以全组VitK_(2)的中位数为截断值,将患者分为VitK 2低水平组(n=95)和高水平组(n=98),分析2组腹主动脉钙化评分(abdominal aortic calcification score,AACs)、死亡终点事件和相关检测指标的差异,采用二元逻辑回归模型探讨VitK_(2)对死亡终点事件的影响。结果G3期组、G4期组和G5期组性别和年龄差异均无统计学意义(P>0.05),原发疾病构成比差异有统计学意义(P<0.05)。G3期组原发病以慢性肾炎和高血压为主,G4期组以慢性肾炎和糖尿病为主,G5期组以糖尿病占多数。3组VitK_(2)、血同型半胱氨酸、血磷、钙磷乘积、全段甲状旁腺素、白细胞介素6、血红蛋白、总胆固醇、血尿酸、eGFR和AACs差异均有统计学意义(P<0.05),随分期的增加,VitK_(2)、eGFR和血红蛋白水平逐渐降低,全段甲状旁腺素和AACs水平逐渐升高。多因素线性回归分析提示,eGFR、AACs、总胆固醇和血尿酸对VitK 2水平均有影响(P<0.05)。VitK_(2)低水平组AACs和死亡终点事件大于高水平组,差异有统计学意义(P<0.05)。二元逻辑回归分析表明,经校正年龄、VitD 3、血同型半胱氨酸、eGFR等协变量后,VitK_(2)是影响患者死亡的独立危险因素(P=0.001)。结论检测血清VitK_(2)对于CKD3~5期患者预测AACs,判断终点预后,综合评估CKD的病情,具有一定的临床意义。Objective To investigate the clinical significance of serum vitamin K_(2)(VitK_(2))detection in patients with stage 3-5 chronic kidney disease(CKD).Methods A total of 193 patients with stage 3-5 CKD who were hospitalized in the Department of Nephrology,Tianchang City People's Hospital from September 2020 to May 2023 were selected.According to the estimated glomerular filtration rate(eGFR)staging criteria,patients were divided into G3 stage group(n=30),G4 stage group(n=47)and G5 stage group(n=116).The differences of VitK_(2) and its related indexes among the three groups were compared,and the independent risk factors of VitK_(2) were explored by multivariate linear regression analysis.Then,patients were divided into low VitK_(2) level group(n=95)and high VitK_(2) level group(n=98)with the median of serum VitK_(2) as the cut-off value.The differences of abdominal aortic calcification score(AACs),death endpoint events and related detection indexes between the two groups were analyzed.Binary logistic regression model was used to explore the effect of VitK_(2) on the endpoint of death.Results There were no significant differences in gender and age among G3 group,G4 group and G5 group(P>0.05),but there was a significant difference in the proportion of primary diseases(P<0.05).The primary diseases in the G3 group were mainly chronic nephritis and hypertension and G4 group were mainly chronic nephritis and diabetes,and diabetes was the dominant primary disease in the G5 group.There were significant differences in VitK_(2),homocysteine(Hcy),serum phosphorus,calcium-phosphorus product,intact parathyroid hormone(iPTH),interleukin 6(IL-6),hemoglobin(HB),total cholesterol(TC),uric acid(UA)and AACs among the three groups(P<0.05).With the increase in clinical stage of CKD,VitK_(2),eGFR and HB gradually decreased,while iPTH and AACs gradually increased.Multivariate linear regression analysis showed significantly influences of eGFR,AACs,TC and UA on VitK_(2)(P<0.05).The AACs and the proportion achieving the endpoint(death)were si

关 键 词：慢性肾疾病-矿物质和骨代谢异常 维生素K_(2) 血管钙化 死亡终点事件 

分 类 号：R681.1[医药卫生—骨科学]