中国成人血清25羟维生素D水平与24小时尿钙排泄量及高钙尿症的相关性分析  

Correlation between serum 25-hydroxyvitamin D levels and 24-h urinary calcium excretion and hypercalciuria in Chinese adults

作　　者：沈力 张浩[1] 卢琪 李珊珊 高超 梅亚曌 岳华 于祥田 姚麒[2] 霍亚南[3] 曾玉红[4] 蒋茵 谢忠建[6] 晁爱军[7] 金小岚 毛莉[9] 章振林 Shen Li;Zhang Hao;Lu Qi;Li Shanshan;Gao Chao;Mei Yazhao;Yue Hua;Yu Xiangtian;Yao Qi;Huo Yanan;Zeng Yuhong;Jiang Yin;Xie Zhongjian;Chao Aijun;Jin Xiaolan;Mao Li;Zhang Zhenlin(Clinical Research Center,Department of Osteoporosis and Bone Disease,Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine,Shanghai 200233,China;Department of Geriatrics,Ningbo First Hospital,Ningbo 315010,China;Department of Endocrinology,Jiangxi People's Hospital,Nanchang 330006,China;Department of Osteoporosis,Honghui Hospital,Xi'an Jiaotong University Medical College,Xi'an 710054,China;Department of Rheumatism,Liuzhou Worker's Hospital,Liuzhou 545007,China;Department of Metabolism and Endocrinology,the Second Xiangya Hospital of Central South University,Changsha 410011,China;Department of Orthopaedics,Tianjin Hospital,Tianjin 300211,China;Department of Endocrinology,Affiliated Hospital of Chengdu University of Traditional Chinese Medicine,Chengdu 610075,China;Department of Endocrinology,Huai'an First People's Hospital Affiliated to Nanjing Medical University,Huai'an 223300,China)

机构地区：[1]上海交通大学医学院附属第六人民医院临床研究中心、骨质疏松和骨病专科,上海200233 [2]宁波市第一医院老年医学科,宁波315010 [3]江西省人民医院内分泌代谢科,南昌330006 [4]西安交通大学医学院附属红会医院骨质疏松科,西安710054 [5]柳州市工人医院风湿免疫科,柳州545007 [6]中南大学湘雅二医院代谢内分泌科,长沙410011 [7]天津市天津医院骨内科,天津300211 [8]成都中医药大学附属医院内分泌科,成都610075 [9]南京医科大学附属淮安第一医院内分泌科,淮安223300

出　　处：《中华内科杂志》2025年第4期318-324,共7页Chinese Journal of Internal Medicine

基　　金：上海申康医院发展中心研究型医师创新转化能力培训项目(SHDC2022CRT022,SHDC2023CRS039);上海市第六人民医院院级回顾类临床研究课题(ynhg202210)。

摘　　要：目的:探讨中国成人血清25羟维生素D[25(OH)D]水平与24 h尿钙排泄量(24 h UCaE)及高钙尿症的相关性。方法:横断面研究。2022年3月至2023年3月对中国9个城市18岁以上居民进行调查,开展“中国钙水平流行病学调查研究”。纳入符合标准1239人,采集空腹血液样本以检测骨代谢指标,收集24 h尿液样本以检测尿钙排泄量水平等。采用多元线性回归模型分析血清25(OH)D水平与尿钙排泄量及骨代谢指标的相关性,并应用logistic回归模型结合限制性立方样条分析血清25(OH)D水平与高钙尿症的相关性。结果:本研究对象年龄为(47.9±18.1)岁,其中男性453名(36.6%)。维生素D充足、不足和缺乏的比例分别为7.6%(94/1239)、29.0%(359/1239)和63.4%(786/1239)。限制性立方样条分析结果显示,调整相关协变量后,血清25(OH)D水平与24 h UCaE呈正向非线性关联(P总体<0.001,P非线性<0.001)。logistic回归模型分析显示,与维生素D缺乏组相比,维生素D充足组和维生素D不足组中高钙尿症患病风险的OR值分别为3.290(95%CI 1.745~6.202)和3.742(95%CI 2.458~5.697)。限制性立方样条模型分析显示,血清25(OH)D与高钙尿症的患病率呈正向非线性关系(P总体<0.001,P非线性<0.001)。当25(OH)D>17.00μg/L时,高钙尿症的患病风险增加,并在25(OH)D为26.71μg/L时达到最高,之后随着25(OH)D水平的增加,高钙尿症的患病风险呈下降趋势。结论:中国成年人群血清25(OH)D水平与尿钙排泄量及高钙尿症风险之间存在关联。Objective:To investigate the association between serum 25-hydroxyvitamin D[25(OH)D]levels and 24-h urinary calcium excretion(24-h UCaE)and hypercalciuria in Chinese adults.Methods:This cross-sectional study was conducted from March 2022 to March 2023 in nine cities in China and included 1239 residents.Demographic characteristics were collected through questionnaires and physical examinations,fasting blood samples were assessed for bone metabolism indicators,and 24-h urine samples were used to determine the 24-h UCaE.Multiple linear regression analysis was used to explore the relationship between serum 25(OH)D and 24-h UCaE and bone metabolism indexes.The relationship between serum 25(OH)D and hypercalciuria was analyzed using a multiple logistic regression model combined with restricted cubic spline modeling.Results:The mean participant age was(47.9±18.1)years,of which 453(36.6%)were male.The percentages of vitamin D sufficiency,insufficiency,and deficiency were 7.6%(94/1239),29.0%(359/1239),and 63.4%(786/1239),respectively.The multiple linear regression model showed that after adjusting for the covariates the 24-h UCaE gradually increased with higher levels of 25(OH)D(P overall<0.001,P nonlinear<0.001).The logistic regression analysis revealed that compared with the vitamin D deficient group,the OR for the prevalence of hypercalciuria in the vitamin D sufficient and vitamin D insufficient groups were 3.290(95%CI 1.745 to 6.202)and 3.742(95%CI 2.458 to 5.697),respectively.The results of the restricted cubic spline modeling showed a positive nonlinear relationship between 25(OH)D and the prevalence of hypercalciuria(P overall<0.001,P nonlinear<0.001).The prevalence of hypercalciuria increased when 25(OH)D was>17.00μg/L and peaked at 26.71μg/L,after which there was a decreasing trend in the prevalence of hypercalciuria with increasing 25(OH)D.Conclusion:Associations between serum 25(OH)D levels and urinary calcium excretion and the prevalence of hypercalciuria were observed in the Chinese adult population.

关 键 词：25羟维生素D 高钙尿症 尿钙排泄量 横断面研究 相关性分析 

分 类 号：R589.5[医药卫生—内分泌]