慢性肾脏病患者血清25(OH)D、IGF-1及骨质疏松指标水平变化及其临床意义

Changes and clinical significance of serum 25(OH)D,IGF-1 and osteoporosis in patients with chronic kidney disease

目的探讨慢性肾脏病(CKD)患者血清25-羟维生素D[25(OH)D]、胰岛素样生长因子-1(IGF-1)及骨质疏松指标的水平变化及其临床意义。方法选取2015年8月—2018年8月西安交通大学医学院附属汉中三二〇一医院肾内科收治CKD患者100例(观察组),另选取同期在医院体检的健康志愿者30例作为健康对照组,收集2组临床资料,比较2组血清25(OH)D、IGF-1及骨质疏松指标的水平。根据CKD分期将观察组分为CKD 1亚组(27例)、CKD 2亚组(29例)、CKD 3亚组(23例)、CKD 4亚组(21例)4个亚组。比较各亚组血清25(OH)D、IGF-1及骨质疏松指标的水平,并应用Pearson线性相关分析血清25(OH)D、IGF-1水平与骨质疏松指标之间的相关性。结果观察组患者血清25(OH)D、IGF-1、钙(Ca)水平均低于健康对照组(t/P=9.654/0.000、21.399/0.000、4.840/0.000),血清磷(P)、碱性磷酸酶(ALP)、Ⅰ型胶原β-C末端肽(β-CTX)、总Ⅰ型胶原氨基端延长肽(tPINP)、N端骨钙素(N-MID)和全段甲状旁腺素(iPTH)水平均高于健康对照组(t/P=3.659/0.000、10.275/0.000、8.022/0.000、15.572/0.000、17.568/0.000、25.608/0.000)。随CKD病情加重,血清25(OH)D水平、IGF-1、Ca水平依次降低(F/P=26.541/0.000、107.935/0.000、6.871/0.000),P、ALP、β-CTX、tPINP、N-MID和iPTH水平依次升高(F/P=15.986/0.000、52.449/0.000、433.074/0.000、171.993/0.000、258.851/0.000、311.589/0.000)。CKD患者血清25(OH)D水平和IGF-1水平与ALP、β-CTX、tPINP、N-MID、iPTH水平均呈负相关[25(OH)D:r/P=-0.516/0.013、-0.662/0.010、-0.733/0.008、-0.165/0.024、-0.298/0.029;IGF-1:r/P=-0.419/0.019、-0.302/0.032、-0.519/0.013、-0.395/0.022、-0.314/0.027],与Ca、P无明显相关性(P>0.05)。结论随着CKD患者病情的加重,血清25(OH)D和IGF-1水平降低,骨代谢异常情况加重,血清25(OH)D、IGF-1与骨质疏松指标ALP、β-CTX、tPINP、N-MID、iPTH均存在一定的相关性,检测血清25(OH)D和IGF-1水平有助于CKD患者并发骨质疏松的诊断和预防。

Objective To investigate the changes of serum 25 hydroxyvitamin D[25(OH)D],insulin-like growth factor-1(IGF-1)and osteoporosis in patients with chronic kidney disease(CKD)and their clinical significance.Methods From August 2015 to August 2018,100 CKD patients(observation group)were enrolled in the Department of Nephrology of Hanzhong 301 Hospital Affiliated to Xi'an Jiaotong University School of Medicine,and 30 healthy volunteers who were in the hospital at the same time were selected as the health control group.The clinical data of the two groups were collected,and the levels of serum 25(OH)D,IGF-1 and osteoporosis indexes of the two groups were compared.According to the stage of CKD,the observation group was divided into four subgroups:CKD 1(27 cases),CKD 2(29 cases),CKD 3(23 cases)and CKD 4(21 cases).The levels of serum 25(OH)D,IGF-1 and osteoporosis indexes were compared among the subgroups,and the correlation between serum 25(OH)D,IGF-1 and osteoporosis indexes was analyzed by Pearson linear correlation.Result The levels of serum 25(OH)D,IGF-1,CA in the observation group were lower than those in the control group(t/P=9.654/0.000,21.399/0.000,4.840/0.000),and the levels of serum P,ALP,β-C-terminal peptide(β-CTX),tPINP,N-terminal Osteocalcin and whole parathyroid hormone(iPTH)were higher than those of healthy controls(t/P=3.659/0.000,10.275/0.000,8.022/0.000,15.572/0.000,17.568/0.000,25.608/0.000).With the aggravation of CKD,the levels of serum 25(OH)D,IGF-1,Ca decreased in turn(F/P=26.541/0.000,107.935/0.000,6.871/0.000),P,ALP,β-CTX,tPINP,N-MID and iPTH increased in turn(F/P=15.986/0.000,52.449/0.000,433.074/0.000,171.993/0.000,258.851/0.000,311.589/0.000).Serum 25(OH)D and IGF-1 levels in CKD patients are negatively correlated with ALP,β-CTX,tPINP,N-MID,and iPTH levels[25(OH)D:r/P=-0.516/0.013,-0.662/0.010,-0.733/0.008,-0.165/0.024,-0.298/0.029;IGF-1:r/P=-0.419/0.019,-0.302/0.032,-0.519/0.013,-0.395/0.022,-0.314/0.027],and there was no significant correlation with Ca and P(P>0.05).Conclusion With the aggravation of CKD patients'condition,the levels of serum 25(OH)D and IGF-1 decreased,and the abnormal condition of bone metabolism aggravated.Serum 25(OH)D and IGF-1 were correlated with ALP,β-CTX,tPINP,N-MID and iPTH.The detection of serum 25(OH)D and IGF-1 was helpful to the diagnosis and prevention of osteoporosis in CKD patients.