慢性肾脏病3～5期非透析患者25(OH)D与1,25(OH)_2D水平的相关性及影响因素

The relationship between plasma 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D levels and the factors affecting the levels in patients with chronic kidney disease at stage 3-5 and without dialysis

目的调查慢性肾脏病(chronic kidney disease,CKD)3～5期非透析人群25(OH)D与1,25(OH)2D缺乏的情况,探讨25(OH)D与1,25(OH)2D水平的相关性及影响因素。方法采用放射免疫法检测82例CKD3～5期非透析患者的血浆25(OH)D与1,25(OH)2D水平,采用自动生化分析仪测定血钙、磷、碱性磷酸酶(alkaline phosphatase,ALP)、血清肌酐(serum creatinine,SCr)、白蛋白(albumin,Alb)、肝功能、血糖等。采用单因素相关分析探讨25(OH)D及1,25(OH)2D水平的相关因素并探讨二者的相关性。采用多因素回归分析探讨25(OH)D水平及1,25(OH)2D水平的独立影响因素。结果 82例CKD3～5期非透析人群25(OH)D水平中位数8.81ng/ml,全距0.34～37.69ng/ml;血浆1,25(OH)2D水平中位数17.14pg/ml,全距1.10～65.40pg/ml。82例患者中25(OH)D不足占15.0%,缺乏占81.3%;1,25(OH)2D缺乏发生率44.0%。CKD3～5期间25(OH)D的水平及缺乏比例差异均无统计学意义(均P>0.05),但是1,25(OH)2D的水平及缺乏比例差异均有统计学意义(均P<0.05)。单因素相关分析提示:血浆25(OH)D水平与血浆Alb和24h尿蛋白定量相关;1,25(OH)2D水平与估算肾小球滤过率(estimatedglomerular filtration rate,eGFR)正相关,与合并糖尿病、血磷负相关;1,25(OH)2D水平与25(OH)D水平正相关。多因素回归分析结果提示:血浆Alb是25(OH)D水平的独立影响因素;血浆25(OH)D水平和eGFR是1,25(OH)2D水平的独立影响因素。结论 CKD3～5非透析患者普遍存在25(OH)D和1,25(OH)2D缺乏。25(OH)D水平与1,25(OH)2D水平具有相关性。血浆Alb是25(OH)D水平的独立影响因素。血浆25(OH)D水平,eGFR是1,25(OH)2D水平的独立影响因素。

Objectives To observe the plasma levels of 25（OH）D and 1,25（OH）2D in patients with chronic kidney disease （CKD） at stages 3-5 and without dialysis, and to explore the association between 25（OH）D and 1,25（OH）2D levels and the factors affecting the levels. Methods Serum 25（OH）D and 1,25（OH）2D were detected by radioimmunoassay. Serum calcium, phosphorous, alkaline phosphatase, creatinine, albumin, hepatic function parameters, glucose were measured by an automatic biochemical analyzer. The association between 25（OH）D and 1,25（OH）2D levels and the factors affecting the levels were assayed by correlation analyses. The independent factors relating to 25（OH）D level and 1,25（OH）2D level were estimated by multiple linear regression analyses. Results Eighty-two CKD patients at stage 3-5 and without dialysis were enrolled in this study. Their average level of 25（OH）D level was 8.81ng/ml （0.34-37.69ng/ml） and 1,25（OH）2D was 17.14pg/ml （1.10-65.40 pg/ml）. The prevalence of 25（OH）D insufficiency and deficiency were 15.0% and 81.3%, respectively, and that of 1,25（OH）2D deficiency was 44.0%. In patients at different stages, discrepancies in serum level and deficiency prevalence were insignificant to 25（OH）D （P=0.903; X^2=0.343, P=0.842）, but were statistically significant to 1,25（OH）2D （P=0.000; X^2=20.384, P=0.000）. Pearson＇s correlation analyses revealed that serum albumin and 24h urine protein positively correlated with serum 25（OH）D, eGFR positively correlated with serum 1,25（OH）2D, and diabetes and serum phosphorous negatively correlated with serum 1,25（OH）2D. Multiple linear regression analyses demonstrated that serum albumin was the independent factor affecting serum 25（OH）D level, and serum 25（OH）D and eGFR were the independent factors affecting serum 1,25（OH）2D level. Conclusions 25（OH）D and 1,25（OH）2D deficiencies were frequently found in CKD patients at stages 3-5. Serum 25（OH）D correlated significantly with serum 1,25（OH）2D. Serum albumin was the predictor for 25（OH）D level. Serum 25（OH）D and eGFR were the independent factors affecting serum 1,25（OH）2D.