维持性血液透析患者维生素D缺乏的调查

Investgation of vitamin D deficiency in patients with maintenance hemodialysis

目的:了解维持性血液透析(maintenancehemodialysis,MHD)患者维生素D的基线水平,并分析其与临床指标之间的相关性。方法:选取南京医科大学第二附属医院肾脏病中心278例MHD患者,ELISA方法检测患者血清25羟基-维生素D[25(OH)D]的水平,并用多元回归分析法分析25(OH)D水平与患者临床指标间的相关性,后者包括年龄、性别、体质量指数(bodymassindex,BMI)、血压、药物、原发病、透析龄、并发症以及生化指标如血钙、血磷、甲状旁腺激素等。结果:278例MHD患者(其中男175例,女103例)平均年龄为(57.4±18.2)岁,平均透析龄为(62.3±61.9)月。25(OH)D缺乏(<15ng/ml)和不足(15～30ng/ml)的患者分别占55%和37%,仅有8%的患者血清25(OH)D水平在正常范围内。进一步分析其与临床指标间的相关性发现,25(OH)D水平与女性、心血管并发症呈负相关(P<0.05),与男性、应用RAAS阻断剂呈正相关(P<0.05)。糖尿病患者25(OH)D水平低于非糖尿病患者,但无统计学差异。25(OH)D水平与年龄、BMI、血钙及甲状旁腺激素等无相关性。结论:维生素D缺乏和不足在MHD患者中发生率十分高,女性及心血管并发症的发生与之密切相关,应用RAAS阻断剂可能改善25(OH)D的缺乏和不足。

Objective： Vitamin D deficiency has been reported to be closely associated with many clinical complications such as cardiovascular events and osteodystrophy in chronic renal failure patients. The aims of this study are to screen serum Vitamin D level in maintenance hemodialysis （MHD） patients from our hemodialysis center and analyze their clinical features. Methodology： Two hundred and seventy eight MHD patients were enrolled in this study,and their serum 25-hydroxyvitamin-D level was detected by using a commercial available ELISA kit. The correlation of patients＇ clinical features including age, gender, body mass index （BMI） , blood pressure, medicine, primary kidney disease, duration of dialysis, complications and biochemical indexes with their serum 25 （OH） D level were analyzed by using multiple logic regression analysis method. Results：They were 175 male and 113 female with an average of （57.4 ~ 18.2） years old （ ranged from 23 to 89） and the duration dialysis of （62.3 ~ 61.9） months. Serum 25 （OH） D deficiency （ 〈 15 ng/ml） and insufficiency （ 15 - 30 ng/ml） were present in 55% and 37% of the dialysis patients respectively. Only 8% of the patients showed normal serum 25 （OH） D level. Further analysis of their clinical features revealed that Vitamin D deficiency was more prevalent in female or patients with cardiovascular complications （ P 〈 0.05 ） , while less Vitamin D deficiency could be found in male or patients received RAAS inhibitors （ P 〈 0.05 ）. Diabetic patients showed a low 25 （OH） D level compared with the other patients. No close correlation was found as to the other clinical features including age, BMI, serum calcium and iPTH levels with Vitamin D deficiency. Conclusion： The prevalence of hypovitaminosis D is high in MHD patients. The female, cardiovascular complications and diabetes are correlated with Vitamin D deficiency, and taking RAAS inhibitors may benefit the patients with such deficiency.