维持性血液透析患者25-羟维生素D水平及其影响因素

Serum level of 25 （OH） D and its relevant influencing factors in patients on maintenance hemodialysis

目的探讨维持性血液透析（MHD）患者25-羟维生素D[25（OH）D]水平及其影响因素。方法采用电化学发光法测定北京朝阳医院血液净化中心162例MHD患者25（OH）D水平，行前瞻性研究，分为3组：维生素D缺乏组：25（OH）D水平≤15μg/L，维生素D不足组：25（OH）D水平≤30μg／L，维生素D正常组：25（OH）D水平〉30μg/L。比较5组患者年龄、性别、相关生化指标、超敏C反应蛋白（hsCRP）、胰岛素抵抗指数（HOMA-IR）等差异。25（OH）D与各变量的相关性用单因素相关分析，25（OH）D水平的独立影响因素采用多元线性回归分析。结果本组患者血25（OH）D水平4.0-43．5μg／L，中位数为10．3μg／L，维生素D不足及缺乏的发生率为88．9％（144／162），3组年龄、总胆固醇、低密度脂蛋白胆固醇（LDL）、脂蛋白（a）、血肌酐、超敏C反应蛋白（hsCRP）的对数值、胰岛素抵抗指数（RI）的对数值、25（oH）D的对数值差异均有统计学意义（均P〈0．05），单因素分析血白蛋白、肌酐、钙与25（OH）D显著正相关，白细胞、总胆固醇、LDL、脂蛋白（a）、年龄、RI、hsCRP与25（OH）D显著负相关。多元线性回归分析显示hsCRP、RI、LDL、年龄是25（OH）D的独立影响因素。结论MHD患者维生素D不足及缺乏的发生率高，微炎症和胰岛素抵抗与维生素D不足及缺乏密切相关，hsCRP、RI、LDL、年龄是血25（OH）D的独立影响因素。

Objective To explore the serum level of 25（OH）D and its relevant influencing factors in patients on maintenance hemodialysis. Methods The serum level of 25 （OH）D was detected by electrochemiluminescence. A total of 162 patients on maintenance hemodialysis were divided into 3 groups according to the serum level of 25 （OH） D： vitamin D deficiency： 25 （OH） D ≤ 15 μg/L, vitamin D insufficiency ： 25 （OH） D ≤〈 30 μg/L and vitamin D normal ： 25 （OH） D 〉 30 μg/L. Age, gender, relevant biochemical indices, high sensitivity C-reactive protein （hsCRP） and HOMA-IR were compared among there groups. The associations between 25 （OH） D and the influencing factors of its levels were analyzed by Pearson＇s correlation. The independent factors correlated with the level of 25 （OH）D were estimated by multiple linear regression. Results The average level of 25（OH）D was 10. 3 （range： 4. 0 -43.5） μg/L and the prevalence of 25 （OH）D insufficiency and deficiency 88. 9% （144/162）. Significant differences existed in age, cholesterol （CHOL）, low density lipoprotein （LDL）, lipoprotein （a） （LP（a） ）, creatinine （Cr）, lg（ hsCRP）, lg （ reductase inhibitor） （ lg （RI） ） and lg （ vitamin D） （ lg （ VitD ） ） between three groups （all P 〈 0. 05 ）. Pearson＇s correlation analyses revealed that the serum levels of albumin （ALB）, Cr and Ca2~ were correlated positively with lg（VitD） while those of white blood cell, CHOL, LDL, Lp（a）, age, RI and hsCRP were correlated negatively with VitD. Multiple linear regression analyses demonstrated that hsCRP, RI, LDL and age were the independent influencing factors of the serum levels of 25 （OH） D. Conclusions The prevalence of 25 （OH） D insufficiency and deficiency is high. And microinflammation and insulin resistance are closely correlated with the insufficiency and deficiency of 25 （OH）D. The independent influencing factors of serum 25 （OH） D are hsCRP, RI, LDL and age.