维持性血液透析患者血清25-羟维生素D水平及其影响因素研究

Factors in Patients with 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:选择MHD患者116例,检测血清25(OH)D水平并分为三组:维生素D缺乏组(n=31)、不足组(n=61)、正常组(n=24)。检测各项血生化指标,包括白蛋白(Alb)、促红细胞生成素浓度(EPO)、血钙(Ca)、血磷(P)、甘油三酯(TG)、低密度脂蛋白(LDL)、全段甲状旁腺素(iPTH)、高敏C反应蛋白(hs-CRP)、氨基末端脑钠肽前体(NT-proBNP)等,并统计分析。结果:维生素D缺乏组和不足组中男性比例显著高于正常组。维生素D缺乏组TG、LDL显著高于正常组(P均<0.05)。缺乏组hsCRP和NT-proBNP显著高于不足组和对照组(P均<0.05),其余各项指标无显著差异。逐步回归分析发现hsCRP(β=-0.496,F=8.128,P<0.001)、LDL(β=-0.315,F=4.42l,P=0.015)、TG(β=-0.065,F=3.542,P=0.032)是影响25(OH)D水平的重要因素。结论:MHD患者中存在明显的维生素D缺乏或不足,hsCRP、LDL、TG是血25(OH)D的独立影响因素,建议对严重缺乏维生素D的MHD患者酌情补充维生素D。

Objective：To investigate the 25-hydroxyvitamin D [25 （OH） D] levels and their influen-cing factors in patients with maintenance hemodialysis （ MHD） .Method：A total of 116 cases of MHD pa-tients were collected and divided into three groups in accordance with serum 25 （ OH） D levels：Deficiency group （ n =31） , insufficient group （ n =61） and normal group （ n =24） .Serum levels of biochemistry in-cluding albumin （Alb）, erythropoietin concentration （EPO）, calcium （Ca）, phosphorus （P）, triglycer-ides （TG）, low density lipoprotein （LDL）, intact parathyroid hormone （iPTH）, high-sensitivity C-reac-tive protein （ hs-CRP ） , amino-terminal pro-brain natriuretic peptide （ NT-proBNP ） .were detected and statistical analyzed .Result： Male ratio was significantly higher in deficiency group and insufficient group than the normal group .TG, LDL in vitamin D deficiency group were significantly higher than normal group （ P ＆lt;0.05） .hsCRP and NT-proBNP were significantly higher in deficiency group than insufficient group and normal group （P ＆lt;0.05）.The rest of the indicators had no significant differences .Stepwise regression analy-sis showed that hsCRP （β=-0.496, F =8.128, P ＆lt;0.001） , LDL （β=-0.315, F =4.42l, P =0. 015）, TG （β=-0.065, F =3.542 , P =0.032） were affecting 25 （OH） D levels and they were the in-dependent factors .Conclusion：Serum hsCRP , LDL, TG levels were independent factors of 25 （ OH） D, MHD patients with deficient or insufficient vitamin D , which suggested an appropriate supplemental vitamin D for MHD patients with a serious lack of vitamin D .