慢性肾脏病患者维生素D缺乏与动脉僵硬度的相关性

Correlation of vitamin D deficiency and arterial stiffness in patients with chronic kidney disease

目的 探讨慢性肾脏病患者维生素D缺乏与动脉僵硬度的相关性.方法 选取慢性肾脏病（CKD l～5期）患者300例,根据血25（OH）D3浓度分为维生素D缺乏组[25 （OH）D3＜20 μg/L]和维生素D非缺乏组[25（OH）D3≥20 μg/L].采集临床资料数据,测定动脉僵硬度指标肱踝脉搏波传导速度（baPWV）.对血25（OH）D3水平与baPWV间的关系进行单因素相关分析及多元线性回归分析. 结果 维生素D缺乏组188例（62.7％）,维生素D非缺乏组112例（37.3％）.全部CKD患者25（OH）D3平均浓度为（17.62±8.54） μg/L,维生素D缺乏组和非缺乏组分别为（12.38±4.55） μg/L与（26.44±6.05） μg/L（P＜0.01）.维生素D缺乏组baPWV值高于非缺乏组[（1 827.34±429.11） cm/s比（1 555.31±353.14） cm/s,P＜0.01].单因素相关分析显示全体CKD患者（r=-0.38,P＜0.01）以及CKD 2～5期患者[r=-0.30,P＜0.05;r=-0.26,P＜0.05;r=-0.46,P＜0.01;r=-0.57,P＜0.01]血25（OH）D3浓度与baPWV均呈负相关.多元线性回归分析显示血25 （OH）D3浓度下降与baPWV的增加独立相关（模型1：β=-0.18,P＜0.01;模型2：β=-0.17,P=0.01）,回归模型1与模型2均可解释baPWV变化的50％.结论 CKD患者普遍存在维生素D缺乏,维生素D缺乏与动脉僵硬度增加相关.维生素D替代治疗可能影响CKD患者的心血管预后,但有待未来研究的进一步明确.

Objective To evaluate the association between serum 25-hydroxyvitamin D3 [25 （OH）D3] and arterial stiffness in patients with chronic kidney disease （CKD）.Methods Three hundred patients with CKD were included,and were divided into two groups based on serum 25（OH）D3 levels：vitamin D deficient [25（OH）D3 〈 20 μg/L] and vitamin D non-deficient [25（OH）D3≥20 μg/L].Brachial ankle pulse wave velocity （baPWV）,which reflected arterial stiffness,was calculated using the single-point method.Clinical data were collected in details.Correlation between serum 25（OH）D3 level and baPWV was assessed by the single factor correlation test and multiple linear regression analysis.Results The prevalence of vitamin D deficiency was 62.7%（188/300）.The concentration of 25（OH）D3 was （17.62±8.54） μg/L in total patients,but was （12.38±4.55） μg/L and （26.44±6.05） μg/L in the subgroups of vitamin D deficient and non-deficient,respectively（P 〈 0.01）.There was a higher value of baPWV in the group of vitamin D deficient than that of vitamin D non-deficient （1 827.34±429.11 vs 1 555.31 ±353.14,P 〈 0.01）.Serum 25（OH）D3 level and baPWV was negatively correlated in total patients（r=-0.38,P 〈 0.01） and each stage of CKD（stage 2-5）[r=-0.30,P 〈 0.05; r=-0.26,P 〈 0.05; r=-0.46,P 〈 0.01; r=-0.57,P 〈 0.01].Multiple linear regression analysis showed that vitamin D level was independently associated with baPWV（Model 1：β=-0.18,P 〈 0.01; Model 2：β=-0.17,P=0.01）.Both models accounted for 50% （R2=0.50） of total variance of baPWV.Conclusions Vitamin D deficiency is common in CKD,and a low 25（OH）D3 level is significantly associated with increased arterial stiffness in these patients.Clinical intervention studies are needed to clarify whether treatment with vitamin D decreases the risk of cardiovascular disease in patients with CKD.