慢性肾脏病非透析患者维生素D水平调查

Vitamin D levels in non-dialysis chronic kidney disease patients

目的 了解慢性肾脏病（CKD）患者维生素D不足及缺乏的患病率及其影响因素,为合理治疗维生素D缺乏提供依据。方法 对506例住院CKD 1~5期非透析患者的临床资料进行回顾性分析。用串联质谱法测定血清25（OH）D3水平,并检测血肌酐（SCr）,尿酸（UA）,白蛋白（Alb）,血清钙（Ca）、磷（P）,甲状旁腺激素（PTH）,血红蛋白（Hb）,计算估计肾小球滤过率（e GFR）等;分析25（OH）D3水平与上述临床指标的关系。结果 506例患者的25（OH）D3平均水平为（17.70±8.77）ng/ml;25（OH）D3不足和缺乏总患病率为90.54%。单因素相关分析显示,25（OH）D3与Scr（r=-0.258,P=0.000）,P（r=-0.175,P=0.003）,PTH（r=-0.154,P=0.01）呈负相关,与e GFR（r=0.271,P=0.000）,Hb（r=0.227,P=0.000）,Alb（r=0.186,P=0.002）呈正相关。多元线性回归分析显示,e GFR和Alb是25（OH）D3的独立影响因素。结论 维生素D不足和缺乏在CKD非透析患者中普遍存在。e GFR和Alb是CKD患者维生素D水平的独立影响因素。应在CKD人群中普遍开展维生素D水平检测,早期发现、合理治疗维生素D缺乏。

Objective To investigate the prevalence of vitamin D insufficiency and deficiency in chronic kidney disease （CKD） without dialysis, and explore the factors affecting the vitamin D. Provide the evidence for treatment of these pa- tients. Methods The clinical data of 506 inpatients without dialysis CKD from stage 1 to 5 were analyzed retrospectively. The level of 25 （ OH ） D3, serum creatinin （ SCr）, uric acid （ UA ）, albumin （ Alb ）, calcium （ Ca ）, phosphorus （ P ）, parathy- roid hormone （ PTH）, hemoglobin （ Hb ）, estimated GFR were determined. The correlation between 25 （ OH ） D3 and those parameters was analyzed. Results The mean level of 25 （OH） D3 in these 506 patients was （ 17.70 ± 8.77 ） ng/ml. The total prevalence of vitamin D insufficiency and deficiency was 90.54%. Single factor correlation analysis indicated that se- rum 25 （OH） D3 was a significantly negative correlation with Scr（ r = - 0. 258, P = 0. 000）, P （ r = - 0. 175, P = O. 003 ）, PTH （r = -0. 154, P = 0.01 ）. serum 25 （OH）D3 was significantly positive correlated with eGFR（ r = 0.271, P = 0. 000）, Hb（r =0.227,P =0. 000） ,Alb（r =0. 186,P =0. 002）. Muhivariable regression analysis showed that 25（OH） D3 was positively correlated with eGFR and Alb. Conclusion The prevalence of 25 （OH）D3 insufficiency and deficiency in pa- tients with CKD is quite high. Alb and eGFR may be the key factors influencing 25 （OH） D3 level. Vitamin D level should be measured early among CKD patients in order to carry out corresponding treatment.