急性肾损伤危重患者血清1,25二羟维生素D水平对其预后的影响

The effect of serum 1,25 dihydroxy vitamin D levels on prognosis of critically ill patients with acute kidney injury

目的观察血清1,25二羟维生素D[1,25（OH）2D]水平与急性肾损伤（AKI）危重患者预后的相关性。方法回顾性分析2014年12月至2015年12月入住上海交通大学附属第六人民医院45例AKI患者的临床资料,按预后结果分为存活组和死亡组。检测患者血清1,25（OH）2D、甲状旁腺激素、25-OH维生素D、钙和磷等对预后的影响。结果 45例患者中10例住院死亡,病死率为22.2%。存活组与死亡组AKI患者的血清1,25（OH）2D水平间差异有统计学意义[（63.2±41.5）pg/mL vs.（33.8±24.1）pg/mL,P=0.043];死亡组患者血清磷水平高于存活组,且差异有统计学意义[（6.3±2.1）mg/dL vs.（4.5±1.6）mg/dL,P=0.019]。多因素Logistic回归分析显示,高急性生理与慢性健康评分（APACHEⅡ评分）以及高水平1,25（OH）2D为AKI患者预后的危险因素（OR=1.191,95%CI：1.154~1.233,P=0.008;OR=1.281,95%CI：1.067~1.538,P=0.018）。结论1,25（OH）2D与AKI患者死亡具有相关性,临床上可作为判断AKI患者预后的指标。

Objective To investigate the effect of 1,25 dihydroxy vitamin D [1,25（OH）2D]levels on prognosis of critically ill patients with acute kidney injury（AKI）.Methods A retrospective analysis was conducted on the 45 critically ill patients with AKI who were admitted into the hospital from December 2014 to December 2015.And the patients were divided into survival group and dead group.Serum 1,25（OH）2D,intact parathyroid hormone,25-OH vitamin D,calcium and phosphorus were measured in those patients to study the effect on prognosis of AKI patients.Results Of 45 patients,10died in the hospital（22.2%）.The mean 1,25（OH）2D level in survival group[（63.2±41.5）pg/mL]was significantly higher than that in dead group [（33.8±24.1）pg/mL]（P=0.043）.In addition,serum phosphorus in survival group[（4.5±1.6）mg/dL]was significantly lower than that in dead group[（6.3±2.1）mg/dL]（P=0.019）.The multivariate Logistic analysis showed that higher APACHEⅡ（OR=1.191,95%CI：1.154-1.233,P=0.008）and 1,25（OH）2D（OR=1.281,95%CI：1.067-1.538,P=0.018）were risk factors for the prognosis of critically ill patients with AKI.Conclusion 1,25（OH）2D is related to adverse prognosis outcome in AKI patients,which could be used as an indicator to predict the prognosis of AKI patients in clinic.