慢性肾脏病非透析患者中血清25-羟维生素D_3与心肌损伤的相关性

The Relationship Between Serum 25-Hydroxyvitamin D_3 and Myocardial Injury in Non-Dialysis Chronic Kidney Disease Patients

目的 通过对慢性肾脏病（CKD）非透析患者中心肌肌钙蛋白T（cTnT）和活性维生素D3水平的研究,分析心肌损伤的原因,探讨活性维生素D3与心肌损伤的可能作用机制。方法 对443例CKD 2-5期非透析患者的临床资料进行回顾性分析。使用组间比较、单因素线性回归分析探讨血清cTnT与维生素D3之间的关系。结果 （1）除CKD1期患者外,CKD 2-5期的cTnT的均值分别为（0.114±0.093）ng/ml、（0.166±0.110）ng/ml、（0.193±0.160）ng/ml、（0.218±0.140）ng/ml,均高于对照组（0.038±0.016）ng/ml,与对照组相比,P〈0.05;而CKD患者中CK-MB水平无明显升高,与对照组相比,P〉0.05。（2）在CKD 3期中,随着维生素D水平从正常到缺乏,cTnT的水平从（0.148±0.120）ng/ml到（0.198±0.140）ng/ml逐渐升高,与对照组均值（0.038±0.016）ng/ml相比,P〈0.05。而CK-MB的均值水平无明显变化,与对照组相比,P〉0.05。（3）在CKD 3期中,随着维生素D的降低,平均cTnT水平逐渐增高,两者呈负相关（r=-0.105,P〈0.05）结论 （1）CKD患者心肌损伤存在CKD患者各期,且随着CKD分期逐渐加重,心肌损伤逐渐加重,cTnT可作为一个反应心肌损伤的指标。（2）维生素D具有多效的生物学效应,在心肌损伤的保护中有一定的作用。

Objective To analyze reasons of myocardial injury and to explore the functional mechanisrrl of vitamin D3 and myocardial injury through researches of serum cardiac troponin T （ cTnT ） and vitamin D3 in non-dialysis chronic kidney disease （ CKD ） patients. Methods Crosssectional study was applied. The clinical data of 443 inpatients without dialysis CKD from stage 2 to 5 were analyzed retrospectively. And comparisons between groups and lineal regression analysis were utilized to investigate the relationship between serum vitamin D3 and cTnT. Results （ 1 ） Except patients of CKDI, average cTnT in CKD2-5 were （ 0.114 ± 0.093 ） ng/ml, （ 0.166 ± 0.110 ） ng/ml, （ 0.193 ± 0.160 ） ng/ml, and （0.218 ± 0.140 ） ng/ml, which were higher than control group （0.038± 0.016 ） ng/ml.Compared with the control group, the difference was statistically significant （P 〈 0.05 ） . However, the level of CK-MB in patients with CKD has no obvious rise, P 〉 0.05. （ 2 ） With vitamin D decreasing from nomaal to lack in CKD3, the level of cTnT increased from （ 0.148±0.120 ） ng/ml to （ 0.198±0.140 ） ng/ml. Compared with normal control group （0.038±0.016 ） ng/ml, the difference was statistically significant （P 〈 0.05 ） . However, the level of CK-MB in patients with CKD has no obvious rise, P 〉 0.05. （3） The average cant gradually increased with the reduction of vitamin D in CKD3, which showed a negative correlation （r=-0.105, P 〈 0.05 ） . Conclusion （ 1 ） Myocardial injuries exist in CKD2-5 and will exacerbate with CKD stage aggravation, cTnT can be used as a reaction index of myocardial injury. （ 2 ） With multiple biological effects, vitamin D could play a certain role in the protection of myocardial injury.