糖尿病维持性血液透析患者甲状旁腺激素及25羟维生素D_3水平的改变及相关因素分析

CChanges of parathyroid hormone and 25-OH vitamin D_3 levels and their related factors in maintenance hemodialysis patients

目的 分析合并糖尿病与否的尿毒症维持性血液透析（maintenance hemodialysis,MHD）患者全段甲状旁腺激素（intact parathyroid hormone,iPTH）水平及25羟维生素D3[25 hydroxy vitamin D3,25 （OH）D3]水平的可能差异.方法 选择2015年1～12月在南京医科大学第一附属医院血液净化中心维持性透析且未曾行甲状旁腺切除术的180例尿毒症患者,根据是否合并糖尿病,分为糖尿病组（DH）与非糖尿病组（NDH）,比较2组之间的临床资料,并分析iPTH及25 （OH）D.的可能影响因素. 结果 DH组的iPTH水平显著低于NDH组[219.7（164.1～275.2） pg/ml比500.4 （398.1～602.7） pg/ml,Z=4.473,P＜0.001],同时DH组25 （OH）D.亦显著低于NDH组[（30.8±16.0）pg/ml比（45.2±25.1）pg/ml,t=3.327,p=0.001].iPTH与糖尿病病史（r=-0.339,P＜0.001）呈负相关,与透析龄（r=0.386,P＜0.001）、血磷（r=0.437,P＜0.001）、碱性磷酸酶（r=0.426,P＜0.001）、25 （OH）D.（r=0.254,P=0.016）呈正相关.多元线性回归分析显示糖尿病病史（β=-0.173,P=0.012）、透析龄（β=0.147,P=0.028）为iPTH的独立影响因素（经年龄、性别、维生素D类似物服用史、拟钙剂服用史、白蛋白、三酰甘油校正）.25 （OH）D.与糖尿病病史（r=0.296,P=0.004）呈负相关,与透析龄（r=0.228,P=0.030）、血磷（r=0.237,p=0.023）、血镁（r=0.286,P=0.007）、血清白蛋白（r=0.263,P=0.012）、iPTH （r=0.254,P=0.016）呈正相关.多元线性回归分析显示糖尿病病史（β=-0.317,P=0.004）为25 （OH）D.的独立影响因素（经年龄、性别、服用维生素D类似物服用史、拟钙剂服用史、胆固醇、三酰甘油校正）.结论 合并糖尿病MHD患者iPTH水平和25 （OH）D3水平均显著低于非糖尿病MHD患者,糖尿病病史是iPTH和25 （OH）D3的独立影响因素.

Objective To analyze the changes of serum intact parathyroid hormone （iPTH） and 25-hy- droxyvitamin D3 [25（OH）D3] levels and their related factors in maintenance hemodialysis （MHD） patients with or without diabetes mellitus. Method A total of 180 MHD patients without parathyroidectomy and treated in the period from Jan. to Dec. 2015 in the Blood Purification Center of the First Affiliated Hospital of Nan- jing Medical University were enrolled in this study. They were divided into DH group （MHD patients with diabetes） and NDH group （MHD patients without diabetes）. Their clinical data, including general information, di- alysis age, history of diabetes, and laboratory data were compared between the two groups to analyze the influ- ence factors for serum iPTH and 25（OH）D3 levels in these patients. Results Serum iPTH level was 219.7 （164.1-275.2） pg/ml in DH group significantly lower than the level of 500.39 （398.1-602.7） pg/ml in NDH group （Z=-4.473, P〈0.001）. Similarly, serum 25（OH）D3 level was also lower in DH group than in NDH group （30.9±16.0 pg/ml vs. 45.2±25.1 pg/ml, t=-3.327, P=-0.001）. Serum iPTH level was negatively correlated with history of diabetes （r=-0.339, P〈0.001）, and positively correlated with dialysis age （r=0.386, P〈 0.001）, serum phosphatase, （r=0.437, P〈0.001）, alkaline phosphatase （r=0.426, P〈0.001） and 25-OH D3 （r= 0.254, P=0.016）. Multivariate linear regression analysis showed that history of diabetes （fla=-0.173, P=0.012）and dialysis age （fla=0.147, P=-0.028） were the independent factors for iPTH. Serum 25-OH D3 level was nega- tively correlated with history of diabetes （r=-0.296, P=0.004）, and positively correlated with dialysis age （r= 0.228, P=0.030）, serum phosphatase （r=0.237, P=-0.023）, serum magnesium （r=0.286, P=-0.007）, serum albu- min （r=0.263, P=0.012） and iPTH （r=0.254, P=0.016）. Multivariate linear regression analysis showed that history of diabetes （βa=-0.317, P=0.004） was the independent factor for 25-OH D3. Conclusion The levels of iPTH and 25-OH D3 were significantly lower in NH group than in NDH group. History of diabetes was the in- dependent factor for iPTH and 25-OH D3.