维持性血液透析患者血清25羟维生素D水平与其红细胞生成素低反应性的相关性研究

Correlation between serum 25-hydroxyvitamin D level and erythropoietin hyporesponsiveness in maintenance hydroxyvitas patients

目的探讨维持性血液透析患者血清25羟基维生素D[25(OH)D]水平与其红细胞生成素低反应性的相关性。方法选取上海市第八人民医院透析中心的80例维持性血液透析(maintenance hemodialysis,MHD)患者回顾性分析12个月,根据25(OH)D水平分为重度缺乏组(<5ng/ml,n=14),轻度缺乏组(5~15ng/ml,n=38),非缺乏组(>15ng/ml,n=28)。收集患者性别、年龄、体质量指数(body mass index,BMI)及红细胞生成素使用剂量,测定各组血清25(OH)D、血红蛋白(hemoglobin,Hb)、超敏C反应蛋白(high sensitive C-reactive protein,hs-CRP)、尿素清除指数(Kt/V)、肌酐清除率(creatinine clearance,Ccr)等指标,使用红细胞生成素抵抗指数(erythropoietin resistance index,ERI)作为评价患者对红细胞生成素反应性的指标。分析各组间ERI的差异性,以及ERI与25(OH)D水平的相关性。结果全部80例MHD患者ERI平均值为13.514IU/(w?kg?g?dl),其中15%的患者存在红细胞生成素抵抗。3组患者ERI相比具有统计学差异(F=21.212,P<0.001)。Pearson相关分析显示与ERI呈相关性的指标有25羟维生素D(r=-0.633,P=0.013),血清白蛋白(r=-0.330,P=0.003)及hs CRP(r=0.238,P=0.032)。多因素Logistic回归分析显示,校正年龄、性别、透析龄、Kt/V、全段甲状旁腺素(intact Parathyroid,i PTH)、BMI、hs CRP、血清白蛋白后,25(0H)D缺乏与红细胞生成素低反应性有独立相关关系(HR:3.355,95%CI:0.136~43.731,P=O.016)。结论血清25(OH)D缺乏是导致维持性血透患者促红细胞生成素低反应性的独立风险因素。

Objective To investigate the relationship between serum 25-hydroxyvitamin D（25（OH）D）level and erythropoietin（EPO） hyporesponsiveness in maintenance hemodialysis（MHD） patients. Methods A total of 80 MHD patients were recruited and divided into three groups according to serum 25（OH）D level,severe deficiency group（〈5 ng/ml, n=14）, mild deficiency group（5-15 ng/ml, n=38） and normal group（〉15 ng/ml, n=28）. Gender, age, body mass index（BMI）, EPO dose, serum 25（OH）D, hemoglobin（Hb）, highsensitivity C reactive protein（hs CRP）, urea clearance rate（kt/V）, creatinine clearance rate（Ccr） and other biochemical indexes were collected and analyzed. EPO resistance index（ERI） was used for the evaluation of EPO responseness. The difference of ERI and its correlation with serum 25（OH）D level were analyzed among the groups. Results The mean ERI was 13.514 IU/（w·kg·g·dl） in all the MHD patients. EPO resistance was found in 15% of the patients. ERI was significantly different among the 3 groups（F=21.212, P〈0.001）. Pearson correlation analysis showed that ERI was correlated with 25（OH）D（r=-0.633, P=0.013）, albumin（r=-0.330, P=0.003） and hs CRP（r=0.238, P=0.032）. Multivariate logistic regression demonstrated that adjusted age, gender, dialysis vantage, Kt/V, intact parathyroid（i PTH）, BMI, hs CRP, serum albumin and 25（0 H）D deficiency were the independent factors for EPO hyporesponsiveness（HR： 3.355, 95% CI： 0.136-43.731, P=0.016）. Conclusion Serum 25（OH）D deficiency is an independent risk factor for EPO hyporesponsiveness in MHD patients.