腹膜透析患者维生素D水平与血管钙化相关性研究

Correlation between vitamin D level and vascular calcification in peritoneal dialysis patients

目的了解持续不卧床腹膜透析(continuous ambulatory peritoneal dialysis,CAPD)患者血1,25(OH)_2D_3水平及血管钙化情况,探讨CAPD患者血管钙化的相关因素及血1,25(OH)_2D_3水平测定在腹主动脉钙化(abdominal aortic calcification,AAC)中的作用及意义。方法选取河北医科大学第二医院行CAPD 3个月以上患者84例,收集其临床资料,侧位X线平片评估AAC情况,计算腹主动脉钙化积分(abdominal aortic calcification score,AACs)。酶联免疫吸附测定检测血清1,25(OH)_2D_3浓度。相关分析法分析1,25(OH)_2D_3与AACs关系,Logistic回归法和多元回归法进行血管钙化相关危险因素分析,受试者工作曲线(ROC)评价1,25(OH)_2D_3预测AAC的准确性。结果 84例CAPD患者中,AAC患者34例(42.5%),CAPD患者血清1,25(OH)_2D_3水平较低,与AAC呈负相关,口服骨化三醇可提高血清1,25(OH)_2D_3浓度。Logistic回归分析显示高龄、罹患糖尿病、服用骨化三醇、高胆固醇、高磷、高血尿酸、低1,25(OH)_2D_3为血管钙化发生的危险因素(P <0.05),多元回归分析结果显示去除混杂因素后,年龄、血磷、1,25(OH)_2D_3是AAC进展的独立影响因素(P <0.05)。1,25(OH)_2D_3 ROC曲线下面积(AUC)为0.652(95%CI=0.442~0.696,P <0.05),提示1,25(OH)_2D_3预测AAC有一定准确性,取1,25(OH)_2D_3浓度为250.43pg/ml作为截点时,其预测AAC的敏感性为55.9%,特异性为66%,约登指数为0.219。结论 CAPD患者血清1,25(OH)_2D_3水平与AAC程度呈负相关,低血清1,25(OH)_2D_3水平是AAC的独立危险因素之一。口服骨化三醇可改善CAPD患者1,25(OH)_2D_3水平,但口服骨化三醇可增加血管钙化的风险,监测1,25(OH)_2D_3水平可预测血管钙化的风险。

Objective To investigate the level of blood 1,25（OH） 2D 3 and vascular calcification in patients with continuous ambulatory peritoneal dialysis （CAPD）, and to explore the factors for serum calcium calcification and blood 1,25（OH） 2D 3 in patients with CAPD. The role of blood 1,25（OH） 2D 3 in abdominal aortic calcification（AAC） and significance were explored.Methods A total of 84 patients with CAPD for more than 3 months were enrolled, and clinical data were collected. Lateral radiographic calcification was performed and AAC score （AACs） was calculated. Serum 1,25（OH） 2D 3 concentration was measured by ELISA. Correlation analysis was used to analyze the relationship between 1,25（OH） 2D 3 and AACs, logistic regression and multiple regression analysis for risk factors of vascular calcification, and receiver operating curve （ROC） evaluation of 1,25（OH） 2D 3 for the accuracy of AAC.Results Of 84 patients with CAPD, 34 cases（ 42.5% ） had AAC. The serum level of 1,25（OH） 2D 3 was lower in CAPD patients, which was negatively correlated with AAC. Oral calcitriol increased serum 1,25（OH） 2D 3 concentration. Logistic regression analysis showed that elderly patients with diabetes, taking calcitriol, high total cholesterol, high P, high blood uric acid, and low 1,25（OH） 2D 3 were risk factors for vascular calcification （ P 〈 0.05 ）. Multiple regression analysis showed that age, serum phosphorus, and 1,25（OH） 2D 3 were independent factors for AAC progression （ P 〈 0.05 ）. 1,25（OH） 2D 3 ROC curve area （AUC） was 0.652 （95% CI = 0.442 - 0.696 , P 〈 0.05 ）, suggesting that 1,25（OH） 2D 3 predicted the accuracy of AAC. When 1,25（OH） 2D 3 was 250.43 pg/ml as the cut-off point, the sensitivity of AAC was 55.9% , the specificity 66%, and Yoden index 0.219.Conclusion Serum 1,25（OH） 2D 3 level in CAPD patients is negatively correlated with the degree of AAC. Low serum 1,25（OH） 2D 3 level was one of the independent risk factors for AAC. Oral calcitriol can improve 1,25（OH） 2D 3 levels in patients with CAPD, but in can also increases the risk of vascular calcification, and monitoring on the 1,25（OH） 2D 3 level should be performed to prevent the risk of vascular calcification.