持续非卧床腹膜透析患者血25(OH)D水平与炎症因子及营养状况的临床研究

Clinical Study of Serum 25-hydroxyvitamin D level and Inflammatory Factors and Nutritional Status in Continuous Ambulatory Peritoneal Dialysis Patients

目的:探讨持续非卧床腹膜透析患者血25(OH)D水平与体内炎症因子及营养不良的关系。方法:测定89例持续不卧床腹膜透析患者的25(OH)D、血白蛋白、前白蛋白、中性粒细胞与淋巴细胞比值、超敏C反应蛋白、白介素-6及肿瘤坏死因子-a,根据25(OH)D>30ng/m L、16<25(OH)D≤30ng/m L及25(OH)D≤15ng/m L分为维生素D正常组、不足组和缺乏组。分析3组患者炎症因子及营养指标的关系。结果:持续不卧床腹膜透析患者25(OH)D水平为5.0~41.2ng/m L,维生素D缺乏和不足的发生率为86.51%,维生素D正常组患者血超敏C反应蛋白、白介素-6、肿瘤坏死因子-a及中性粒细胞与淋巴细胞比值均低于维生素D缺乏组和不足组的患者,而血白蛋白、前白蛋白均高于维生素D缺乏组和不足组的患者,差异有统计学意义(P<0.001)。结论:持续非卧床腹膜透析患者血25(OH)D水平在微炎症状态及营养不良中起重要作用。

Objective:To evaluate the association between 25-hydroxyvitamin D level and inflammatory and nutritional factors in continuous ambulatory peritoneal dialysis.Methods:Serum levels of 25-hydroxyvitamin D,albumin,prealbumin,neutrophi-lymphocyte ratio(NLR),high-sensitivity-reactive protein(Hs-CRP),IL-6,and TNF-a were measured in 89 patients with continuous peritoneal dialysis.All the patients were divided into there groups according to the serum 25-hydroxyvitamin D level.Vitamin D normal:25(OH)D>30ng/ml,Vitamin D insufficiency:16<25(OH)D≤30ng/ml,Vitamin D deficiency:25(OH)D≤15ng/ml,Inflammatory factory and nutritive index were compared among the three groups.Result:The average of serum 25(OH)D level was 5.0~41.2ng/ml in patients with continuous peritoneal dialysis,the prevalence of 25(OH)D deficiency was 86.51%.The levels of Hs-CRP,IL-6,TNF-a,and NLR were obviously lower in 25(OH)D normal group than deficiency and insufficiency group,albumin and prealbumin were higher than patients with vitamin D deficiency and insufficiency groups.the difference was statistically significant(P<0.001).Conclusion:The level of blood 25(OH)D in continuous ambulatory peritoneal dialysis patients plays an important role in micro inflammatory state and malnutrition.