持续不卧床腹膜透析患者25(OH)D_3水平及铁代谢状况分析

Analysis of the Level of 25(OH)D_3 and Iron Metabolism in Continuous Ambulatory Peritoneal Dialysis Patients

目的:分析持续不卧床腹膜透析患者25-羟基维生素D3[25(OH)D_3]水平及铁代谢状况,探讨25(OH)D_3与铁代谢指标的相关性。方法:选取2015年01月~2017年12月期间我院收治的60例持续不卧床腹膜透析患者进行研究,作为观察组,另选取同期在我院接受体检的30例健康者作为对照组。比较两组的生化指标,包括血红蛋白(Hb)、血白蛋白(Alb)、血肌酐(Scr)、尿素氮(BUN)和全段甲状旁腺激素(PTH)、血清25(OH)D_3、铁调素(hepcidin)和血清铁、血清铁蛋白(Fer)和总铁结合力(TIBC)等铁代谢指标,并分析观察组的25(OH)D_3与铁代谢指标的相关性。结果:观察组患者的Hb和Alb显著低于对照组,观察组的Scr、BUN和PTH等指标显著高于对照组,差异均有统计学意义(P <0. 05)。观察组患者的25(OH)D_3、血清铁和TIBC均显著低于对照组,观察组的Fer显著高于对照组,差异均有统计学意义(P <0. 05)。两组的hepcidin相比,差异不具有统计学意义(P> 0. 05)。观察组的25(OH)D_3与hepcidin和Fer呈负相关关系(r_1=-4. 252,r_2=-3. 518,P均<0. 05),与血清铁和TIBC呈正相关关系(r_1=2. 657,r_2=2. 614,P均<0. 05)。结论:持续不卧床腹膜透析患者血清25(OH)D_3水平降低,机体存在铁代谢异常,且两者密切相关,25(OH)D_3可通过降低hepcidin影响肾性贫血,服用维生素D可改善贫血及铁代谢异常。

Objective:To analyze the level of 25(OH)D 3 and iron metabolism in continuous ambulatory peritoneal dialysis patients,and to explore the correlation between 25(OH)D 3 and iron metabolism index.Methods:60 cases of continuous ambulatory peritoneal dialysis patients in our hospital from January 2015 to December 2017 were selected as observation group,and another 30 healthy persons who received physical examination in our hospital during the same period were selected as control group.Biochemical indicators(Hb,Alb,Scr,BUN and PTH),25(OH)D 3,hepcidin and iron metabolism indicators(serum iron,Fer and TIBC)were compared between the two groups,and the correlation between 25(OH)D 3 and the iron metabolism indexes in the observation group were analyzed.Results:The Hb and Alb in the observation group were significantly lower than those in the control group,and the indexes of Scr,BUN and PTH in the observation group were significantly higher than those in the control group,the differences were statistically significant(P<0.05).The 25(OH)D 3,serum iron and TIBC in the observation group were significantly lower than those in the control group.The Fer in the observation group was significantly higher than that in the control group,the difference was statistically significant(P<0.05).The difference between the two groups of hepcidin was not statistically significant(P>0.05).The 25(OH)D 3 of the observation group had a negative correlation with hepcidin and Fer(r 1=-4.252,r 2=-3.518,P<0.05),and had a positive correlation with serum iron and TIBC(r 1=2.657,r 2=2.614,P<0.05).Conclusion:The level of serum 25(OH)D 3 in patients with continuous ambulatory peritoneal dialysis was decreased,and the body had abnormal iron metabolism,and the two were closely related.25(OH)D 3 can affect renal anemia by reducing hepcidin.Vitamin D can improve anemia and iron metabolism abnormality.