慢性肾脏病4～5期患者血清25羟维生素D水平与左心室肥厚相关性的研究

Relationship between the serum 25 hydroxyvitamin D level and left ventricular hypertrophy in patients with advanced chronic kidney disease

目的探讨慢性肾脏病4～5期(CKD4～5)患者血清25-羟维生素D[25 (OH) D]水平与左心室肥厚(LVH)的相关性及影响LVH的相关因素分析。方法回顾性收集医院肾内科收治的CKD4～5期223例患者的一般资料、实验室检查及超声心动图检查结果,按照美国与欧洲超声心动图学会推荐标准,以左心室质量指数(LVMI)判断LVH。采用Spearman相关分析探讨血清25(OH) D水平与LVMI的相关性,同时采用二元Logistic回归探讨LVH的危险因素,并计算各危险因素的优势比(OR)及95%的可信区间(CI)。结果223例CKD4～5患者中,LVH组130例(58. 3%),LVMI(153. 39±32. 72) g/m2,血清25(OH) D水平(8. 62±5. 98)μg/L;非LVH组93例(41. 7%),LVMI(102. 65±14. 92) g/m2,血清25(OH) D水平(12. 83±8. 33)μg/L。LVH组的血清25(OH) D水平明显低于非LVH组(t=4. 163,P <0. 001)。Spearman相关分析显示血清25(OH) D水平与LVMI呈负相关性,多因素二元Logistic回归分析显示血清25(OH) D水平(OR=0. 933,95%CI:0. 885～0. 983,P=0. 010)、左心室射血分数(OR=0. 892,95%CI:0. 843～0. 944,P <0. 001)、体质量指数(OR=1. 143,95%CI:1. 033～1. 246,P=0. 010)为LVH的影响因素。血清25(OH) D水平对左心室肥厚的ROC曲线下面积为0. 672 (95%CI:0. 602～0. 743,P <0. 001)。血清25(OH) D水平为9. 1μg/L时诊断左心室肥厚的敏感度和特异度最高(敏感度63. 4%,特异度61. 5%)。结论 CKD4～5期患者中普遍存在血清25(OH) D的缺乏,这类患者中同时普遍存在LVH,两者间存在负相关。血清25(OH) D缺乏与CKD4～5期患者LVH的危险性增加有关。

Objective To investigate the relationship between the level of serum 25-hydroxy vitamin D[25(OH)D]and left ventricular hypertrophy(LVH)in patients with chronic kidney disease4~5(CKD4~5)and analyze the related factors of LVH.Methods The general data,laboratory results and echocardiographic of 223 patients with stage CKD4~5 in hospital were retrospectively collected.According to the recommended standard of American and European echocardiography,the left ventricular mass index(LVMI)was used to estimate LVH.The relationships between the level of serum 25(OH)D and LVMI were analyzed by correlation analysis.The binary logistic regression was used to explore the risk factors of LVH and calculate the odds ratio(OR)and 95%confidence interval(CI)for each risk factors.Results 223 cases of CKD4~5 patients included 130 cases of LVH and 93 cases of non-LVH.In 130 cases of LVH(58.3%),the LVMI were(153.39±32.72)g/m 2,and the level of serum 25(OH)D were(8.62±5.98)μg/L.In 93 cases of non-LVH(41.7%),the LVMI were(102.65±14.92)g/m 2,and the level of serum 25(OH)D were(12.83±8.33)μg/L.The level of serum 25(OH)D in LVH patients were significantly lower than that in non-LVH patients(t=4.163,P<0.001).Spearman correlation analysis showed the level of serum 25(OH)D were negatively correlated with LVMI,and the binary logistic multivariate regression analysis showed left ventricular ejection fraction(OR=0.892,95%CI:0.843~0.944,P<0.001),body index(OR=1.143,95%CI:1.033~1.246,P=0.010)and serum 25(OH)D(OR=0.933,95%CI:0.885~0.983,P=0.010)were influence factors for LVH.The area under the ROC curve of serum 25(OH)D level for LVH was 0.672(95%CI:0.602~0.743,P<0.001).The sensitivity and specificity of serum 25(OH)D levels at 9.1μg/L were the highest in diagnosing left ventricular hypertrophy(sensitivity:63.4%,specificity:61.5%).Conclusion The serum 25(OH)D deficiency and the morbidity of LVH are common in patients with CKD4~5,which has a negative correlation between them.The deficiency of serum 25(OH)D is associated with increased risk of LVH in stage CKD4~5 patients.