维持性血液透析病人血清25-羟维生素D水平与营养状况、血脂水平和炎性因子水平的相关性分析

Study on the relationships between serum levels of 25-hydroxy vitamin D and nutritional status,lipid metabolism and inflammatory factors in maintenance hemodialysis patients

目的观察维持性血液透析病人的血清25-羟维生素D水平,并分析其与病人营养状况、血脂水平及炎性因子水平的相关性。方法回顾性分析2015年3月至2016年8月在山东中医药大学第二附属医院接受维持性血液透析病人的临床资料,根据其25-羟维生素D水平分为A组(重度缺乏组,25-羟维生素D<5 ng/mL)、B组(轻度缺乏组,25-羟维生素D 5～15 ng/mL)和C组(非缺乏组,25-羟维生素D 16～30 ng/mL)。观察三组病人血实验室营养指标、血脂水平和炎性因子水平的差别,分析25-羟维生素D水平与血实验室营养指标、血脂水平及炎性因子水平的相关性。结果 A、B、C三组病人白蛋白(Alb)[(42.35±4.63)g/L比(57.62±4.13)g/L比(68.95±5.57)g/L]、前白蛋白(PA)[(398.78±13.65) mg/L比(425.36±12.23) mg/L比(463.15±15.02) mg/L]、血红蛋白(Hb)[(65.74±6.11)g/L比(78.02±7.82)g/L比(95.86±10.02)g/L]及高密度脂蛋白(HDL)[(1.22±0.34)mmol/L比(1.39±0.46)mmol/L比(1.51±0.52)mmol/L]水平为C组>B组>A组(P<0.05);三组病人低密度脂蛋白(LDL)、三酰甘油(TC)、胆固醇(TG)、C反应蛋白(CRP)及白介素-6(IL-6)水平为A组>B组>C组(P<0.05);维持性血液透析病人25-羟维生素D水平与Alb、PA、Hb、HDL水平呈正相关(P<0.05),与TC、TG、LDL、CRP和IL-6水平呈负相关(P<0.05)。结论维持性血液透析病人血清25-羟维生素D水平与其营养状况、血脂水平和炎性因子水平密切相关,可作为临床监测的重要指标。

Objective To observe the serum levels of 25-hydroxy vitamin D in maintenance hemodialysis patients and to analyze the relationships between serum levels of 25-hydroxy vitamin D and nutritional status,lipid metabolism and inflammatory factors.Methods The clinical data of maintenance hemodialysis patients in our hospital from March 2015 to August 2016 were retrospectively analyzed.According to the levels of serum 25-hydroxy vitamin D,all patients were divided into A group(severe deficiency group,25-hydroxy vitamin D<5 ng/mL),B group(mild deficiency group,25-hydroxy vitamin D 5-15 ng/mL)and C group(non deficient group,25-hydroxy vitamin D 16-30 ng/mL).The difference of nutritional indexes,lipid metabolism and inflammatory factors in the three groups were detected and the relationships between serum levels of 25-hydroxy vitamin D and nutritional status,lipid metabolism and inflammatory factors were analyzed.Results The levels of Alb[(42.35±4.63)g/L vs.(57.62±4.13)g/L vs.(68.95±5.57)g/L],PA[(398.78±13.65)mg/L vs.(425.36±12.23)mg/L vs.(463.15±15.02)mg/L],Hb[(65.74±6.11)g/L vs.(78.02±7.82)g/L vs.(95.86±10.02)g/L]and HDL[(1.22±0.34)mmol/L vs.(1.39±0.46)mmol/L vs.(1.51±0.52)mmol/L]in the three groups from high to low were C group,B group,A group(P<0.05).The levels of TC.TG.LDL.,CRP and IL-6 in the three groups from high to low were A group,B group,C group(P<0.05).The level of 25-hydroxy vitamin D was positively correlated with the levels of Alb,PA,Hb and HDL in maintenance hemodialysis patients(P<0.05)and negatively correlated with the levels of TC,TG,LDL,CRP and IL-6(P<0.05).Conclusion The level of serum 25-hydroxy vitamin D in patients with maintenance hemodialysis is closely related to their nutritional status,serum lipid levels and inflammatory factors.