慢性肾脏病5期未透析患者血清25羟维生素D3水平及相关因素研究

The study of the serum 25-hydroxyvitamin D3 level and its correlated factors in non-dialysis patients with stage 5 chronic kidney diseases

目的探讨慢性肾脏病(CKD)5期未透析患者的血清25羟维生素D 3[25(OH)D 3]水平及其相关因素。方法选取在肾内科住院诊断为CKD 5期未透析的72例患者,回顾性的收集患者人口统计学数据及临床资料,根据血清25(OH)D 3水平将患者分为25(OH)D 3缺乏组及非缺乏组,比较两组间临床资料的差异。采用spearman相关分析及逐步多元线性回归分析探讨血清25(OH)D 3水平的相关因素。采用单因素logistic回归分析探讨血清25(OH)D 3缺乏的相关因素,并计算各个相关因素的比值比(OR)及其95%的可信区间(CI)。结果72例CKD 5期未透析患者血清25(OH)D 3水平3.0~38.3μg/L[平均(8.8±7.0)μg/L],25(OH)D 3缺乏组61例,非缺乏组11例,25(OH)D 3缺乏率达到84.7%。25(OH)D 3缺乏组与非缺乏组在血清钙、磷、碱性磷酸酶、全段甲状旁腺激素、氨基末端B型钠尿肽前体、左心室舒张末期内径、左心室后壁厚度、室间隔厚度、左室射血分数的差异无统计学意义(P均>0.05)。Spearman线性相关分析提示:血清25(OH)D 3与血清白蛋白(ρ=0.439)呈正相关(P<0.05),与氨基末端B型钠尿肽前体(ρ=-0.383)、左心室舒张末期内径(ρ=-0.256)呈负相关(P均<0.05);与血清钙、磷、碱性磷酸酶、全段甲状旁腺激素无相关性(P均>0.05)。逐步多元线性回归分析显示血清25(OH)D 3与血清白蛋白呈独立正相关(P<0.05)。单因素logistic回归分析显示仅血清白蛋白<36 g/L(OR=6.058,95%CI:1.206~30.428,P=0.029)可能是血清25(OH)D 3缺乏的危险因素。结论CKD 5期未透析患者的血清25(OH)D 3缺乏可能对CKD 5期未透析患者的心血管疾病有重要影响,而对钙磷代谢的影响比较弱。

Objective To investigate the serum 25-hydroxyvitamin D 3[25(OH)D 3]levels and its correlated factors in non-dialysis patients with stage 5 chronic kidney diseases(CKD).Methods A total of 72 non-dialysis patients with stage 5 CKD were selected.The demographic and clinical data of patients were retrospectively collected.According to the 25(OH)D 3 level,patients were divided into 25(OH)D 3 deficiency group and non-deficiency group.The differences in clinical data between the two groups were compared.Spearman correlation analysis and stepwise multivariate linear regression analysis were used to investigate the correlated factors of serum 25(OH)D 3 levels.Univariate logistic regression analysis was used to investigate the correlation factors of serum 25(OH)D 3 deficiency,calculate the Odds Ratio(OR)and 95%confidence interval(CI).Results The serum 25(OH)D 3 levels in 72 non-dialysis patients with stage 5 CKD were 3.0-38.3(8.8±7.0)μg/L.There were 61 cases in the 25(OH)D 3 deficient group,and 11 cases in the non-deficient group.The deficiency rate of serum 25(OH)D 3 reached to 84.7%.There were no statistically significant difference in serum calcium,phosphorus,alkaline phosphatase,parathyroid hormone,N-terminal pro b-type natriuretic peptide(NT-proBNP),left ventricular end-diastolic diameter(LVIDd),left ventricular posterior wall thickness(LVPWTd),interventricular septum thickness(IVSTd),and left ventricular ejection fraction between the two groups(all P>0.05).Spearman linear correlation analysis showed that serum 25(OH)D 3 was positively correlated with albumin(ρ=0.439,P<0.05),negatively correlated with NT-proBNP(ρ=-0.383)and LVIDd(ρ=-0.256)(all P<0.05).The serum 25(OH)D 3 had no correlation with serum calcium,phosphorus,alkaline phosphatase,and parathyroid hormone(all P>0.05).Stepwise multivariate linear regression analysis showed that serum 25(OH)D 3 had independently positive correlation with serum albumin(P<0.05).Univariate logistic regression analysis showed that serum albumin<36 g/L(OR=6.058,95%CI:1.206-30.428,P=0.029)may be risk factor for 25(OH)D 3 deficiency.Conclusion The serum 25(OH)D 3 deficiency is common in non-dialysis patients with stage 5 chronic kidney disease,which may play an important role in cardiovascular disease,while its effect on calcium and phosphorus metabolism may be weaker.