阿法骨化醇对腹膜透析患者微炎症状态的影响

Alfacalcidol Reduces the Micro-Inflammatory in Peritoneal Dialysis Patients

目的:分析维持性腹透患者血清中25羟基维生素D(25(OH)D)与炎性因子IL-6、CRP、血小板/淋巴细胞比值(PLR)之间的关系;采用阿法骨化醇进行干预实验,观察阿法骨化醇纠正25(OH)D缺乏对腹膜透析患者炎症状态的影响。方法:选取2015年9月至2016年9月我院肾科透析龄在6个月至2年之间的腹膜透析患者,共纳入70例腹膜透析患者。将患者分为两组:25(OH)D正常组(25(OH)D≥30ng/mL),26例;25(OH)D缺乏组(25(OH)D<30ng/mL),44例。抽血采用酶联免疫吸附试验(ELISA)检测白介素-6(IL-6)、超敏C反应蛋白(hs-CRP)、25(OH)D含量,并计算PLR,分析25(OH)D与IL-6、hs-CRP、血小板淋巴细胞比率(PLR)的关系。25(OH)D缺乏组患者排除明显软组织异位钙化、高钙血症(Ca>2.5mmol/L)、高磷血症(P<1.78mmol/L)等情况,共21人纳入干预实验,予阿法骨化醇0.25μg/d,干预治疗1月。治疗前后分别抽血,ELISA检测IL-6、hs-CRP、25(OH)D含量,计算PLR。结果:本中心25(OH)D缺乏的维持性腹透患者为62.9%;25(OH)D缺乏组患者血清IL-6、hs-CRP水平和PLR明显高于25(OH)D正常组[(47.19±7.21)pg/mL vs(33.51±3.26)pg/mL,P<0.05;(9.34±0.82)pg/mL vs(6.51±0.49)pg/mL,P<0.05;(120.32±11.23)vs(95.12±10.21),P<0.05]。腹膜透析患者IL-6、hs-CRP、PLR与25(OH)D水平呈负相关(r分别为-0.70、-0.49、-0.63,P<0.05)。给予阿法骨化醇治疗后,25(OH)D缺乏患者血清25(OH)D较治疗前有所升高[(33.32±2.52)pg/mL vs(17.91±3.75)pg/mL,P<0.05],同时,血清IL-6、hs-CRP和PLR有所下降[(48.23±7.40)pg/mL vs(41.32±5.86)pg/mL,(9.20±0.83)pg/mL vs(6.90±0.71)pg/mL,(117.12±9.76)vs(101.28±8.43);P<0.05]。结论:25(OH)D缺乏可能与腹膜透析患者微炎症状态有关,阿法骨化醇能减轻PD患者微炎症。

Objective:To analyze the relationship between serum 25-hydroxyvitamin D(25(OH)D)and inflammatory factors IL-6,CRP,platelet/lymphocyte ratio(PLR)in patients with maintenance peritoneal dialysis(MPD),and to observe the effect of Alfacalciferol on inflammation in patients with MPD.Methods:Seventy peritoneal dialysis patients aged 6 months to 2 years from September 2015 to September 2016 were enrolled in this study.The patients were divided into two groups:25(OH)D normal group(25(OH)D>30ng/mL),26 cases;25(OH)D deficiency group(25(OH)D<30 ng/mL),44 cases.The levels of IL-6,hs-CRP and 25(OH)D were detected by enzyme-linked immunosorbent assay(ELISA).PLR was calculated.The relationship between 25(OH)D and IL-6,hs-CRP and PLR was analyzed.In 25(OH)D deficiency group,21 patients were excluded from obvious ectopic calcification of soft tissue,hypercalcemia(Ca>2.5mmol/L)and hyperphosphatemia(P<1.78mmol/L).Alpha-calciferol was given 0.25μg/d for 1 month.Blood samples were taken before and after treatment.IL-6,hs-CRP and 25(OH)D were detected by ELISA,and PLR was calculated.Results:The serum levels of IL-6,hs-CRP and PLR in patients with 25(OH)D deficiency were 62.9%.The serum levels of IL-6,hs-CRP and PLR in patients with 25(OH)D deficiency were significantly higher than those in patients with 25(OH)D deficiency[(47.19±7.21)pg/mL vs(33.51±3.26)pg/mL,P<0.05;(9.34±0.82)pg/mL vs(6.51±0.49)pg/mL,P<0.05;(120.32±11.23)vs(95.12±10.21),P<0.05].IL-6,hs-CRP and PLR were negatively correlated with 25(OH)D levels in peritoneal dialysis patients(r was-0.70,-0.49,-0.63,P<0.05,respectively).After treatment with alfacalciferol,serum 25(OH)D in 25(OH)D deficient patients increased[(33.32±2.52)pg/mL vs(17.91±3.75)pg/mL,P<0.05],while serum IL-6,hs-CRP and PLR decreased[(48.23±7.40)pg/mL vs(41.32±5.86)pg/mL,(9.20±0.83)pg/mL vs(6.90±0.71)pg/mL,(117.12±9.76)vs(101.28±8.43);P<0.05].Conclusion:25(OH)D deficiency may be related to micro-inflammation in MPD patients.Alfacalcidol can improve 25-OH-vitamin D deficienc yreduces the inflammatory in MPD patients.