腹膜透析患者血管钙化和感染与维生素D受体基因多态性的关联性

Association of vascular calcification and infection complications with vitamin D receptor gene polymorphisms in patients with peritoneal dialysis

目的探讨维生素D受体(VDR)基因多态性对腹膜透析患者血管钙化及感染并发症的影响。方法收集2016年1月-2019年12月于萍乡市人民医院就诊的98例腹膜透析患者作为病例组,均测定25-羟维生素D3[25(OH)2D3]、全段甲状旁腺激素(iPTH)、血白蛋白(Alb)、血肌酐(Scr)、血钙(Ca)、血磷(P)水平,进行血管钙化评估;采用聚合酶链反应(PCR)-限制性内切酶片段长度多态性技术(RELP)检测VDR基因ApaⅠ位点单核苷酸多态性(SNPs),按基因分型分为aa型、Aa型及AA型组,并选择同期于医院体检的健康人100名为对照组,分析两组基因型分布,比较VDR不同基因型患者血管钙化积分、血生化指标、腹膜炎发生率,分析VDR基因多态性与血管钙化及腹膜炎发生的关系。结果病例组携带AA型(14.29%)及A等位基因频率(37.24%)高于对照组(P<0.05);携带AA型患者糖尿病肾病所占比例(35.71%)高于携带其他基因型患者(P<0.05),携带AA型患者Scr为(476.52±110.65)μmol/L,较携带aa型与Aa型患者高(P<0.05),Ca及25(OH)2D3分别为(1.96±0.37)mmol/L、(10.15±2.67)pmol/L,较携带aa型与Aa型基因型患者低(P<0.05);携带AA型患者总Ccr及残肾Ccr分别为(67.51±5.68)及(7.69±1.65)均低于aa型与Aa型患者(P<0.05);腹膜透析携带AA基因型患者血管钙化积分为(5.14±1.59)分,较aa基因型、Aa基因型高(P<0.05),血管钙化、腹膜炎发生率分别为71.43%(10/14)、64.29%(9/14),较携带aa基因型、Aa基因型患者高(P<0.05);携带AA基因型可使腹膜透析患者血管钙化风险增加0.86倍,可使腹膜炎发生风险增加0.56倍(P<0.05)。结论 VDR ApaI位点基因多态性与腹膜透析血管钙化、腹膜炎发生密切相关,携带AA型患者血管钙化、腹膜炎发生风险较高。

OBJECTIVE To investigate the effects of vitamin D receptor(VDR)gene polymorphisms on vascular calcification and infection complications in peritoneal dialysis patients.METHODS A total of 98 peritoneal dialysis patients treated at Pingxiang People′s Hospital from Jan.2016 to Dec.2019 were selected as the case group.The levels of 25-hydroxyvitamin D3[25(OH)2 D3],intact parathyroid hormone(iPTH),blood albumin(Alb),serum creatinine(Scr),blood calcium(Ca)and blood phosphorus(P)were measured,and vascular calcification was assessed.Polymerase chain reaction(PCR)-restriction enzyme fragment length polymorphism(RELP)technique was used to detect single nucleotide polymorphisms(SNPs)at the ApaⅠlocus of the VDR gene.According to the genotype,it was divided into aa type,Aa type and AA type.And 100 healthy people who received physical examination in the hospital during the same period were selected as the control group.The distribution of genotype of the two groups were analyzed,the vascular calcification scores,blood biochemical indicators and the incidence of peritonitis in patients with different VDR genotypes were compared,and the relationship between VDR gene polymorphisms,vascular calcification and peritonitis was analyzed.RESULTS The frequency of AA(14.29%)and A allele(37.24%)in the case group were significanttly higher than those in the control group(P<0.05).The proportion of diabetic nephropathy in patients with AA genotype(35.71%)was significanttly higher than that in patients with other genotypes(P<0.05).The Scr of patients with AA genotype was(476.52±110.65)μmol/L,significanttly higher than that of patients with aa and Aa genotypes(P<0.05).Ca and 25(OH)2 D3 were(1.96±0.37)mmol/L and(10.15±2.67)pmol/L,respectively,significanttly lower than those in patients with aa and Aa genotypes(P<0.05).The total Ccr and residual kidney Ccr of patients with AA genotype were(67.51±5.68)and(7.69±1.65),respectively,significanttly lower than those of patients with aa and Aa genotypes(P<0.05).The vascular calcification score of patients with AA genotype was(5.14±1.59)points,significanttly higher than those of patients with aa and Aa genotypes(P<0.05).The incidences of vascular calcification and peritonitis were 71.43%(10/14)and 64.29%(9/14),respectively,significanttly higher than those in patients with aa and Aa genotypes(P<0.05).Carrying AA genotype could increase the risk of vascular calcification in patients with peritoneal dialysis by 0.86 times and the risk of peritonitis by 0.56 times(P<0.05).CONCLUSION VDR ApaI gene polymorphism was closely related to vascular calcification and peritonitis in patients undergoing peritoneal dialysis.Patients with AA genotype have higher risks of vascular calcification and peritonitis.