终末期肾脏病持续非卧床腹膜透析患者血清活性维生素D与超敏C反应蛋白、白细胞介素-6和中性粒细胞/淋巴细胞比值的关系

The Study of Correlationship between 1,25-dihydroxyvitamin D and High Sensitivity C-reactive Protein,Interleukin-6 as well as Neutrophil to-lymphocyte Ratio in Patients Undergoing Continuous Ambulatory Peritoneal Dialysis

目的:探讨终末期肾脏病持续非卧床腹膜透析(CAPD)患者血清中活性维生素D(VitD)水平与其血清超敏C反应蛋白(hs-CRP)、白细胞介素-6(IL-6)和中性粒细胞/淋巴细胞比值(NLR)的关系。方法:选取入住本院肾脏病透析中心接受CAPD的终末期肾脏病患者247例。依据血清VitD水平将纳入患者分为VitD正常组(n=56)、VitD不足组(n=80)和VitD缺乏组(n=111)。另纳入医院体检中心健康体检者95例作为对照组。所有患者均统一应用含1.24nmol/L钙和1.5%葡萄糖腹膜透析液进行规范化的CAPD至少3个月及以上的透析。比较CAPD开展前及其执行3个月后患者血液中VitD、hs-CRP、IL-6和NLR水平,并分析CAPD前后VitD与三种炎性因子水平的关系。结果:CAPD前后,各组血清VitD以及hs-CRP、IL-6和NLR水平差异均统计学意义(P均<0.01)。与对照组比较,VitD正常组、VitD不足组和VitD缺乏组患者血清VitD水平明显降低,hs-CRP、IL-6和NLR水平均显著增高(P均<0.05)。VitD正常组、不足组和缺乏组患者血清VitD水平逐步下降,hs-CRP、IL-6和NLR水平均逐步增高,且各组间具有显著差异(P均<0.01)。与CAPD前比较,CAPD后VitD正常组、不足组和缺乏组患者血清VitD水平均降低,hs-CRP、IL-6和NLR水平升高(P均<0.01)。在CAPD前后,患者血清VitD水平均与hs-CRP、IL-6和NLR水平呈显著负相关(P均<0.01)。结论:临床在对终末期肾脏病患者开展CAPD过程中应防治VitD水平下降,从而减少微炎症增加引起的严重并发症,确保CAPD治疗优势。

Objective:To investigate of correlationship between 1,25-dihydroxyvitamin D(VitD)and high sensitivity C-reactive protein(hs-CRP),interleukin-6(IL-6)as well as neutrophil to-lymphocyte ratio(NLR)in patients with end-stage renal disease(ESRD)undergoing continuous ambulatory peritoneal dialysis(CAPD)in vivo.Method:A total of 247 patients with ESRD undergoing CAPD were respectively divided into normal VitD group(n=56 cases),deficient VitD group(n=80 cases)and lesser VitD group(n=111 cases)according to defining to serum levels of VitD.Another 95 healthy examinations come from clinic service were enrolled into control group.All patients were treated with normalizated CAPD using 1.24nmol/L calcium and 1.5%glucose dialysate for more than 3 months,and the daily dialysis dose was above 6L.It was respectively collected blood coming from subjects before CAPD and after 3 months with CAPD.VitD and three inflammatory factors were respectively detected in blood of research subjects come from every group.At last the correlationship were added up and analyzed between level of VitD and hs-CRP,IL-6 as well as NLR before and after undergoing CAPD in every groups.Results:The levels of VitD and hs-CRP,IL-6 as well as NLR were significantly different compared with before and after undergoing CAPD in every group(P of all<0.01,respectively).Compared with control group,the level of VitD was obviously decreased,and the levels of hs-CRP,IL-6 and NLR were all notably increased with significant deviation(P of all<0.01,respectively).Otherwise,the level of VitD was gradually descend tendency gradually,and the levels of hs-CRP,IL-6 and NLR were all heightened direction from normal VitD group,deficient VitD group to lesser VitD group(P of all<0.01,respectively).Moreover,compared with before undergoing CAPD,the VitD level was significantly decreased,and the level of hs-CRP,IL-6 and NLR were all markedly increased patients with ESRD undergoing CAPD after 3 months(P of all<0.01,respectively).At last,there were significant negative correlation between the level of VitD and three inflammatory markers in patients with ESRD not only before undergoing CAPD but also after 3 months with undergoing CAPD(P of all<0.01,respectively).Conclusion:It was demonstrated that it might need to prevented the decreasing of VitD level with the patients of ESRD undergoing CAPD in clinic,which could be contributed to reduction microinflammation to prevent ion serious complication,so that to maintain the treatment effectiveness of CAPD.