血清25羟维生素D与维持性血液透析患者炎症指标的关系

The association between serum 25-hydroxyvitamin D and inflammatory markers in maintenance hemodialysis patients

目的 探讨血清25羟维生素D[25(OH)D]水平与维持性血液透析(maintenance hemodialysis,MHD)患者新型炎症指标的关系。方法 选取2022年6月-12月在宁波大学附属第一医院血液净化中心MHD的患者,收集患者的一般资料和实验室检查结果。计算中性粒细胞与淋巴细胞比值(neutrophil to lymphocyte ratio,NLR)、血小板与淋巴细胞比值(platelet to lymphocyte ratio,PLR)、单核细胞与淋巴细胞比值(monocyte to lymphocyte ratio,MLR)、单核细胞与高密度脂蛋白胆固醇比值(monocyte to high-density lipoprotein cholesterol ratio,MHR)及C反应蛋白与白蛋白比值(C-reactive protein to albumin ratio,CAR)。根据血清25(OH)D水平将患者分为25(OH)D正常组、不足组和缺乏组,比较3组间各指标的差异,并分析25(OH)D与NLR、PLR、MLR、MHR和CAR的相关性。结果 共纳入153例患者,25(OH)D正常组46例,不足组57例,缺乏组50例,3组患者的年龄(F=4.061,P=0.019)、糖尿病比例(χ^(2)=6.982,P=0.030)、舒张压(F=3.200,P=0.044)、血清白蛋白(F=8.744,P<0.001)、血肌酐(F=3.844,P=0.024)、总胆固醇(F=3.392,P=0.036)、低密度脂蛋白胆固醇(F=3.296,P=0.040)以及NLR(F=5.633,P=0.004)、MLR(F=7.569,P=0.001)和MHR(F=4.568,P=0.012)差异有统计学意义。血清25(OH)D水平与年龄(r=-0.261,P=0.001)、NLR(r=-0.261,P=0.001)、MLR(r=-0.302,P<0.001)、MHR(r=-0.256,P=0.002)及CAR(r=-0.179,P=0.029)呈负相关,与舒张压(r=0.227,P=0.005)、血清白蛋白(r=0.207,P<0.001)、血肌酐(r=0.288,P<0.001)、血磷(r=0.164,P=0.044)、血钙(r=0.161,P=0.048)、总胆固醇(r=0.241,P=0.004)和低密度脂蛋白胆固醇(r=0.241,P=0.004)呈正相关。多因素线性回归分析结果显示:男性(β=3.445,P=0.033)、糖尿病(β=-4.233,P=0.014)、舒张压(β=0.158,P=0.013)、白蛋白(β=0.584,P=0.013)、NLR(β=-1.351,P=0.001)、MHR(β=-6.894,P=0.032)与血清25(OH)D水平独立相关。结论 血清25(OH)D水平与NLR、MLR、MHR和CAR存在负相关关系,其中NLR和MHR与血清25(OH)D水平独立相关。25(OH)D水平与维持性血液透析患者的炎症状态密切相关。

Objective To investigate the relationship between serum 25-hydroxyvitamin D(25(OH)D)level and novel inflammatory markers in maintenance hemodialysis(MHD)patients.Methods A total of 153 MHD patients were enrolled in this study.Patients were divided into three groups according to the serum 25(OH)D level:25(OH)D deficiency group(serum 25(OH)D<20ng/ml,n=50),25(OH)D insufficiency group(serum 25(OH)D 20~30ng/ml,n=57),and 25(OH)D normal group(serum 25(OH)D>30ng/ml,n=46).The neutrophil to lymphocyte ratio(NLR),platelet to lymphocyte ratio(PLR),monocyte to lymphocyte ratio(MLR),monocyte to high-density lipoprotein cholesterol ratio(MHR)and C-reactive protein to albumin ratio(CAR)were calculated.Spearman correlation analysis and linear regression analysis were used to define differences of the parameters among groups.Results The three groups showed statistical differences of age(F=4.061,P=0.019),diabetes(χ^(2)=6.982,P=0.030),diastolic blood pressure(F=3.200,P=0.044),serum albumin(F=8.744,P<0.001),serum creatinine(F=3.844,P=0.024),total cholesterol(F=3.392,P=0.036),low-density lipoprotein cholesterol(F=3.296,P=0.040),NLR(F=5.633,P=0.004),MLR(F=7.569,P=0.001)and MHR(F=4.568,P=0.012).Serum 25(OH)D level was negatively correlated with age(r=−0.261,P=0.001),NLR(r=−0.261,P=0.001),MLR(r=−0.302,P<0.001),MHR(r=−0.256,P=0.002)and CAR(r=−0.179,P=0.029),and was positively correlated with diastolic blood pressure(r=0.227,P=0.005),albumin(r=0.207,P<0.001),creatinine(r=0.288,P<0.001),calcium(r=0.161,P=0.048),phosphorus(r=0.164,P=0.044),total cholesterol(r=0.241,P=0.004)and low-density lipoprotein cholesterol(r=0.241,P=0.004).Multivariate linear regression revealed that male gender(β=3.445,P=0.033),diabetes(β=-4.233,P=0.014),diastolic blood pressure(β=0.158,P=0.013),albumin(β=0.584,P=0.013),NLR(β=-1.351,P=0.001)and MHR(β=-6.894,P=0.032)were independently associated with serum 25(OH)D level.Conclusions Serum 25(OH)D level is negatively correlated with NLR,MLR,MHR and CAR,in which NLR and MHR are independently correlated with serum 25(OH)D levels.Serum 25(OH)D level is closely related to the inflammatory status in MHD patients.