维生素D对血液透析患者血清生化指标和血管钙化的影响

Effects of vitamin D on serum biochemical indicators and vascular calcification in hemodialysis patients

目的探讨维生素D对血液透析患者血清生化指标和血管钙化的影响。方法选取2019年3月至2020年5月于萍乡市人民医院行血液透析的99例尿毒症患者作为研究对象,根据血清1,25二羟维生素D3[1,25-(OH)2D3]水平分为缺乏组[10μg/L≤1,25-(OH)2D3<20μg/L]、不足组[20μg/L≤1,25-(OH)2D3<30μg/L]与适宜组[30μg/L≤1,25-(OH)2D3<50μg/L],每组33例。比较3组血清炎症因子[白细胞介素-6(IL-6)、白细胞介素-10(IL-10)]、T淋巴细胞亚群(CD3^(+)、CD4^(+)、CD8^(+))水平及腹主动脉钙化(AAC)评分,并分析维生素D与各生化指标与血管钙化的相关性。结果适宜组IL-6、IL-10水平均低于不足组和缺乏组,且不足组低于缺乏组,差异有统计学意义(P<0.05)。适宜组CD3^(+)、CD4^(+)水平均高于不足组和缺乏组,CD8^(+)水平低于不足组和缺乏组,且不足组CD3^(+)、CD4^(+)水平均高于缺乏组,CD8^(+)水平低于缺乏组,差异有统计学意义(P<0.05)。适宜组AAC评分明显高于不足组和缺乏组,且不足组高于缺乏组,差异有统计学意义(P<0.05);Logistic回归分析结果显示,维生素D与血清炎症因子、CD8^(+)呈负相关,而与CD3^(+)、CD4^(+)水平和ACC评分呈正相关(P<0.05)。结论维生素D对血液透析患者有较好的并发症预防效果,能明显降低患者血清炎症因子水平,减少炎症反应,提高患者免疫功能,同时对血管钙化也具有一定的预防作用,值得临床推广应用。

Objective To investigate the effect of vitamin D on serum biochemical indicators and vascular calcification in hemodialysis patients.Methods 99 patients with uremia who underwent hemodialysis in Pingxiang People's Hospital from March 2019 to May 2020 were selected as the study subjects,they were divided into the deficiency group(10μg/L≤1,25-[OH]2D3<20μg/L),the insufficient group(20μg/L≤1,25-[OH]2D3<30μg/L)and the appropriate group(30μg/L≤1,25-[OH]2D3<50μg/L)according to the serum 1,25 dihydroxyvitamin D3(1,25-[OH]2D3)level,with 33 cases in each group.The levels of serum inflammatory factors(interleukin-6[IL-6],interleukin-10[IL-10]),T lymphocyte subsets(CD3^(+),CD4^(+),CD8^(+)),and abdominal aortic calcification(AAC)score were compared among the three groups,and the correlation between vitamin D and various biochemical indicators,and vascular calcificationwere analyzed.Results The levels of IL-6 and IL-10 in the appropriate group were significantly lower than those in the insufficient group and deficient group,and the insufficient group was lower than the deficient group,and the differences were statistically significant(P<0.05).The levels of CD3^(+)and CD4^(+)in the suitable group were higher than those in the insufficient group and deficient groups,the CD8^(+)level was lower than that in the insufficient group and deficient groups,and the levels of CD3^(+)and CD4^(+)in the deficient group were lower than those in the insufficient group,the CD8^(+)level was lower than that in the insufficient group,and the differences were statistically significant(P<0.05).The AAC score in the appropriate group was significantly higher than that in the insufficient group and deficient group,and the the insufficient group was higher than the deficient group,and the differences were statistically significant(P<0.05);Logistic regression analysis results showed that vitamin D was negatively correlated with serum inflammatory factors and CD8^(+),but positively correlated with CD3^(+),CD4^(+)levels,and ACC score(P<0.05).Conclusion Vitamin D has a good preventive effect on complications in hemodialysis patients,can significantly reduce inflammatory factors levels of patients,reduce inflammatory reactions,and improve the immune function of patients,and also has a certain preventive effect on vascular calcification,which is worthy of clinical promotion and application.