维持性血液透析患者25-羟基维生素D与贫血和炎症因子的相关性

Correlation between 25-hydroxyvitamin D and anemia and inflammatory factors in patients with maintenance hemodialysis

目的 分析维持性血液透析患者25-羟基维生素D[25(OH)D]与贫血和炎症因子的相关性。方法 选择2021年10月—2023年10月在平湖市中医院住院部接受维持性血液透析治疗的145例尿毒症患者与111例健康体检者作为研究对象,分别纳入研究组与对照组。应用全自动血细胞分析仪检测所有研究对象血红蛋白(Hb),应用免疫荧光干式定量仪检测白细胞介素-6(IL-6)、血清淀粉样蛋白A(SAA)、C-反应蛋白(CRP),使用全自动化学发光测定仪检测25(OH)D。根据25(OH)D水平不同将研究组患者分为重度缺乏组[63例;25(OH)D <15μg/L]、轻度缺乏组[62例,15μg/L≤25(OH)D <20μg/L]、非缺乏组[20例;25(OH)D≥20μg/L];比较研究组与对照组,以及不同25(OH)D水平患者的贫血发生率和上述指标水平差异。采用Spearman相关性方法分析维持性血液透析患者25(OH)D水平与贫血发生、Hb、血清炎症因子的相关性。结果 研究组的贫血发生率显著高于对照组(88.97%比5.41%,P <0.05)。研究组的Hb、25(OH)D水平均显著低于对照组,CRP、IL-6、SAA水平均显著高于对照组[Hb(g/L):105.97±22.40比147.39±28.05;25(OH)D(μg/L):15.82±3.27比41.61±9.34;CRP(mg/L):7.31±2.46比1.46±0.39;IL-6(ng/L):23.61±6.78比3.34±1.06;SAA(mg/L):160.50±49.37比4.10±1.25;均P <0.05]。重度缺乏组、轻度缺乏组的贫血发生率均显著高于非缺乏组(95.24%、90.32%比65.00%,均P <0.05),而重度缺乏组与轻度缺乏组比较差异无统计学意义(P> 0.05)。非缺乏组的Hb水平显著高于轻度缺乏组和重度缺乏组(g/L:125.35±12.09比107.55±8.43、98.25±7.61,均P <0.05),重度缺乏组的CRP、IL-6、SAA水平均显著高于轻度缺乏组和非缺乏组[CRP(mg/L):8.30±0.95比6.85±0.74、5.61±0.58;IL-6(ng/L):24.74±1.39比23.43±1.32、20.62±1.47;SAA(mg/L):165.40±3.86比163.19±4.37、136.49±11.20;均P <0.05]。相关性分析表明,CRP、IL-6、SAA与维持性血液透析患者的25(OH)D水平均呈负相关(r值分别为-0.879、-0.854、-0.840,P值分别为0.002、0.003、0.003),贫血、Hb与25(OH)D水平均呈正相关(r值分别为0.813、0.832,P值分别为0.005、0.004)。结论 尿毒症维持性血液透析患者体内25(OH)D相对缺乏,其水平与贫血发生和血清炎症因子水平均存在相关性,25(OH)D缺乏可能参与维持性血液透析患者贫血和炎症反应过程。

Objective To analyze the correlation between 25-hydroxyvitamin D[25(OH)D]and anemia and inflammatory factors in patients with maintenance hemodialysis.Methods The 145 patients with uremia who underwent maintenance hemodialysis treatment in the inpatient department of Pinghu Traditional Chinese Medicine Hospital and 111 healthy individuals from October 2021 to October 2023 were selected as study objects,and were respectively included in research group and control group.The level of hemoglobin(Hb)in all study objects was detected using fully automated blood cell analyzer,the levels of interleukin-6(IL-6),serum amyloid A(SAA)and C-reactive protein(CRP)were detected using immunofluorescence dry quantitative instrument,and the level of 25(OH)D was detected using fully automated chemiluminescence analyzer.According to the level of 25(OH)D,the patients in research group were divided into severe deficiency group[63 cases,25(OH)D<15μg/L],mild deficiency group[62 cases,15μg/L≤25(OH)D<20μg/L]and non deficiency group[20 cases,25(OH)D≥20μg/L].The incidence of anemia and the differences in the levels of aforementioned indicators between research group and control group,as well as patients with different levels of 25(OH)D were compared.The correlations between 25(OH)D level and anemia occurrence,Hb and serum inflammatory factors in patients with maintenance hemodialysis were analyzed using Spearman correlation method.Results The incidence of anemia in research group was significantly higher than that in control group(88.97%vs.5.41%,P<0.05).The levels of Hb and 25(OH)D in research group were significantly lower than those in control group,while the levels of CRP,IL-6 and SAA were significantly higher than those in control group[Hb(g/L):105.97±22.40 vs.147.39±28.05;25(OH)D(μg/L):15.82±3.27 vs.41.61±9.34;CRP(mg/L):7.31±2.46 vs.1.46±0.39;IL-6(ng/L):23.61±6.78 vs.3.34±1.06;SAA(mg/L):160.50±49.37 vs.4.10±1.25;all P<0.05].The incidence of anemia in severe deficiency group and mild deficiency group was significantly higher than that in non deficiency group(95.24%,90.32%vs.65.00%,both P<0.05),while there was no statistically significant difference between severe deficiency group and mild deficiency group(P>0.05).The level of Hb in non deficiency group was significantly higher than those in mild deficiency group and severe deficiency group[g/L:125.35±12.09 vs.107.55±8.43,98.25±7.61,both P<0.05].The levels of CRP,IL-6 and SAA in severe deficiency group were significantly higher than those in mild deficiency group and non deficiency group[CRP(mg/L):8.30±0.95 vs.6.85±0.74,5.61±0.58;IL-6(ng/L):24.74±1.39 vs.23.43±1.32,20.62±1.47;SAA(mg/L):165.40±3.86 vs.163.19±4.37,136.49±11.20;all P<0.05].Correlation analysis showed that CRP,IL-6 and SAA were negatively correlated with 25(OH)D level in patients with maintenance hemodialysis(r values were-0.879,-0.854 and-0.840,P values were 0.002,0.003 and 0.003,respectively),while anemia and Hb were positively correlated with 25(OH)D(r values were 0.813 and 0.832,P values were 0.005 and 0.004,respectively).Conclusions There is a relative deficiency of 25(OH)D in patients with maintenance hemodialysis with uremia,and it is correlated with anemia occurrence and serum inflammatory factors.25(OH)D deficiency may be involved in the process of anemia and inflammatory response in patients with maintenance hemodialysis.