1,25(OH)_(2)D和25(OH)D对慢性肾病患者的监测意义

1,25 dihydroxy vitamin D and 25 hydroxyl vitamin D in chronic kidney disease patients and their values for minotring the disease status

目的研究1,25-二羟基维生素D[1,25(OH)_(2)D]和25-羟基维生素D[25(OH)D]在慢性肾病患者血中的变化以及与肾、肝、骨等生化检测指标的关系;探讨两种维生素D检测对慢性肾病患者的临床监测意义以及差异。方法研究对象包括48例临床确诊的慢性肾病患者(研究组)和50例其他疾病患者或健康体检者(对照组),研究组和对照组同时检测1,25(OH)_(2)D、25(OH)D、甲状旁腺素、钙、磷、碱性磷酸酶、肌酐、尿素氮、尿酸、白蛋白、总蛋白、AST、ALT和总胆红素;对各检测指标的结果进行研究组与对照组的均值t检验、多因素逻辑回归以及相关性聚类分析。结果研究组1,25(OH)_(2)D比对照组严重偏低[(8.55±6.75)vs(46.42±23.05)pmol/L,P<0.001],而25(OH)D只是轻度偏低[(13.55±5.85)vs(17.61±6.30)ng/mL,P=0.002];1,25(OH)_(2)D与25(OH)D量值的相关性很低(R=0.16,P>0.05);研究组60岁以上老年人血清1,25(OH)_(2)D和25(OH)D水平均显著性低于59岁以下年龄组,与对照组对比,60岁以上老年人组及59岁以下组的血清1,25(OH)_(2)D和25(OH)D水平显著性降低。用多因素逻辑回归校正性别、年龄后,1,25(OH)_(2)D对区分研究组和对照组仍有显著性(OR=0.007,P<0.001),而25(OH)D已无显著性(OR=0.027,P=0.068)。iPTH、磷、ALP、肌酐和尿素氮在研究组均显著偏高(P<0.01),而1,25(OH)_(2)D、钙、总胆红素、白蛋白和总蛋白在研究组均显著偏低(P<0.01);相关性的层序聚类分析显示与肾功能(eGFR)的紧密关系(P<0.05)依次为肌酐、尿素氮、血清蛋白、钙、1,25(OH)_(2)D、磷、iPTH、总胆红素、ALP,而25(OH)D与各项生化指标的关系均较远。结论60岁以上老年人,无论是正常人或患慢性肾病,血清1,25(OH)_(2)D和25(OH)D水平均显著性降低,患慢性肾病的老年人群更易缺乏维生素D。1,25(OH)_(2)D检测技术难度较大、操作比较复杂,目前仅有手工试剂,而25(OH)D在临床上的应用很广;但是,1,25(OH)_(2)D在慢性肾病患者中的变化更显著,且与相关的肾、骨、肝的生化指标的关系更为密切,可能对慢性肾病疾病状态的监测意义更大。

Objective To study the shifts of 1,25 dihydroxyvitamin D and 25 hydroxyl vitamin D in the blood of patients with chronic kidney disease and their relationships with other biochemical parameters of kidney,liver and bone;exploring the two kinds of vitamin D assay on the monitoring value in chronic kidney disease patiens.Methods The subjects included 48 patients with clinically confirmed CKD(study group)and 50 patients with other diseases or healthy persons(control group),1,25(OH)_(2)D,25(OH)D,parathyroid hormone,calcium,phosphorus,alkaline phosphatase,creatinine,urea nitrogen,uric acid,albumin,total protein,AST,ALT and total bilirubin were detected for both groups;and t-test,multi-factor logistic regression and correlation cluster analysis were performed for the results of various biochemical parameters.Results 1,25(OH)_(2)D was significantly lower in the study group than the control group[(8.55±6.75)vs(46.42±23.05 pmol/L,P<0.001],meanwhile 25(OH)D was only slightly low[(13.55±5.85)vs(17.61±6.30)ng/mL,P=0.002].The correlation between 1,25(OH)_(2)D and 25(OH)D was very low(R=0.16,P>0.05);The serum levels of 1,25(OH)_(2)D and 25(OH)D in the study group were significantly lower than those in the age group below 59 years old,and the serum levels of 1,25(OH)_(2)D and 25(OH)D in the age group above 60 years old and under 59 years old were significantly lower than those in the control group.After adjusting for sex and age by multivariate logistic regression,1,25(OH)_(2)D was significant in distinguishing the study group from the control group(OR=0.007,P<0.001),while 25(OH)D was not significant(OR=0.027,P=0.068).iPTH,phosphorus,ALP,creatinine and urea nitrogen were significantly higher in the study group(P<0.01),while 1,25(OH)_(2)D,calcium,total bilirubin,albumin and total protein were significantly lower in the study group(P<0.01);hierarchical cluster analysis shows the close level with renal function(eGFR)were in order creatinine,urea nitrogen,serum protein,calcium,1,25(OH)_(2)D,phosphorus,iPTH,total bilirubin,ALP;and 25(OH)D was far away from any biochemical parameters.Conclusion Serum levels of 1,25(OH)_(2)D and 25(OH)D are significantly decreased in the elderly over 60 years old,whether normal or with CKD.The elderly with CKD are more prone to vitamin D deficiency.1,25(OH)_(2)D assay is difficult and complicated,currently only manual technology is available,while 25(OH)D is widely used in clinical practice.However,1,25(OH)_(2)D was more significant in patients and more closely related to the biochemistry of kidney,bone and liver,therefore it may have greater value in monitoring the disease status of CKD.