维持性腹膜透析患者血清25羟维生素D浓度及影响因素分析

目的 观察维持性腹膜透析患者体内25羟维生素D[25(OH)D]的浓度及其影响因素分析.方法 选取2015年7月至2015年10月在无锡市人民医院腹膜透析中心行持续不卧床腹膜透析(CAPD)或白天不卧床腹膜透析(DAPD)治疗>6个月的终末期肾衰患者为对象进行横断面调查及回顾性分析.选择同期于本院体检中心行体检健康者100例为健康对照组.采用酶联免疫吸附试验(ELISA)方法检测上述研究对象的25(OH)D的水平,根据K/DOQI指南标准分为维生素D正常组、不足组、缺乏组.分析各组患者及健康对照组之间人口学、临床及实验室资料之间的差异.并分析影响25(OH)D浓度的因素.结果 110例腹膜透析患者的25(OH)D水平(23.27±10.22)ng/mL低于健康对照组25(OH)D水平(34.82±9.58)ng/mL,差异具有统计学意义(P<0.0001).腹膜透析患者中25(OH)D水平正常组22例(20%),不足组67例(60.9%),缺乏组21例(19.1%),提示大部分腹膜透析患者存在25(OH)D水平不足、缺乏.入选腹膜透析患者,女性25(OH)D 水平缺乏比例(31.91%)明显高于男性(9.52%).腹膜透析患者中25(OH)D缺乏组的血红蛋白、白蛋白显著低于正常组,而总胆固醇、低密度脂蛋白胆固醇显著高于正常组(P<0.05).缺乏组的血红蛋白、低密度脂蛋白胆固醇低于不足组,差异具有统计学意义(P<0.05).25(OH)D水平与白蛋白呈正相关(r=0.2883,P<0.0001),与血磷(r=-0.5156,P<0.0001)、甘油三酯(r=-0.2254,P=0.0179)、低密度脂蛋白胆固醇(r=-0.3004,P=0.0014)成负相关.结论 腹膜透析患者普遍存在维生素D缺乏或不足.25(OH)D水平与白蛋白呈正相关,与血磷、甘油三酯、低密度脂蛋白胆固醇成负相关.建议对于严重缺乏维生素D的腹膜透析患者予合理补充维生素D.

Serum 25-hydroxy vitamin D level and its influencing factors in maintenance peritoneal dialysis patients

Objectives To observe the levels of 25-hydroxy vitamin D [25(OH)D] in peritoneal dialysis patients and to investigate its influencing factors.Methods This cross-sectional study was carried out in peritoneal dialysis patients who were regularly followed up in our hospital from July 2015 to October 2015.One hundred cases in our hospital physical examination center line of physical health in the same period were selected as healthy controls.The levels of 25(OH)D were tested by enzyme-linked immunosorbent assay (ELISA).According to the K/DOQI guidelines standards, all patients were divided into vitamin D normal group, insufficient group and deficiency group.The differences of demography clinical and laboratory data between groups of patients and healthy controls, and the influencing factors of 25 hydroxy vitamin D were analyzed.Results One hundred and ten patients were enrolled in this study, 25 (OH) D level (23.27±10.22) ng/mL was significantly lower than the 100 healthy controls (34.82±9.58)ng/mL, (P<0.0001).Of these patients, 22 cases(20%) were considered 25(OH)D normal ,67 cases(60.9%) were insufficient and 21 cases (19.1%) were deficiency.Most of the peritoneal dialysis patients lacked of 25 (OH) D.The percentage of 25 (OH) D levels in female peritoneal dialysis patients was 31.91%, significantly higher than male (9.52%).Hb and Alb in 25 (OH) D deficiency group were significantly lower than normal group.TC and LDLC in 25 (OH) D deficiency group were significantly higher than normal group (P<0.05).Compared with insufficient group, Hb and LDLC in 25 (OH) D deficiency group were significantly lower (P< 0.05).25 (OH) D level was positively correlated with Alb (r=0.2883, P<0.0001), and negatively correlated with P (r=0.5156,P<0.0001),TG(r=0.2254, P=0.2254),LDLC(r=0.3004, P=0.3004).Conclusions Peritoneal dialysis patients generally have vitamin D deficiency.25 (OH) D levels are positively correlated with Alb, and negatively correlated with P, TG and LDLC.Which suggests an appropriate supplemental vitamin D for peritoneal dialysis patients with a serious lack of vitamin D.