上海交通大学学报（医学版）

›› 2010, Vol. 30 ›› Issue (10): 1213-.doi: 10.3969/j.issn.1674-8115.2010.10.007

• 论著（临床研究） • 上一篇    下一篇

CKD 5期维持性血液透析患者血清25(OH)D3水平的横断面调查

钱 莹, 陈晓农, 任 红, 张 文, 朱 萍, 陈 楠   

  1. 上海交通大学 医学院附属瑞金医院肾脏科, 上海 200025
  • 出版日期:2010-10-25 发布日期:2010-10-27
  • 通讯作者: 陈 楠, 电子信箱: Chen-nan@medmail.com.cn。
  • 作者简介:钱 莹（1969—）, 女, 副主任医师, 博士；电子信箱: huangqw_6869yahoo.com.cn。
  • 基金资助:

    上海市重点学科（T0201）；上海市卫生局重点学科（05III001）；上海市科委重点项目（07JC14037）

Cross-sectional survey on serum 25(OH)D3 level in maintained hemodialysis patients with stage 5 chronic kidney disease

QIAN Ying, CHEN Xiao-nong, REN Hong, ZHANG Wen, ZHU Ping, CHEN Nan   

  1. Department of Nephrology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China
  • Online:2010-10-25 Published:2010-10-27
  • Supported by:

    Shanghai Key Disciplines, China, T0201；Key Disciplines of Shanghai Municipal Health Bureau, China, 05III001；Key Project of Shanghai Committee of Science and Technology, China, 07JC14037

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摘要：

目的 调查慢性肾脏病（CKD）维持性血液透析（血透）患者中25羟基维生素D[25（OH）D3]缺乏和不足的发生情况，分析血清25（OH）D3水平与矿物质代谢、营养和透析充分性指标的相关性。方法 以195例CKD 5期血透患者作为调查对象，其中透析龄为3~6个月且未服用钙剂或活性维生素D（VitD）制剂的新近血透患者22例，透析龄≥6个月且服用钙剂和（或）活性VitD制剂长期血透患者173例。采用放射免疫分析法统一检测患者空腹血清25（OH）D3水平（长期血透患者检测前停用钙剂或活性VitD制剂2周）以评估VitD储备情况，比较新近与长期血透患者25（OH）D3不足的发生率。对血清25（OH）D3水平与患者矿物质代谢指标（血钙、血磷及血清碱性磷酸酶和全段甲状旁腺激素水平）、营养指标（血清白蛋白含量）及透析充分性指标（尿素清除指数和血清肌酐）的相关性进行多元逐步回归分析。结果 195例调查对象血清25（OH）D3水平为（56.55±17.62）ng/mL。总体25（OH）D3不足的发生率为4.62%（9/195），新近血透患者（18.18%）显著高于长期血透患者（2.89%）（P<0.05）；未发现25（OH）D3缺乏病例。多元逐步回归分析显示，血清25（OH）D3与血Ca水平呈显著正相关（β=0.203，P=0.010）。结论 本研究中CKD 5期血透患者中25（OH）D3不足的发生率较低，可能与多数调查对象长期且规则服用钙制剂和（或）活性VitD制剂有关。

关键词: 慢性肾脏病, 维持性血液透析, 25羟基维生素D, 矿物质代谢, 营养, 透析充分性

Abstract:

Objective To investigate the condition of lack and inadequacy of 25-hydroxyvitamin D [25(OH)D3] in maintained hemodialysis (HD) patients with chronic kidney disease (CKD) and to analyze relationship between 25(OH)D3 and parameters of mineral metabolism, nutrition, and dialysis adequacy indexes. Methods A total of 195 maintained HD patients with stage 5 CKD were selected. Among them, 22 patients who had recent HD in past 3-6 months did not get calcium and active vitamin D (VitD) supplement, but the other 173 patients with long-time HD, over 6 months, got calcium and/or VitD supplement. The fasting serum 25(OH)D3 levels of patients were measured by radioimmunoassay for evaluating VitD reservation. Patients with long-time HD stopped administration of calcium and/or VitD 2 weeks before experiment. The incidences of 25(OH)D3 inadequacy were recorded and compared. The relationships between 25(OH)D3 and parameters of mineral metabolism (serum calcium, serum phosphorus, serum alkaline phosphatase, and intact parathyroid hormone), nutrition (serum albumin), and dialysis adequacy (urea clearance index and serum creatinine) were analyzed by multivariable Logistic regression analysis. Results The mean level of 25(OH)D3 was (56.55±17.62) ng/mL of all 195 HD patients. The total incidence of 25(OH)D3 inadequacy was only 4.61% (9/195). The incidence of  25(OH)D3 inadequacy in recent HD patients (18.18%) was significantly higher than that of long-time HD patient (2.89%)(P<0.05). There was no patient with lack of 25(OH)D3. Multivariable regression analysis showed that there was positive correlation between 25(OH)D3 and serum calcium level (β=0.203，P=0.010). Conclusion This study indicates that incidence of 25(OH)D3 inadequacy is low in maintained HD patients with stage 5 CKD, which may be caused by long-time and regular calcium and/or VitD supplement.

Key words: chronic kidney disease, maintenance hemodialysis, 25-hydroxyvitamin D3, mineral metabolism, nutrition, dialysis adequacy