慢性肾脏病患者血清维生素D水平在整体营养状况评价中的应用及其意义

doi:10.13481/j.1671-587x.20190524

摘要/Abstract

摘要： 目的：研究大连地区不同阶段慢性肾脏病（CKD）患者血清维生素D水平及缺乏率，阐明血清维生素D水平在CKD患者营养状况评价中的应用价值。方法：选择284例肾内科病房确诊为CKD并自愿参加调查的患者为研究对象，按不同肾功能状态进行分期，分为早期（CKD1-2期）组（n=115）、中晚期（CKD3~5期）组（n=131）和透析组（n=38），比较各组患者血清中25羟维生素D[25（OH） D]水平和维生素D缺乏率。根据K/DOQI指南，按照血清25（OH） D水平将患者分为维生素D缺乏组（n=196）、维生素D不足组（n=76）和维生素D充足组（n=12），比较各组患者红细胞（RBC）计数、血红蛋白（Hb）、红细胞压积（Hct）、平均红细胞体积（MCV）、平均红细胞血红蛋白量（MCH）、平均红细胞血红蛋白浓度（MCHC）、血白蛋白（Alb）、前白蛋白（PA）、总蛋白（TP）、血肌酐（Cr）、尿素氮（BUN）和尿蛋白（Up）水平。采用Spearman相关分析法进行血清25（OH） D水平相关影响因素分析，分析指标包括RBC、Hb、Hct、MCV、Cr、PA、Alb和Up；采用多元线性回归分析法进行血清25（OH） D水平影响因素分析，纳入分析的指标包括Hb、MCV、PA、Alb、Cr和Up。结果：早期组、中晚期组和透析组患者维生素D缺乏率分别为77.4%、66.4%和52.6%；早期组患者血清25（OH） D水平明显低于中晚期组和透析组（P<0.05）；早期组患者维生素D缺乏率明显高于透析组（P<0.05）。维生素D缺乏组患者RBC计数、Hb水平和Hct明显低于维生素D不足组（P<0.05）；维生素D缺乏组和维生素D不足组患者血Cr水平明显低于维生素D充足组（P<0.05）；维生素D缺乏组患者Alb和TP水平明显低于其他2组（P<0.05）；维生素D缺乏组患者Up水平明显高于维生素D不足组（P<0.05）。Spearman相关分析法，血清25（OH） D水平与患者RBC计数、Hb水平、Hct、MCV、Cr、PA、Alb和TP水平呈正相关关系（r=0.199，P=0.01；r=0.232，P<0.01；r=0.232，P<0.01；r=0.131，P=0.028；r=0.147，P=0.013；r=0.277，P<0.01；r=0.696，P<0.01；r=0.677，P<0.01），与Up水平呈负相关关系（r=-0.603，P<0.01）。以25（OH） D为因变量，以RBC计数、Hb水平、Hct、MCV、PA、Alb、TP、Cr和Up为自变量进行多元线性回归分析，由于Hb与Hct和RBC计数呈正相关关系（r=0.974，P<0.01；r=0.943，P<0.01），Alb与TP呈正相关关系（r=0.874，P<0.01），为避免共线性，最后选择Hb、MCV、PA、Alb、Cr和Up为自变量进行多元线性回归分析，Alb和Up是25（OH） D水平的独立影响因素。结论：大连地区CKD患者维生素D缺乏现象严重，这一现象在早期CKD患者中尤为明显。过低的血清25（OH） D水平与CKD患者贫血、低蛋白血症及尿蛋白丢失有关联。

关键词: 慢性肾脏病, 维生素D, 营养评价, 肾性贫血, 低蛋白血症

Abstract: Objective:To study the vitamin D levels and deficiency rates in the patients with chronic kidney disease (CKD) in different stages, and to clarify the value of serum vitamin D levels in the evaluation on nutritional status of the patients with CKD. Methods:The patients diagnosed as CKD in the Department of Nephrology and volunteered to participate in the survey were selected as the subjects. According to the different renal function stages, the patients were divided into early stage (CKD1-2 stage) group(n=115),middle and late stage(CKD3-5 stage) group(n=131) and dialysis group(n=38); the serum 25(OH) D levels and vitamin D deficiency rates of the patients in various groups were compared. According to K/DOQI guidelines, the patients were divided into vitamin D deficiency group(n=196), vitamin D insufficiency group(n=76), and vitamin D sufficiency group(n=12); the red blood cell (RBC) count, hemoglobin (Hb), hematocrit (Hct), mean red blood cell volume (MCV), mean red blood cell hemoglobin (MCH), mean red blood cell hemoglobin concentration (MCHC), serum albumin (Alb), prealbumin (PA), total protein (TP), creatinine (Cr), blood urea nitrogen (BUN), 25 hydroxy vitamin D[25(OH)D] and urea protein (Up) of the patients in various groups were compared. The serum 25(OH) D-related factors were analyzed by Spearman correlation analysis method; the influencing factors of serum 25 (OH) D level were analyzed by multiple linear regression analysis. Results:The vitamin D deficiency rates of the patients in early stage group, middle and late stage group, and dialysis group were 77.4%, 66.4%, and 52.6%, respectively; the serum 25(OH) D level of the patients in early stage group was significantly lower than those of the patients in middle and late group and dialysis group (P<0.05); the vitamin D deficiency rate of the patients in early stage group was significantly higher than that of the patients in dialysis group (P<0.05).The count of RBC,the level of Hb,and Hct of the patients in vitamin D deficiency group were significantly lower than those of the patients in Vitamin D insufficiency group (P<0.05).The Cr levels of the patients in vitamin D deficiency group and vitamin D insufficiency group were significantly lower than that in vitamin D sufficiency group (P<0.05).The levels of Alb and TP of the patients in vitamin D deficiency group were significantly lower than those in other two groups (P<0.05); the level of Up in vitamin D deficiency group was significantly higher than that in vitamin D deficiency group (P<0.05).The Spearman correlation analysis results showed that the serum 25(OH) D level was positively correlated with the RBC count, Hb level, Hct, MCV, Cr, PA, Alb,and TP levels(r=0.199,P=0.01;r=0.232,P<0.01;r=0.232,P<0.01;r=0.131,P=0.028;r=0.147,P=0.013;r=0.277,P<0.01;r=0.696,P<0.01;r=0.677,P<0.01); and it was negatively correlated with Up (r=-0.603, P<0.01).When 25 (OH) D was selected as the dependent variable,the RBC count, Hb, Hct, MCV, PA, Alb, TP, Cr, and Up as the independent variables, multiple linear regression analysis was performed; as Hb was positively correlated with Hct and the RBC count(r=0.974, P<0.01; r=0.943, P<0.01) and Alb was positively correlated with TP (r=0.874, P<0.01), Hb, MCV, PA, Alb, Cr,and Up were selected as the independent variables in order to avoid collinearity. The multiple linear regression analysis results showed that Alb and Up were the independent factors of 25(OH) D level. Conclusion:Vitamin D deficiency is a serious problem in the patients with CKD in Dalian area, especially in the patients with early stage CKD. The too low serum 25(OH)D levels are associated with anemia, hypoproteinemia, and urinary protein loss in the patients with CKD.

Key words: chronic kidney disease, vitamin D, nutritional assessment, renal anemia, hypoproteinemia

中图分类号:

R151.41

李敬, 李鹤, 赵婷. 慢性肾脏病患者血清维生素D水平在整体营养状况评价中的应用及其意义[J]. 吉林大学学报(医学版), 2019, 45(05): 1113-1118.

LI Jing, LI He, ZHAO Ting. Application of vitamin D level in nutritional status evaluation of patients with chronic kidney disease and its significance[J]. Journal of Jilin University(Medicine Edition), 2019, 45(05): 1113-1118.

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