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目的:观察慢性肾脏病(chronic kidney disease,CKD)患者活性维生素D3水平以及探讨25(OH)D3缺乏的原因。方法:对174例住院CKD患者的临床资料进行前瞻性研究。测定血清25(OH)D3水平、空腹血糖(FBG)、空腹胰岛素(FINS)及C肽(CP),并常规检测Scr、BUN、碱性磷酸酶(ALP)、白蛋白(Alb),血清钙、磷,全段甲状旁腺激素(iPTH)、C反应蛋白(CRP)、24 h尿蛋白等。根据25(OH)D3水平将CKD患者分三组,A组25(OH)D3<25 nmoL/l(n=47)、B组25(OH)D3 25～50 nmol/L(n=115)、C组25(OH)D3>50 nmol/L(n=12),比较各组间差异。分析CKD患者25(OH)D3与各临床指标的关系。结果:非透析患者25(OH)D3水平不足占93.3%,其中25(OH)D3严重缺乏占24.2%。透析患者25(OH)D3不足的占95.8%,严重缺乏占39.1%。C组Alb和Ca2+明显高于A、B组,C组尿蛋白和Scr与A、B组有明显减低(P<0.05)。单因素相关分析显示,25(OH)D3与Alb(r=0.435)、eGFR(r=0.256)正相关(P<0.01),和Scr(r=-0.284)、尿蛋白(r=-0.383)、CP(r=-0.208)负相关(P<0.01),与年龄、BMI、iPTH、ALP、CRP、FINS、胰岛素抵抗指数(IR)呈负相关,与胰岛素敏感指数(ISI)呈正相关,但差异均无统计学意义(均P>0.05)。多元线性回归分析结果显示,25(OH)D3与尿蛋白、Scr和CP呈负相关,与Alb呈正相关。结论:慢性肾脏病中维生素D不足和缺乏普遍存在,大量蛋白尿和高C肽是维生素D不足和缺乏的高危因素。Alb、尿蛋白、高C肽是影响维生素D水平的重要因素之一。
Objective: To observe the level of active vitamin D3 in patients with chronic kidney disease (CKD) and to explore the causes of 25 (OH) D3 deficiency. Methods: The clinical data of 174 hospitalized patients with CKD were prospectively studied. Serum 25 (OH) D3 levels, fasting blood glucose (FBG), fasting insulin (FINS) and C-peptide were measured and Scr, BUN, ALP, Alb, , P, whole parathyroid hormone (iPTH), C-reactive protein (CRP), 24 h urine protein and so on. According to the level of 25 (OH) D3, CKD patients were divided into three groups: 25 (OH) D3 25 ~ 50 nmol / L (n = , 25 (OH) D3 in group C> 50 nmol / L (n = 12), and the differences between groups were compared. To analyze the relationship between 25 (OH) D3 and various clinical indexes in CKD patients. Results: The deficiency of 25 (OH) D3 in non-dialysis patients accounted for 93.3%, of which 25 (OH) D3 was serious lack of 24.2%. Dialysis patients 25 (OH) D3 insufficient 95.8%, a serious lack of 39.1%. Alb and Ca2 + in group C were significantly higher than those in group A and B, while urinary protein and Scr in group C were significantly lower than those in group A and B (P <0.05). Univariate analysis showed that 25 (OH) D3 was positively correlated with Alb (r = 0.435) and eGFR (r = 0.256) (P <0.01) (P <0.01), but negatively correlated with age, BMI, iPTH, ALP, CRP, FINS, insulin resistance index (IR) and insulin sensitivity index (ISI) There was no significant difference (all P> 0.05). Multiple linear regression analysis showed that 25 (OH) D3 was negatively correlated with urinary protein, Scr and CP, and positively correlated with Alb. CONCLUSION: Insufficient and lack of vitamin D in chronic kidney disease is widespread, and high levels of proteinuria and high C-peptide are risk factors for vitamin D deficiency and deficiency. Alb, urinary protein, high C-peptide is one of the important factors affecting the level of vitamin D.