中华肾脏病杂志
中華腎髒病雜誌
중화신장병잡지
2009年
9期
668-672
,共5页
吕轶伦%林颍%史浩%张文%任红%陈楠
呂軼倫%林潁%史浩%張文%任紅%陳楠
려질륜%림영%사호%장문%임홍%진남
维生素D%肾疾病%慢性%甲状旁腺激素%患病率
維生素D%腎疾病%慢性%甲狀徬腺激素%患病率
유생소D%신질병%만성%갑상방선격소%환병솔
vitamin D%Kidney disease%chronic%Parathyroid hormone%Prevalence
目的 了解慢性肾脏病(CKD)患者维生素D不足与缺乏的患病率,为合理的维生素D治疗提供依据.方法 对358例住院CKD患者的临床资料进行回顾性分析.用酶标法测定血清25(OH)D3水平,并常规检测血红蛋白(Hb)、Scr、BUN、CO2CP、白蛋白(Alb)、血清钙、磷、伞段甲状旁腺激素(iPTH)等.分析25(OH)D3水平与临床指标的关系.结果 358例患者的25(OH)D3平均水平为(18.58±11.7)μg/L,显著低于正常值(P<0.01);CKD1-5期患者25(OH)D3水平分别为(25.84±9.71)、(20.76±6.99)、(20.40±17.02)、(19.49±11.29)和(14.16±7.98)μg/L.维生素D缺乏患病率为39.66%;在CKD1～5期中分别为5.00%、17.50%、37.21%、42.37%和57.14%,患病率随CKD分期逐级增加.维生素D不足患病率为44.97%,在CKD1～5期中分别为72.50%、47.50%、45.35%、33.90%和40.60%.维生素D缺乏及不足患病率为84.63%,在CKD1-5期中分别为77.50%、65.00%、82.56%、76.27%和97.74%,CKD各期间差异无统计学意义.单因素相关分析显示,25(OH)D3与Hb(r=0.163)、Alb(r=0.291)、Scr(r=-0.236)、eGFR(r=0.156)和iPTH(r=-0.178)相关(P<0.01).多元线性回归分析显示,25(OH)D3与Alb呈正相关,而和iPTH、Scr呈负相关.CRP、钙磷乘积等与25(OH)D3无相关.按K/DOQI指南,根据25(OH)D3和iPTH水平,CKD3～5期患者符合维生素D治疗指征的比例分别为87.20%、83.05%和26.31%;而仪根据iPTH水平,符合治疗指征的比例仅为16.28%、35.59%和26.31%.结论 CKD患者维生素D缺乏和不足患病率高.Alb、Scr和iPTH是CKD患者维生素D水平的重要影响因子.应在CKD人群中开展维生素D水平检测,并早期、合理治疗维生素D缺乏和不足.
目的 瞭解慢性腎髒病(CKD)患者維生素D不足與缺乏的患病率,為閤理的維生素D治療提供依據.方法 對358例住院CKD患者的臨床資料進行迴顧性分析.用酶標法測定血清25(OH)D3水平,併常規檢測血紅蛋白(Hb)、Scr、BUN、CO2CP、白蛋白(Alb)、血清鈣、燐、傘段甲狀徬腺激素(iPTH)等.分析25(OH)D3水平與臨床指標的關繫.結果 358例患者的25(OH)D3平均水平為(18.58±11.7)μg/L,顯著低于正常值(P<0.01);CKD1-5期患者25(OH)D3水平分彆為(25.84±9.71)、(20.76±6.99)、(20.40±17.02)、(19.49±11.29)和(14.16±7.98)μg/L.維生素D缺乏患病率為39.66%;在CKD1～5期中分彆為5.00%、17.50%、37.21%、42.37%和57.14%,患病率隨CKD分期逐級增加.維生素D不足患病率為44.97%,在CKD1～5期中分彆為72.50%、47.50%、45.35%、33.90%和40.60%.維生素D缺乏及不足患病率為84.63%,在CKD1-5期中分彆為77.50%、65.00%、82.56%、76.27%和97.74%,CKD各期間差異無統計學意義.單因素相關分析顯示,25(OH)D3與Hb(r=0.163)、Alb(r=0.291)、Scr(r=-0.236)、eGFR(r=0.156)和iPTH(r=-0.178)相關(P<0.01).多元線性迴歸分析顯示,25(OH)D3與Alb呈正相關,而和iPTH、Scr呈負相關.CRP、鈣燐乘積等與25(OH)D3無相關.按K/DOQI指南,根據25(OH)D3和iPTH水平,CKD3～5期患者符閤維生素D治療指徵的比例分彆為87.20%、83.05%和26.31%;而儀根據iPTH水平,符閤治療指徵的比例僅為16.28%、35.59%和26.31%.結論 CKD患者維生素D缺乏和不足患病率高.Alb、Scr和iPTH是CKD患者維生素D水平的重要影響因子.應在CKD人群中開展維生素D水平檢測,併早期、閤理治療維生素D缺乏和不足.
목적 료해만성신장병(CKD)환자유생소D불족여결핍적환병솔,위합리적유생소D치료제공의거.방법 대358례주원CKD환자적림상자료진행회고성분석.용매표법측정혈청25(OH)D3수평,병상규검측혈홍단백(Hb)、Scr、BUN、CO2CP、백단백(Alb)、혈청개、린、산단갑상방선격소(iPTH)등.분석25(OH)D3수평여림상지표적관계.결과 358례환자적25(OH)D3평균수평위(18.58±11.7)μg/L,현저저우정상치(P<0.01);CKD1-5기환자25(OH)D3수평분별위(25.84±9.71)、(20.76±6.99)、(20.40±17.02)、(19.49±11.29)화(14.16±7.98)μg/L.유생소D결핍환병솔위39.66%;재CKD1～5기중분별위5.00%、17.50%、37.21%、42.37%화57.14%,환병솔수CKD분기축급증가.유생소D불족환병솔위44.97%,재CKD1～5기중분별위72.50%、47.50%、45.35%、33.90%화40.60%.유생소D결핍급불족환병솔위84.63%,재CKD1-5기중분별위77.50%、65.00%、82.56%、76.27%화97.74%,CKD각기간차이무통계학의의.단인소상관분석현시,25(OH)D3여Hb(r=0.163)、Alb(r=0.291)、Scr(r=-0.236)、eGFR(r=0.156)화iPTH(r=-0.178)상관(P<0.01).다원선성회귀분석현시,25(OH)D3여Alb정정상관,이화iPTH、Scr정부상관.CRP、개린승적등여25(OH)D3무상관.안K/DOQI지남,근거25(OH)D3화iPTH수평,CKD3～5기환자부합유생소D치료지정적비례분별위87.20%、83.05%화26.31%;이의근거iPTH수평,부합치료지정적비례부위16.28%、35.59%화26.31%.결론 CKD환자유생소D결핍화불족환병솔고.Alb、Scr화iPTH시CKD환자유생소D수평적중요영향인자.응재CKD인군중개전유생소D수평검측,병조기、합리치료유생소D결핍화불족.
Objective To elucidate the prevalence of vitamin D insufficiency and deficiency in chronic kidney diseases (CKD) patients and provide the evidence for treatment of these patients. Methods Clinical data of 358 inpatients with CKD from stage 1 to stage 5 were analyzed retrospectively. Level of 25 (OH)D3 in these inpatients, as well as the levels of intact parathyroid hormone (iPTH), hemoglobin (Hb), serum creatinine (Scr), urea nitrogen (BUN), carbon dioxide combining power (CO2CP), alhumin (Alb), serum calcium (Ca) and blood serum (P) were examined. Correlation between 25 (OH)D3 and parameters was analyzed. Results The mean level of 25 (OH)D3 in these CKD patients was (18.58±11.7) μg/L, which was significantly lower than that of normal reference (P<0.01). The 25(OH )D3 levels of CKD patients from stage 1 to stage 5 were (25.84±9.71) μg/L, (20.76±6.99) μg/L, (20.40±17.02) μg/L, (19.49±11.29) μg/L, and (14.16±7.98) μg/L respectively. The prevalence of vitamin D defieiency was 39.66%, and from CKD stage 1 to stage 5 was 5.00%, 17.50%, 37.21%, 42.37% and 57.14%. The prevalence of vitamin D insufficiency was 44.97%, and from CKD stage 1 to stage 5 was 72,50%, 47.50%, 45.35%, 33.90% and 40.60%. The prevalence of decreased vitamin D level was 84.63%, and from CKD stage 1 to stage 5 was 77.50%, 65.00%, 82.56%, 76.27% and 97.74%. Single factor correlation analysis showed 25 (OH)D3 was correlated with Hb, Alb, Scr, eGRF and iPTH. Regression analysis indicated that 25 (OH)D3 was negatively correlated with iPTH and Scr, and positively correlated with Alb. According to K/DOQI, percentage of CKD patients from stage 3 to stage 5 who were consistent with vitamin D treatment was 87.20%, 83.05% and 26.31% based on 25 (OH)3 and iPTH levels, but such percentage was 16.28%, 35.59% and 26.31% based on iPTH level only. Conclusions The prevalence of vitamin D insufficiency and deficiency in patients with CKD is quite high. Alia, iPTH and Scr are key factors influencing vitamin D level. Vitamin D level should be measured among CKD patients in order to carry out corresponding treatment.
