维持性血液透析病人血清25-羟维生素D水平与营养状况、血脂水平和炎性因子水平的相关性分析
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摘要
目的观察维持性血液透析病人的血清25-羟维生素D水平,并分析其与病人营养状况、血脂水平及炎性因子水平的相关性。方法回顾性分析2015年3月至2016年8月在山东中医药大学第二附属医院接受维持性血液透析病人的临床资料,根据其25-羟维生素D水平分为A组(重度缺乏组,25-羟维生素D<5 ng/mL)、B组(轻度缺乏组,25-羟维生素D 5～15 ng/mL)和C组(非缺乏组,25-羟维生素D 16～30 ng/mL)。观察三组病人血实验室营养指标、血脂水平和炎性因子水平的差别,分析25-羟维生素D水平与血实验室营养指标、血脂水平及炎性因子水平的相关性。结果 A、B、C三组病人白蛋白(Alb)[(42.35±4.63)g/L比(57.62±4.13)g/L比(68.95±5.57)g/L]、前白蛋白(PA)[(398.78±13.65) mg/L比(425.36±12.23) mg/L比(463.15±15.02) mg/L]、血红蛋白(Hb)[(65.74±6.11)g/L比(78.02±7.82)g/L比(95.86±10.02)g/L]及高密度脂蛋白(HDL)[(1.22±0.34)mmol/L比(1.39±0.46)mmol/L比(1.51±0.52)mmol/L]水平为C组>B组>A组(P<0.05);三组病人低密度脂蛋白(LDL)、三酰甘油(TC)、胆固醇(TG)、C反应蛋白(CRP)及白介素-6(IL-6)水平为A组>B组>C组(P<0.05);维持性血液透析病人25-羟维生素D水平与Alb、PA、Hb、HDL水平呈正相关(P<0.05),与TC、TG、LDL、CRP和IL-6水平呈负相关(P<0.05)。结论维持性血液透析病人血清25-羟维生素D水平与其营养状况、血脂水平和炎性因子水平密切相关,可作为临床监测的重要指标。
Objective To observe the serum levels of 25-hydroxy vitamin D in maintenance hemodialysis patients and to analyze the relationships between serum levels of 25-hydroxy vitamin D and nutritional status,lipid metabolism and inflammatory factors.Methods The clinical data of maintenance hemodialysis patients in our hospital from March 2015 to August 2016 were retrospectively analyzed.According to the levels of serum 25-hydroxy vitamin D,all patients were divided into A group(severe deficiency group,25-hydroxy vitamin D<5 ng/mL),B group(mild deficiency group,25-hydroxy vitamin D 5-15 ng/mL) and C group(non deficient group,25-hydroxy vitamin D 16-30 ng/mL).The difference of nutritional indexes,lipid metabolism and inflammatory factors in the three groups were detected and the relationships between serum levels of 25-hydroxy vitamin D and nutritional status,lipid metabolism and inflammatory factors were analyzed.Results The levels of Alb[(42.35±4.63)g/L vs.(57.62±4.13)g/L vs.(68.95±5.57)g/L],PA[(398.78±13.65) mg/L vs.(425.36±12.23) mg/L vs.(463.15±15.02) mg/L],Hb[(65.74±6.11)g/L vs.(78.02±7.82)g/L vs.(95.86±10.02)g/L] and HDL[(1.22±0.34)mmol/L vs.(1.39±0.46)mmol/L vs.(1.51±0.52)mmol/L] in the three groups from high to low were C group,B group,A group(P<0.05).The levels of TC.TG.LDL.,CRP and IL-6 in the three groups from high to low were A group,B group,C group(P<0.05).The level of 25-hydroxy vitamin D was positively correlated with the levels of Alb,PA,Hb and HDL in maintenance hemodialysis patients(P<0.05) and negatively correlated with the levels of TC,TG,LDL,CRP and IL-6(P<0.05).Conclusion The level of serum 25-hydroxy vitamin D in patients with maintenance hemodialysis is closely related to their nutritional status,serum lipid levels and inflammatory factors.
Objective To observe the serum levels of 25-hydroxy vitamin D in maintenance hemodialysis patients and to analyze the relationships between serum levels of 25-hydroxy vitamin D and nutritional status,lipid metabolism and inflammatory factors.Methods The clinical data of maintenance hemodialysis patients in our hospital from March 2015 to August 2016 were retrospectively analyzed.According to the levels of serum 25-hydroxy vitamin D,all patients were divided into A group(severe deficiency group,25-hydroxy vitamin D<5 ng/mL),B group(mild deficiency group,25-hydroxy vitamin D 5-15 ng/mL) and C group(non deficient group,25-hydroxy vitamin D 16-30 ng/mL).The difference of nutritional indexes,lipid metabolism and inflammatory factors in the three groups were detected and the relationships between serum levels of 25-hydroxy vitamin D and nutritional status,lipid metabolism and inflammatory factors were analyzed.Results The levels of Alb[(42.35±4.63)g/L vs.(57.62±4.13)g/L vs.(68.95±5.57)g/L],PA[(398.78±13.65) mg/L vs.(425.36±12.23) mg/L vs.(463.15±15.02) mg/L],Hb[(65.74±6.11)g/L vs.(78.02±7.82)g/L vs.(95.86±10.02)g/L] and HDL[(1.22±0.34)mmol/L vs.(1.39±0.46)mmol/L vs.(1.51±0.52)mmol/L] in the three groups from high to low were C group,B group,A group(P<0.05).The levels of TC.TG.LDL.,CRP and IL-6 in the three groups from high to low were A group,B group,C group(P<0.05).The level of 25-hydroxy vitamin D was positively correlated with the levels of Alb,PA,Hb and HDL in maintenance hemodialysis patients(P<0.05) and negatively correlated with the levels of TC,TG,LDL,CRP and IL-6(P<0.05).Conclusion The level of serum 25-hydroxy vitamin D in patients with maintenance hemodialysis is closely related to their nutritional status,serum lipid levels and inflammatory factors.
引文
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[10] 韦秀芳,阮素莲,谢兴文.慢性肾功能衰竭行维持血液透析患者死亡原因及其影响因素分析[J].实用临床医药杂志,2016,20(3):160-161.
[11] 彭彦平,周平,马遥,等.长期血液透析和腹膜透析糖尿病患者的糖代谢状况[J].实用临床医药杂志,2016,20(13):192-193.
[12] 蒋文勇,吴欣,杨静.维持性血液透析患者白介素-6与动脉粥样硬化和心脏结构及功能关系的临床研究(附58例报告)[J].贵州医药,2014,38(6):514-515.
[13] JUONALA M,VOIPIO A,PAHKALA K,et al.Childhood 25-OH vitamin D levels and carotid intima-media thickness in adulthood:the cardiovascular risk in young Finns study[J].Atherosclerosis,2015,235(2):1469-1476.
[14] PLETZ MW,TERKAMP C,SCHUMACHER U,et al.Vitamin D deficiency in community-acquired pneumonia:low levels of 1,25(OH)2 D are associated with disease severity[J].Respiratory Research,2014,15(1):53.
[15] 沈波,张立元,邹建洲,等.血液透析患者血清25-羟维生素D[25(OH)D]水平及相关因素研究[J].复旦学报医学版,2012,39(2):135-140.
[16] 乔国洪,张玲,吴黎明,等.宜兴地区50岁以上2型糖尿病患者血清25羟维生素D与糖脂代谢关系的研究[J].实用老年医学,2016,31(5):403-405.
[17] 黄兰,周瑾,王小丽,等.维持性血液透析患者血25(OH)D水平与慢性炎症状态及营养不良的关系[J].实用医学杂志,2016,32(20):3318-3320.
[2] 杨春琴,翁明祥,黄敏.高通量透析对维持性血液透析患者慢性并发症的影响[J].浙江医学,2015,37(19):1585-1587.
[3] 穆晓冬,马立萍,辛颖.锌-α2-糖蛋白水平变化与维持性血液透析患者营养不良的关系[J].临床内科杂志,2016,33(1):50-52.
[4] 高慧,陈听雨,张露青.1,25二羟维生素D3缺乏与衰老的研究进展[J].医学综述,2015,32(21):3841-3844.
[5] 闫慧明,安燕,张雪.维生素D与结缔组织病关系的研究进展[J].中国全科医学,2014,17(14):1588-1590.
[6] 张欢,吴灏,张优,等.维持性血液透析患者血清25羟基维生素D水平与贫血的相关性研究[J].中国血液净化,2015,14(3):145-147.
[7] 王菊,王海燕,张桂霞,等.慢性肾脏病患者血清25-羟维生素D 水平及其影响因素分析[J].安徽医科大学学报,2016,51(1):106-108.
[8] PALMER SC,STRIPPOLI GF,CRAIG JC.KHA-CARI commentary on the KDIGO clinical practice guideline for lipid management in chronic kidney disease[J].Nephrology,2014,19(11):663-666.
[9] GAROFALO C,IAZZETTA N,CAMOCARDI A,et al.Anti-diabetics and chronic kidney disease[J].Kidney International,2015,32(5):1112-1114.
[10] 韦秀芳,阮素莲,谢兴文.慢性肾功能衰竭行维持血液透析患者死亡原因及其影响因素分析[J].实用临床医药杂志,2016,20(3):160-161.
[11] 彭彦平,周平,马遥,等.长期血液透析和腹膜透析糖尿病患者的糖代谢状况[J].实用临床医药杂志,2016,20(13):192-193.
[12] 蒋文勇,吴欣,杨静.维持性血液透析患者白介素-6与动脉粥样硬化和心脏结构及功能关系的临床研究(附58例报告)[J].贵州医药,2014,38(6):514-515.
[13] JUONALA M,VOIPIO A,PAHKALA K,et al.Childhood 25-OH vitamin D levels and carotid intima-media thickness in adulthood:the cardiovascular risk in young Finns study[J].Atherosclerosis,2015,235(2):1469-1476.
[14] PLETZ MW,TERKAMP C,SCHUMACHER U,et al.Vitamin D deficiency in community-acquired pneumonia:low levels of 1,25(OH)2 D are associated with disease severity[J].Respiratory Research,2014,15(1):53.
[15] 沈波,张立元,邹建洲,等.血液透析患者血清25-羟维生素D[25(OH)D]水平及相关因素研究[J].复旦学报医学版,2012,39(2):135-140.
[16] 乔国洪,张玲,吴黎明,等.宜兴地区50岁以上2型糖尿病患者血清25羟维生素D与糖脂代谢关系的研究[J].实用老年医学,2016,31(5):403-405.
[17] 黄兰,周瑾,王小丽,等.维持性血液透析患者血25(OH)D水平与慢性炎症状态及营养不良的关系[J].实用医学杂志,2016,32(20):3318-3320.