老年慢性肾脏病3~4期患者的血清维生素D水平及相关因素的探讨
Serum vitamin D levels and influencing factors in elderly patients with stage 3 to 4 chronic kidney disease
目的 了解老年慢性肾脏病(CKD)3~4期患者的维生素D水平及其相关因素,并探讨维生素D缺乏和左心室肥厚的关系. 方法 收集2014年1月至2016年9月在我院老年医学部门诊随访,年龄≥60岁,肾小球滤过率(eGFR)≤60 ml-1·min-1·1.73 m-2的CKD患者入组,收集的资料包括性别、年龄、身高、体重、血压、糖化血红蛋白、血红蛋白(Hb)、白蛋白、血脂、血肌酐、血钙、血磷、全段甲状旁腺素(iPTH)、超敏C反应蛋白、B型脑钠肽(BNP)、25羟维生素D(25 (OH)D3)及心脏彩超结果,对107例患者的临床资料进行回顾性分析.根据eGFR将患者分为CKD3a、3b及4期,根据25(OH)D3水平将患者分为维生索D缺乏组及非缺乏组,分别比较各指标在不同分组间的差异;根据左心室质量指数将患者分为左心室肥厚组及非肥厚组,观察各指标的组间差异以及维生素D缺乏和左心室肥厚之间的关系. 结果 CKD3a期、CKD3b期及CKD4期体质指数、体表面积、Hb、血钙水平呈下降趋势,年龄、血磷、BNP水平呈上升趋势,部分组间差异有统计学意义.CKD3期和CKD4期25(OH)D3的中位数分别为22.6(5.9~58.0) μg/L、17.5(10.1~46.3) μg/L,两组间分布差异有统计学意义(Z=-2.121,P=0.033).维生素D缺乏组与不缺乏组比较女性居多(x2=7.460,P=0.006),血磷(Z=-2.090,P=0.037)、iPTH(Z=-2.855,P=0.004)、BNP(Z=-3.134,P=0.002)水平高,Hb(t=-3.305,P=0.001)水平较低,差异有统计学意义;且缺乏组与不缺乏组左心室肥厚率分别为8例(34.8%)和12例(14.3%)(x2 =4.468,P=0.035),差异有统计学意义. 结论 维生素D水平随CKD分期进展下降,维生素D缺乏患者中女性居多,Hb低,钙磷代谢紊乱增多、BNP高,左室肥厚的发生率高,提示维生素D在肾性贫血、钙磷代谢、左心室肥厚中均起到重要作用.
更多Objective To investigate serum vitamin D levels and influencing factors in elderly patients with stage 3 to 4 chronic kidney disease (CKD) and to analyze the relationship between vitamin D deficiency and left ventricular hypertrophy (LVH).Methods This study involved 107 elderly outpatients (≥60 years) with stage 3 to 4 CKD who had visited Beijing Hospital between January 2014 and September 2016.We retrospectively analyzed their clinical and laboratory data including gender,age,height,weight,blood pressure,glycosylated hemoglobin,hemoglobin (Hb),albumin,creatinine,lipid,calcium,phosphorus,intact parathyroid hormone (iPTH),high sensitivity C-reactive protein,B-type natriuretic peptide (BNP),25-OH-D3,and ultrasonic cardiogram.Based on estimated glomerular filtration rate,patients were divided into three groups:the stage 3a CKD group,the stage 3b CKD group,and the stage 4 CKD group.Differences in the parameters between the groups were compared.In addition,25-OH-D3 levels were used to determine whether the patient had vitamin D deficiency and the left ventricular mass index was used to identify left ventricular hypertrophy (LVH),and the relationship between vitamin D deficiency and LVH was examined.Results Body mass index,body surface area and calcium levels declined while age,phosphorus and BNP levels increased with the development of stage 3a,stage 3b and stage 4 CKD.Mean 25 O)H-D3 levels were 22.6 (5.9-58.0) μg/L and 17.5 (10.1 46.3) μg/L for CKD stage 3 and 4 patients,respectively,and the difference between them was statistically significant (Z =-2.121,P 0.033).Compared with patients with no vitamin D deficiency,patients with vitamin D deficiency were more likely to be female (x2 7.460,P=0.006) and were associated with higher P (Z=-2.090,P=0.037),iPTH (Z=-2.855,P=0.004) and BNP (Z=-3.134,P 0.002),and lower Hb (t=-3.305,P=0.001).The rates of LVH in vitamin D deficient patients and non-vitamin D deficient patients were 8 cases(34.8 %) and 12 cases(14.3 %),respectively (P=0.035).Conclusions Vitamin D levels show progressive decline as chronic kidney disease advances into later stages.In addition,vitamin D deficiency is more common among female patients and is often accompanied by lower Hb levels,higher BNP levels and higher incidences of calcium-phosphate metabolism disorders and LVH.The results suggest that vitamin D may play an important role in renal anemia,calcium-phosphate metabolism and LVH.
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