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目的探讨不同慢性肾脏病(CKD)分期患者的25-羟维生素D3(25-OH-D3)浓度,分析其相关临床因素。方法连续入选2009-03-01—2009-07-01于大连市中心医院肾内科住院确诊为CKD的患者,电化学发光法检测25-OH-D3浓度,免疫化学发光法检测全段甲状旁腺素(iPTH),全自动生化仪检测血钙、磷、白蛋白等生化指标。结果共有127例CKD患者入选,男63例,女64例。年龄平均(60.9±15.3)岁。CKD分期:1期9例,2期11例,3期11例,4期18例,5期78例(其中非透析患者16例,维持性血液透析患者62例)。血清25-OH-D3的平均浓度为(12.06±6.41)μg/L,105例患者(82.6%)血清25-OH-D3缺乏(<15μg/L),123例患者(96.9%)血清25-OH-D3不足(<30μg/L)。CKD1期、2期、3期之间25-OH-D3浓度差异无统计学意义(P>0.05);显著高于CKD4期和CKD5期未透析的患者(P<0.05)。25-OH-D3浓度与iPTH、血钙、血磷无显著相关性,与血浆白蛋白、未透析患者的eGFR呈正相关;与未透析患者的血肌酐和总胆固醇浓度呈负相关。结论 CKD患者维生素D不足和缺乏十分普遍,随着肾功能损害的进展进一步加重,并且与传统的CKD矿物质-骨代谢指标无显著相关性。
Objective To investigate the concentration of 25-hydroxyvitamin D3 (25-OH-D3) in patients with chronic kidney disease (CKD) staging and analyze the related clinical factors. Methods The patients with CKD diagnosed as nephropathy in Department of Nephrology, Dalian Central Hospital were enrolled in this study. The concentration of 25-OH-D3 was detected by the chemiluminescence method. The total parathyroid gland (IPTH), automatic biochemical analyzer detection of blood calcium, phosphorus, albumin and other biochemical indicators. Results A total of 127 cases of CKD were enrolled, including 63 males and 64 females. The average age (60.9 ± 15.3) years old. CKD staging included 9 cases of stage 1, 11 cases of stage 2, 11 cases of stage 3, 18 cases of stage 4 and 78 cases of stage 5 (including 16 cases of non-dialysis and 62 cases of maintenance hemodialysis). Serum levels of 25-OH-D3 were significantly lower in 12 patients than in controls (12.06 ± 6.41) μg / L for serum 25-OH-D3 and 25- OH-D3 for 105 patients (82.6% OH-D3 deficiency (<30 μg / L). There was no significant difference in the concentration of 25-OH-D3 between CKD stage 1, stage 2 and stage 3 (P> 0.05), which was significantly higher than that of CKD stage 4 and CKD stage 5 patients without dialysis (P <0.05). There was no significant correlation between the concentration of 25-OH-D3 and iPTH, serum calcium and phosphorus, and positively correlated with eGFR in plasma albumin and non-dialysis patients, but negatively correlated with serum creatinine and total cholesterol in non-dialysis patients. Conclusions The deficiency and deficiency of vitamin D in CKD patients is very common. The progression of renal dysfunction further aggravates and has no significant correlation with the traditional CKD mineral-bone metabolism index.