腹膜透析患者维生素D水平与血管钙化相关性研究

doi:10.3969/j.issn.1004-583X.2018.10.012

摘要/Abstract

摘要：

目的了解持续不卧床腹膜透析(continuous ambulatory peritoneal dialysis，CAPD)患者血1,25(OH)2D3水平及血管钙化情况，探讨CAPD患者血管钙化的相关因素及血1,25(OH)2D3水平测定在腹主动脉钙化(abdominal aortic calcification, AAC)中的作用及意义。方法选取河北医科大学第二医院行CAPD 3个月以上患者84例，收集其临床资料，侧位X线平片评估AAC情况，计算腹主动脉钙化积分(abdominal aortic calcification score，AACs)。酶联免疫吸附测定检测血清1,25(OH)2D3浓度。相关分析法分析1,25(OH)2D3与AACs关系，Logistic回归法和多元回归法进行血管钙化相关危险因素分析，受试者工作曲线（ROC）评价1,25(OH)2D3预测AAC的准确性。结果 84例CAPD患者中，AAC患者34例(42.5%)，CAPD患者血清1,25(OH)2D3水平较低，与AAC呈负相关，口服骨化三醇可提高血清1,25(OH)2D3浓度。Logistic回归分析显示高龄、罹患糖尿病、服用骨化三醇、高胆固醇、高磷、高血尿酸、低1,25(OH)2D3为血管钙化发生的危险因素(P<0.05)，多元回归分析结果显示去除混杂因素后，年龄、血磷、1, 25(OH)2D3是AAC进展的独立影响因素(P<0.05)。1,25(OH)2D3 ROC曲线下面积(AUC)为0.652（95%CI=0.442~0.696，P<0.05）, 提示1,25(OH)2D3预测AAC有一定准确性，取1,25(OH)2D3浓度为250.43 pg/ml作为截点时，其预测AAC的敏感性为55.9%，特异性为66%，约登指数为0.219。结论 CAPD患者血清1,25(OH)2D3水平与AAC程度呈负相关，低血清1,25(OH)2D3水平是AAC的独立危险因素之一。口服骨化三醇可改善CAPD患者1,25(OH)2D3水平，但口服骨化三醇可增加血管钙化的风险，监测1,25(OH)2D3水平可预测血管钙化的风险。

关键词: 主动脉, 腹；钙质沉着症；透析；矿物质代谢紊乱 1, 25二羟维生素D3

Abstract:

Objective To investigate the level of blood 1,25(OH)2D3 and vascular calcification in patients with continuous ambulatory peritoneal dialysis (CAPD), and to explore the factors for serum calcium calcification and blood 1,25(OH)2D3 in patients with CAPD. The role of blood 1,25(OH)2D3 in abdominal aortic calcification(AAC) and significance were explored. Methods A total of 84 patients with CAPD for more than 3 months were enrolled, and clinical data were collected. Lateral radiographic calcification was performed and AAC score (AACs) was calculated. Serum 1,25(OH)2D3 concentration was measured by ELISA. Correlation analysis was used to analyze the relationship between 1,25(OH)2D3 and AACs, logistic regression and multiple regression analysis for risk factors of vascular calcification, and receiver operating curve (ROC) evaluation of 1,25(OH)2D3 for the accuracy of AAC.Results Of 84 patients with CAPD, 34 cases(42.5%) had AAC. The serum level of 1,25(OH)2D3 was lower in CAPD patients, which was negatively correlated with AAC. Oral calcitriol increased serum 1,25(OH)2D3 concentration. Logistic regression analysis showed that elderly patients with diabetes, taking calcitriol, high total cholesterol, high P, high blood uric acid, and low 1,25(OH)2D3 were risk factors for vascular calcification (P<0.05). Multiple regression analysis showed that age, serum phosphorus, and 1,25(OH)2D3 were independent factors for AAC progression (P<0.05). 1,25(OH)2D3 ROC curve area (AUC) was 0.652 (95%CI=0.4420.696, P<0.05), suggesting that 1,25(OH)2D3 predicted the accuracy of AAC. When 1,25(OH)2D3 was 250.43 pg/ml as the cutoff point, the sensitivity of AAC was 55.9%, the specificity 66%, and Yoden index 0.219. Conclusion Serum 1,25(OH)2D3 level in CAPD patients is negatively correlated with the degree of AAC. Low serum 1,25(OH)2D3 level was one of the independent risk factors for AAC. Oral calcitriol can improve 1,25(OH)2D3 levels in patients with CAPD, but in can also increases the risk of vascular calcification, and monitoring on the 1,25(OH)2D3 level should be performed to prevent the risk of vascular calcification.

Key words: aortic, , abdominal, calcinosis, dialysis；minerals, 1, 25dihydroxyvitamin D3

杨芳，裴华颖，杨刘阳，卢素玉，吴晓磊，王敏. 腹膜透析患者维生素D水平与血管钙化相关性研究[J]. 临床荟萃, doi: 10.3969/j.issn.1004-583X.2018.10.012.

Yang Fang, Pei Huaying, Yang Liuyang, Lu Suyu, Wu Xiaolei, Wang Min. Correlation between vitamin D level and vascular calcification in peritoneal dialysis patients[J]. Clinical Focus, doi: 10.3969/j.issn.1004-583X.2018.10.012.

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链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2018.10.012

https://huicui.hebmu.edu.cn/CN/Y2018/V33/I10/883

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腹膜透析患者维生素D水平与血管钙化相关性研究

Correlation between vitamin D level and vascular calcification in peritoneal dialysis patients

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