中国血液净化

中国血液净化 ›› 2016, Vol. 15 ›› Issue (11): 620-623.doi: 10.3969/j.issn.1671-4091.2016.11.010

• 综述与讲座 • 上一篇    下一篇

慢性肾脏病患者维生素D缺乏与贫血的关系

刘烨歆1,刘虹1   

  1. 中南大学湘雅二医院肾内科
  • 收稿日期:2016-07-08 修回日期:2016-08-03 出版日期:2016-11-12 发布日期:2016-11-12
  • 通讯作者: 刘虹liuh0618@163.com E-mail:liuh0618@163.com
  • 基金资助:

    “十二五”国家科技支撑计划项目（No.2011BAI10B08）

The interplay of vitamin D deficiency and anemia in CKD

  • Received:2016-07-08 Revised:2016-08-03 Online:2016-11-12 Published:2016-11-12

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摘要： 慢性肾脏病(chronic kidney disease，CKD)患者在病程中逐渐出现活性维生素D 缺乏，红细胞生成素分泌减少，导致继发性甲状旁腺功能亢进以及肾性贫血。贫血及继发性甲状旁腺功能亢进的管理与CKD 患者的预后息息相关。不论是对社区人群、CKD 患者还是透析患者，目前临床研究均观察到维生素D 在红细胞生成方面的积极作用，从而改善贫血。维生素D 与贫血的联系部分依赖全段甲状旁腺素(intact parathyroid hormone，iPTH)。除此之外，非甲状旁腺素依赖的炎性反应、铁调素等也起到重要作用，其均有维生素D 受体(vitamin D receptor,VDR)激活这一共同途径。本文旨在探讨维生素D 与贫血的相互作用以及维生素D 缺乏与贫血相关性的可能机制，并从改善贫血的角度为CKD 患者，包括透析患者补充维生素D提供一些参考。

关键词: 慢性肾脏病, 维生素D, 肾性贫血, 甲状旁腺素, 炎性反应, 铁调素, 维生素D受体。

Abstract: Patients of chronic kidney disease usually suffer from anemia and hyperparathyroidism secondary to deficiency of EPO and vitamin D as CKD progresses. The outcome of CKD is significantly influenced by the management of anemia and secondary hyperparathyroidism. Recently the association of vitamin D and anemia has been found in many researches no matter the population, the CKD patients and the patients on dialysis, but the mechanism is undefined. The relevance of vitamin D deficiency and anemia is partially dependent on parathyroid hormone (PTH). Besides, hepcidin and inflammation independent of PTH also play a significant role. The above possible aspects contribute to anemia via a common VDR pathway. This review focuses on current situation and probable mechanism of the interplay between vitamin D and anemia in order to provide a suggestion that administration of vitamin D or its analogues may improve the anemia state in CKD patients.

Key words: Chronic kidney disease, Vitamin D, Vitamin D, renal anemia, parathyroid hormone, inflammation, hepcidin,  Vitamin D receptor.