中国血液净化

中国血液净化 ›› 2016, Vol. 15 ›› Issue (12): 682-685.doi: 10.3969/j.issn.1671-4091.2016.12.008

• 临床研究 • 上一篇    下一篇

糖尿病维持性血液透析患者甲状旁腺激素及25羟维生素D3水平的改变及相关因素分析

杨娟1,杨光1,张波1,俞香宝1,任海滨1,黄抱娣1,邢昌赢1   

  1. 1. 南京医科大学第一附属医院（江苏省人民医院）肾内科
  • 收稿日期:2016-05-24 修回日期:2016-09-02 出版日期:2016-12-12 发布日期:2016-12-05
  • 通讯作者: 邢昌赢 cyxing62@126.com E-mail:cyxing62@126.com
  • 基金资助:

    江苏省临床医学科技专项(BL2014080)

CChanges of parathyroid hormone and 25-OH vitamin D3 levels and their related factors in maintenance hemodialysis patients

  • Received:2016-05-24 Revised:2016-09-02 Online:2016-12-12 Published:2016-12-05

RichHTML

1

PDF

349

摘要： 目的分析合并糖尿病与否的尿毒症维持性血液透析(maintenance hemodialysis，MHD)患者全段甲状旁腺激素(intact parathyroid hormone，iPTH)水平及25 羟维生素D3[25 hydroxy vitaminD3，25(OH)D3]水平的可能差异。方法选择2015 年1～12 月在南京医科大学第一附属医院血液净化中心维持性透析且未曾行甲状旁腺切除术的180 例尿毒症患者，根据是否合并糖尿病，分为糖尿病组(DH)与非糖尿病组(NDH)，比较2 组之间的临床资料，并分析iPTH 及25(OH)D3的可能影响因素。结果DH 组的iPTH 水平显著低于NDH 组[219.7(164.1～275.2)pg/ml 比500.4(398.1～602.7)pg/ml，Z=-4.473，P＜0.001]，同时DH 组25(OH)D3亦显著低于NDH 组[(30.8±16.0)pg/ml 比(45.2±25.1)pg/ml，t=-3.327，P=0.001]。iPTH 与糖尿病病史(r=-0.339，P＜0.001)呈负相关，与透析龄(r=0.386，P＜0.001)、血磷(r=
0.437，P＜0.001)、碱性磷酸酶(r=0.426，P＜0.001)、25(OH)D3(r=0.254，P=0.016)呈正相关。多元线性回归分析显示糖尿病病史(β=-0.173，P=0.012)、透析龄 (β= 0.147，P=0.028)为iPTH 的独立影响因素(经年龄、性别、维生素D 类似物服用史、拟钙剂服用史、白蛋白、三酰甘油校正)。25(OH)D3与糖尿病病史(r= -0.296, P=0.004)呈负相关，与透析龄(r=0.228，P=0.030)、血磷(r=0.237，P=0.023)、血镁(r=0.286，P= 0.007)、血清白蛋白(r=0.263，P=0.012)、iPTH (r= 0.254, P=0.016)呈正相关。多元线性回归分析显示糖尿病病史(β=-0.317，P=0.004)为25(OH)D3的独立影响因素(经年龄、性别、服用维生素D 类似物服用史、拟钙剂服用史、胆固醇、三酰甘油校正)。结论合并糖尿病MHD 患者iPTH 水平和25(OH)D3水平均显著低于非糖尿病MHD患者，糖尿病病史是iPTH 和25(OH)D3的独立影响因素。

关键词: 尿毒症, 糖尿病, 甲状旁腺激素, 25羟维生素D3, 血液透析

Abstract: Objective To analyze the changes of serum intact parathyroid hormone (iPTH) and 25-hydroxyvitamin D3 [25(OH)D3] levels and their related factors in maintenance hemodialysis (MHD) patients with or without diabetes mellitus. Method A total of 180 MHD patients without parathyroidectomy and treated
in the period from Jan. to Dec. 2015 in the Blood Purification Center of the First Affiliated Hospital of Nanjing Medical University were enrolled in this study. They were divided into DH group (MHD patients with diabetes) and NDH group (MHD patients without diabetes). Their clinical data, including general information, dialysis age, history of diabetes, and laboratory data were compared between the two groups to analyze the influence factors for serum iPTH and 25(OH)D3 levels in these patients. Results Serum iPTH level was 219.7 (164.1～275.2) pg/ml in DH group significantly lower than the level of 500.39 (398.1～602.7) pg/ml in NDH group (Z=- 4.473, P＜0.001). Similarly, serum 25(OH)D3 level was also lower in DH group than in NDH group (30.9±16.0 pg/ml vs. 45.2±25.1 pg/ml, t=-3.327, P=0.001). Serum iPTH level was negatively correlated with history of diabetes (r=- 0.339, P＜0.001), and positively correlated with dialysis age (r=0.386, P＜0.001), serum phosphatase, (r=0.437, P＜0.001), alkaline phosphatase (r=0.426, P＜0.001) and 25-OH D3 (r=0.254, P=0.016). Multivariate linear regression analysis showed that history of diabetes (βa=-0.173, P=0.012) and dialysis age (βa=0.147, P=0.028) were the independent factors for iPTH. Serum 25-OH D3 level was negatively correlated with history of diabetes (r=-0.296, P=0.004), and positively correlated with dialysis age (r= 0.228, P=0.030), serum phosphatase (r=0.237, P=0.023), serum magnesium (r=0.286, P=0.007), serum albumin (r=0.263, P=0.012) and iPTH (r=0.254, P=0.016). Multivariate linear regression analysis showed that history of diabetes (βa=-0.317, P=0.004) was the independent factor for 25-OH D3. Conclusion The levels of iPTH and 25-OH D3 were significantly lower in NH group than in NDH group. History of diabetes was the independent factor for iPTH and 25-OH D3.

Key words: Uremia, Diabetes Mellitus, Parathyroid Hormone, 25 hydroxy vitamin D3, Hemodialysis