中国血液净化

中国血液净化 ›› 2017, Vol. 16 ›› Issue (08): 537-541.doi: 10.3969/j.issn.1671-4091.2017.08.009

• 临床研究 • 上一篇    下一篇

维持性血液透析患者血清维生素C 水平与其骨-矿物质代谢关系初探

黄雯1,蔡笑1,张国娟1,段晓峰2,赵慧颖1,张梅1,姜丽萍1,郑洁1   

  1. 1首都医科大学附属北京同仁医院肾内科
    2北京普仁医院肾内科
  • 收稿日期:2016-12-30 修回日期:2017-06-26 出版日期:2017-08-12 发布日期:2017-08-12
  • 通讯作者: 黄雯 huangw6@126.com E-mail:huangw6@126.com

Exploring the relationship between the serum vitamin C concentration and parameter values reflecting the Mineral and Bone Disorder in hemodialysis patients

  • Received:2016-12-30 Revised:2017-06-26 Online:2017-08-12 Published:2017-08-12

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摘要： 目的观察维持性血液透析患者(maintenance hemodialysis，MHD)血清维生素C(vitaminC，VC)水平，对血清VC 水平与慢性肾脏病-骨矿物质代谢异常(chronic kidney disease-mineral and bone disorder，CKD-MBD)的关系进行初步探讨。方法采取自身前后对照方法。入选MHD 患者92 例，检测患者透析前基础血清VC 值，以及血清全段甲状旁腺激素(intact Parathyroid hormone，iPTH)、碱性磷酸酶(alkaline Phosphatase，ALP)、钙(calcium，Ca)、磷(phosphate，P)、及钙磷乘积。根据患者血清VC 水平，将患者分为VC 正常组(VC≥4mg/L，非干预组)及VC 缺乏组(VC＜4mg/L，干预组)。干预组于每次血液透析后给予VC 注射液300mg 静注，共计36 次。观察3 个月。于观察期结束时再次测定患者的血清VC 值、血iPTH、ALP、Ca、P 及钙磷乘积。采用SPSS19.0 软件进行统计分析。结果1、MHD 患者VC 缺乏达78.3%。VC 正常组和VC 缺乏组的基础血清VC 均值有明显差异[5.644(2.200)比1.312(1.940) mg/L，Z= - 6.895，P＜0.001]；且两组的血清iPTH 值[99.00(230.72)比206.30(315.10)pg/ml，Z=- 1.049，P=0.029]和ALP 值[82.00(42.50)比123.00(234.00)U/L,Z=-2.367，P=0.018]亦有明显差异。2、3 个月观察期后:①血清VC 水平：非干预组患者较前降低，但无明显差异 [5.64(4.29, 6.49) 比5.11(3.94, 6,15) Z=-1.904, P=0.057]。干预组患者较前明显增高[1.31(0.80, 2.02)比4.59(2.46，5.70)，Z=- 3.320，P＜0.001]，差异有统计学意义。②血清MBD 指标：非干预组患者血清iPTH、ALP、P、钙磷乘积较前轻度升高，但差异均无统计学意义。干预组患者血清iPTH [206.30(133.40, 428.50)比154.00(76.50, 388.00)pg/mL, Z=-2.207, P＜0.001]和血清ALP[123.00(78.00, 312.00)比95.00(60.00, 140.00)U/L, Z=-3.749, P=0.011]明显降低，差异有统计学意义；血清Ca、P、钙磷乘积较前轻度降低，但差异无统计学意义。③ Pearson/ Spearman 相关系数及线性回归方程结果显示，MHD 患者血清VC 水平与ALP 水平之间存在负相关关系(B= -8.538,P=0.014)。结论MHD 患者VC 缺乏现象普遍存在。常规透析可造成患者VC 丢失；予血液透析患者补充VC 可使患者iPTH、ALP 降低。血清VC 水平与ALP 水平之间存在负相关关系。MHD 患者VC的缺乏可能与其骨矿物质代谢的异常有一定的关系。

关键词: 血液透析, 维生素C（VC）, 骨矿物质代谢异常（MBD）

Abstract: Purpose To explore the relationship between the serum concentration of vitamin C (VC) and parameter values reflecting the Mineral and Bone Disorder (MBD) in Maintenance hemodialysis (MHD) patients. Method This study employs a pre-post self-comparison design. 92 patients were selected and divided into two groups based on the level of the serum VC concentration at the beginning of the study: a normal-VC group (VC＞=4mg/L, the control group) and a deficient-VC group (VC＜4mg/L, the intervention group). At the same times, all patients’intact Parathyroid hormone (iPTH), Alkaline Phosphatase (ALP), Calcium (Ca),
Phosphate (P), and Ca×P were examined and recorded at the beginning of the study. During the study, the intervention group was given an injection of 300mg vitamin C at the end of each dialysis, while the normal group got no treatment. The patients were monitored for 3 months and then examined again on the serum concentration of VC, iPTH, ALP, Ca, P and Ca×P at the end of the observation period. The data was analyzed with SPSS 19.0. Results ①VC deficiency was common in the MHD patients (78.3%). There was a significant difference in the base serum vitamin C level between the normal-VC group and the deficient-VC group [5.644(2.200) vs.1.312(1.940) mg/L，Z=- 6.895，P＜0.001], as well as in the serum iPTH [99.00(230.72)vs. 206.30(315.10)pg/ml，Z=-1.049，P=0.029] and ALP [82.00(42.50)vs.123.00(234.00)U/L, Z=-2.367，P=0.018]. ②After the three-month observation period: ① The serum VC concentration of the control group was reduced than before, but the difference was not statistically significant (5.64(4.29，6.49) vs. 5.11 (3.94，6,15)P=0.057). The VC concentration of the intervention group was statistically significantly increased (mg/L ，(1.31(0.80，2.02) vs. 4.59(2.46，5.70)，P＜0.001). ②The serum MBD indicators: the serum iPTH, ALP, P, and Ca×P of the patients in the control group were increased, but none of the difference was statistically significant. The intervention group showed statistically significant reduce in serum iPTH [206.30(133.40，428.50) vs.154.00(76.50, 388.00)pg/mL, Z= - 2.207 ，P<0.001] and serum ALP [123.00(78.00，312.00) vs. 95.00(60.00，140.00) U/L, Z=-3.749，P=0.011]. The Serum Ca, P, and Ca×P were also slightly lower than before, but the differences were
not statistically significant. 3. The Pearson/Spearman correlation coefficients, as well as the coefficients of the linear regressions suggested that there was a negative correlation between the plasma vitamin C level and ALP level of the MHD patients(B=-8.538, P=0.014). Conclusion Vitamin C deficiency is a common phenomenon in MHD patients. Regular dialysis can cause the loss of vitamin C. Providing supplementary Vitamin C to MHD patients can reduce the level of iPTH and ALP. There is a negative correlation between the plasma vitaminC level and ALP level. The deficiency of Vitamin C in MHD patients may be correlated with MBD.

Key words: Maintenance hemodialysis (MHD), Vitamin C (VC), Mineral and Bone Disorder (MBD)