中国血液净化

中国血液净化 ›› 2024, Vol. 23 ›› Issue (11): 807-812.doi: 10.3969/j.issn.1671-4091.2024.11.002

• 临床研究 • 上一篇    下一篇

透析患者25-羟维生素D3与慢性肾脏病相关性瘙痒的相关性分析

纪博凡    陈晶晶    麻雪洁    张晓良    汤日宁   

  1.  210009 南京，1东南大学附属中大医院肾内科
  • 收稿日期:2024-03-15 修回日期:2024-09-01 出版日期:2024-11-12 发布日期:2024-11-12
  • 通讯作者: 汤日宁 E-mail:tangrn77@163.com
  • 基金资助:
    国家自然科学基金面上项目(82370742)；江苏省卫健委重点项目(ZD2022045)

Correlation analysis of 25-hydroxyvitamin D3 with chronic kidney disease-associated pruritus in dialysis patients

JI Bo-fan, CHEN Jing-jing, MA Xue-jie, ZHANG Xiao-liang, TANG Ri-ning   

  1. Department of Nephrology, Zhongda Hospital,  affiliated with Southeast University, Nanjing 210009, China
  • Received:2024-03-15 Revised:2024-09-01 Online:2024-11-12 Published:2024-11-12
  • Contact: 210009 南京，1东南大学附属中大医院肾内科 E-mail:tangrn77@163.com

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摘要： 目的 探讨25-羟维生素D3[25(OH)D3]在维持性血液透析(maintenance hemodialysis,MHD)和腹膜透析(peritoneal dialysis,PD)患者中与慢性肾脏病相关性瘙痒(chronic kidney disease-associated pruritus,CKD-aP)的关系及25(OH)D3水平对透析患者CKD-aP的预测价值。 方法 采用单中心横断面研究方法，选取2022年1月1日—12月31日在东南大学附属中大医院接受MHD、PD治疗的患者为研究对象，依据有无CKD-aP分为无瘙痒组、瘙痒组，比较2组患者临床资料和25(OH)D3水平，根据瘙痒评分进一步将瘙痒组分为轻度瘙痒组和中重度瘙痒组。总人群、MHD、PD患者以瘙痒程度分组比较25(OH)D3水平，通过多因素Logistic回归分析MHD、PD患者发生CKD-aP的影响因素。采用ROC曲线分析25(OH)D3在预测透析患者发生CKD-aP中的临床价值。 结果 共纳入331例患者，其中MHD患者238例，PD患者93例。CKD-aP患病率分别为56.5%、58.4%、51.6%。MHD及PD患者瘙痒组25(OH)D3均低于无瘙痒组(MHD：Z=-3.538，P＜0.001；PD：Z=-3.075，P=0.002)。无瘙痒组、轻度瘙痒组、中重度瘙痒组3组25(OH)D3比较存在统计学差异(总人群：H=28.823，P＜0.001；MHD：H=25.137，P＜0.001；PD：H=12.228，P=0.002)。多因素Logistic回归分析结果显示白细胞计数(OR=1.257，95% CI：1.033～1.529，P=0.022)、血磷  (OR =2.277，95% CI：1.215～4.268，P=0.010)、甲状旁腺激素(OR=1.002，95% CI：1.000～1.003，       P=0.018)、β2-微球蛋白(OR =1.039，95% CI：1.007～1.073，P=0.017)是MHD患者发生CKD-aP的危险因素，血磷(OR=4.613，95% CI：1.354～15.719，P=0.015)、超敏C反应蛋白(OR=1.192，95% CI：1.019～1.395，P=0.028)是PD患者发生CKD-aP的危险因素，25(OH)D3是MHD和PD患者发生CKD-aP的保护因素(MHD：OR=0.937，95% CI：0.901～0.975，P=0.001；PD：OR=0.909，95% CI：0.830～0.995，P=0.038)。ROC曲线显示：当MHD患者25(OH)D3＜18.835 ng/ml时，预测患者发生CKD-aP的AUC为0.635；PD患者25(OH)D3＜10.545 ng/ml时，预测患者发生CKD-aP的AUC为0.685。 结论 较低的25(OH)D3在透析患者CKD-aP中起重要作用，  25(OH)D3水平在预测透析患者发生CKD-aP中具有一定的临床价值。

关键词: 25-羟维生素D3, 慢性肾脏病相关性瘙痒, 维持性血液透析, 腹膜透析

Abstract: Objective  To investigate the association between 25-hydroxyvitamin D3 [25(OH)D3] and chronic kidney disease-associated pruritus (CKD-aP) in patients on maintenance hemodialysis (MHD) or peritoneal dialysis (PD), and the predictive value of 25(OH)D3 level for CKD-aP in dialysis patients. Methods  In this single-center, cross-sectional study, patients with MHD, or PD treatment from 1 January 2022 to 31 December 2022 in the Zhongda Hospital, affiliated with Southeast University were selected as subjects. Based on the absence of CKD-aP, the patients were divided into the non-pruritus and pruritus groups, then compare the clinical data and 25(OH)D3 level between the two groups. The pruritus group further divided into mild and moderate-to-severe pruritus based on the pruritus score. Then we compared the 25(OH)D3 levels in the general population, MHD, and PD patients in different itching severity groups. The ROC curve was used to analyze the clinical value of 25(OH)D3 in predicting the occurrence of CKD-aP in dialysis patients.  Results  A total of 331 dialysis patients were included, including 238 patients with MHD and 93 patients with PD. The prevalence of CKD-aP was 56.5%, 58.4% and 51.6%, respectively. The 25(OH)D3 in the pruritus group of MHD and PD patients was lower than that in the non-pruritus group (MHD: 13.490 (10.140, 17.980) vs. 18.900 (10.910, 24.630), Z=-3.538, P<0.001; PD: 7.215 (4.843, 11.875) vs. 12.090 (6.630, 15.240), Z=-3.075, P=0.002). Further analysis showed that There were statistically differences in 25(OH)D3 among no pruritus group, mild pruritus group, and moderate to severe pruritus group (total population: H=28.823 P<0.001; MHD: H=25.137 P<0.001; PD: H=12.228 P=0.002). 25(OH)D3 decreased with the increase of pruritus in the total population and MHD patients (P<0.05). The 25(OH)D3 in the non-pruritus group was higher than that in the mild pruritus group (P=0.015) and the moderate-to-severe pruritus group (P=0.003), and there was no significant difference in 25(OH)D3 between the mild pruritus group and the moderate-to-severe pruritus group (P=0.081). The results of multivariate logistic regression analysis showed that white blood cell count (OR=1.257, 95% CI: 1.033～1.529, P=0.022), serum phosphorus (OR=2.277, 95% CI: 1.215～4.268, P=0.010), parathyroid hormone (OR=1.002, 95% CI: 1.000～1.003, P=0.018), β2-microglobulin (OR=1.039, 95% CI: 1.007～1.073, P=0.017) were risk factors for CKD-aP in MHD patients, and serum phosphorus (OR=4.613, 95% CI: 1.354～15.719,P=0.015) and hypersensitive C-reactive protein (OR=1.192, 95% CI: 1.019～1.395, P=0.028) were risk factors for CKD-aP in PD patients. 25(OH)D3 was a protective factor for CKD-aP in patients with MHD and PD (MHD: OR=0.937, 95% CI: 0.901～0.975, P=0.001. PD: OR=0.909, 95% CI: 0.830～0.995, P=0.038). The ROC curve showed that the predicted AUC was 0.635 when the 25(OH)D3<18.835 ng/ml in MHD patients and 0.685 when the 25(OH)D3<10.545 ng/ml in PD patients.  Conclusions  Lower 25(OH)D3 may play an important role in CKD-aP in dialysis patients. Moreover, 25(OH)D3 level has certain clinical value in predicting the occurrence of CKD-aP in dialysis patients.

Key words: 25(OH)D3, Chronic kidney disease-associated pruritus, Maintenance hemodialysis, Peritoneal dialysis

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