血液透析患者血清25-羟维生素D 与α-Klotho 及主动脉弓钙化的关系

张爱华; 郭维康; 于玲; 刘文虎

doi:10.3969/j.issn.1671-4091.2019.08.006

中国血液净化 >

2019 , Vol. 18 >Issue 08: 535 - 538

DOI: https://doi.org/10.3969/j.issn.1671-4091.2019.08.006

临床研究

血液透析患者血清25-羟维生素D 与α-Klotho 及主动脉弓钙化的关系

张爱华 ,
郭维康 ,
于玲 ,
刘文虎

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1首都医科大学附属北京友谊医院肾内科
2首都医科大学附属北京朝阳医院血液净化中心

收稿日期: 2019-05-08

修回日期: 2019-06-11

网络出版日期: 2019-08-15

基金资助

北京市医院管理局临床医学发展专项经费资助(ZYLX201824)

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The relationship between serum 25(OH)D level and the changes of serum α-Klotho and aortic arch calcification in hemodialysis patients#br#

ZHANG Ai-Hua ,
GUO Wei-Kang ,
YU Ling ,
LIU Wen-Hu

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1Department of Nephrology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China 2Blood Purification Center, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China

Received date: 2019-05-08

Revised date: 2019-06-11

Online published: 2019-08-15

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摘要

【摘要】目的评价血液透析(hemodialysis,HD)患者血25羟维生素D[25-hydroxyvitamin D，25(OH)D]和α-Klotho 的相关性及二者在血管钙化中的角色。方法选择北京友谊医院血液净化中心中心HD 患者152 例；周中透析日抽取透析前空腹血，采用全自动电化学发光免疫分析仪检测血清25(OH)D 及全段甲状旁腺激素(intact parathormone，iPTH)水平；夹心酶联免疫吸附法测定血清α-Klotho 水平。后前位胸部X 线摄片评估主动脉弓钙化程度。结果患者血清25(OH)D 的平均水平为(19.97±8.30)ng/ml；维生素D 缺乏的罹患率为69.7%(n=106)。血清α-Klotho 的平均浓度为(421.69±185.28)pg/ml。89 例患者(58.6%)存在主动脉弓钙化。维生素D 缺乏组患者女性更多、血清α-Klotho 水平更低(χ2/t 值分别为9.660，- 2.308；P 值分别为0.006，0.022)；主动脉弓钙化罹患率趋向于更高，但未达统计学差异(χ2=3.127，P=0.077)。多元逐步回归分析显示血清25(OH)D 与α-Klotho 水平独立相关(P=0.022)。Logistic回归分析显示年龄和血清25(OH)D 是主动脉弓钙化的独立危险因素(95% CI 值分别为1.069～1.163,0.901～0.998；OR 值分别为1.115,0.948;P 值分别为＜0.001, 0.041)。结论维生素D缺乏在HD患者中非常多见，是循环α-Klotho及主动脉弓钙化的独立危险因素。

关键词： 25 羟维生素D; α-Klotho; 血管钙化; 血液透析

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张爱华 , 郭维康 , 于玲 , 刘文虎 . 血液透析患者血清25-羟维生素D 与α-Klotho 及主动脉弓钙化的关系[J]. 中国血液净化, 2019 , 18(08) : 535 -538 . DOI: 10.3969/j.issn.1671-4091.2019.08.006

Abstract

【Abstract】Objectives To evaluate the relationship between serum 25(OH)D level and the changes of serum soluble α-Klotho and aortic arch calcification in hemodialysis (HD) patients. Methods This was a crosssectional study enrolled in 152 HD patients from the Dialysis Center of Beijing Friendship Hospital. Fasting blood samples were collected prior to hemodialysis at the second hemodialysis session in a week. Serum 25(OH)D and intact parathyroid hormone (iPTH) were assayed by an automatic electrochemiluminescence immunoassay instrument. Serum α-Klotho was determined using a sandwich enzyme-linked immunosorbent assay (ELISA) kit. Posterior-anterior chest X-ray examination was used to assess aortic arch calcification. Results The average serum 25(OH)D level was 19.97±8.30 ng/ml in the HD patients, in which vitamin D deficiency was found in 106 patients (69.7%). The average serum α-Klotho level was 421.69±185.28 pg/ml. Aortic arch calcification was found in 89 patients (58.6%). In patients with vitamin D deficiency, females were more than males (54.7% vs. 28.3%, c2=9.660, P= 0.006); serum α-Klotho levels were lower (399.16±179.62 pg/ml vs. 473.61±189.62 pg/ml, t=-2.308, P=0.022); and the prevalence of aortic arch calcification was higher but without statistical significance (63.2% vs. 47.8%, c2=3.127, P=0.077). Linear stepwise regression analysis showed that serum 25(OH)D level was independently correlated with serum α-Klotho level (P=0.022). Binary logistic regression analysis confirmed that age (OR=1.115, 95% CI=1.069- 1.163, P＜0.001) and serum 25

(OH)D (OR=0.948, 95% CI=0.901-0.998, P=0.041) were the independent risk factors for aortic arch calcification. Conclusions Vitamin D deficiency was prevalent in HD patients. Serum 25(OH)D was the independent risk factor for both circulating α- Klotho and aortic arch calcification. Therefore, serum 25(OH)D assay for HD patients is clinically valuable.

Key words： Serum 25(OH)D; Circulating α-Klotho; Vascular calcification; Hemodialysis

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