慢性肾脏病患者血清1,25(OH)2D水平与蛋白尿及尿炎症细胞因子相关性研究

摘要

Objective :To study the relationship between serum 1,25( OH )2 D levels and albuminuria and urinary inflammatory cytokines in chronic kidney disease ( CKD ) patients. Methods:Clinical and laboratory data of 115 hospitalized CKD patients and 20 healthy hospital staff as control group were collected. serum 1,25( OH )2D, urinary TGF- β1, MCP- 1, TNF, IL-6 levels and the relationship between serum 1,25( OH )2D and these clinical parameters were analysed. Results :( 1 ) The mean levels of , blood pressure, BUN, Scr, serum phosphorus, PTH, 24h urinary protein, CRP, TC, TG, LDL, UA, urinary MCP-1, urinary TGF-β1, urinary IL - 6, urinary TNF of CKD patients were higher than that of control group, and the mean levels of GFR, serum calcium,HDL, serum 1,25( OH )2D levels were lower than control group ( P ＜0.05 ). ( 2 ) Compared with patients of GFR ≥60 ml · min-11.73 m-2 , Serum CRP,The mean levels of urinary TGF - β1 , MCP - 1 , IL -6, TNF and 24 h urinary protein of patients with GFR ＜ 44 ml · min-1 · 1.73 m-2, were higher ( P ＜ 0.05 ), serum 1,25( OH )2 D was decreased ( P ＜ 0.05 ), but those difference were not significantly between patients with GFR ≥60 ml · min-1 · 1.73 m-2 and 45 ～ 59 ml · min-1 · 1.73 m-2( P ＞ 0.05 ). ( 3 ) The levels of serum 1,25( OH )2 D of CKD patients were related with age ( r= -0.442 ), systolic blood pressure ( r= -0.464 ), diastolic blood pressure ( r = - 0. 399 ), GFR ( r= 0.902 ), Scr( r= - 0.430 ), PTH ( r= - 0. 341 ), UA ( r= 0.237 ),24 h urinary protein (r= -0.372)and urinary TGF-β1(r= -0.894), MCP-1(r = -0867), TNF(r= -0.899), IL -6(r= -0.934)(P＜0.05 ). ( 4 ) The levels of serum 1,25( OH )2D of CKD patients were positively correlated with GFR and negative correlated with PTH and 24 h urinary protein urinary TGF -β1, MCP -1, TNF, IL -6. Conclusion:The levels of serum 1,25( OH )2D of CKD patients were closely correlated with proteinuria and the levels of urinary inflammatory cytokines.%目的:探讨慢性肾脏病(CKD)1～4期患者血清1,25(OH)2D水平与蛋白尿、尿炎症细胞因子的关系.方法:对我科115例CKD 1～4期患者及20例健康对照者进行血清1,25(OH)2D、血CRP,尿TGF-β1、MCP-1、TNF、IL-6,24 h尿蛋白定量检测;分析血清1,25(OH)2D水平与以上指标相关性.结果:(1)CKD组患者血清1,25(OH)2D水平低于对照组(P<0.05);血CRP,尿MCP-1、TGF-β1、IL-6、TNF水平,24 h尿蛋白定量高于对照组(P<0.05).(2)与GFR≥60 ml·min-1·1.73 m-2患者比较:GFR<44 ml·min-1·1.73 m-2患者CRP,尿MCP-1、TGF-β1、IL-6、TNF水平、24 h尿蛋白定量升高(P<0.05);血清1,25(OH)2D水平降低(P<0.05);而GFR 45～59 ml·min-1·1.73 m-2患者与GFR≥60 ml·min-1·1.73 m-2患者比较,两组间差异无统计学意义(P＞0.05);(3)单因素相关分析显示CKD患者血清1,25(OH)2D与年龄(r=-0.442)、收缩压(r=-0.464)、舒张压(r=-0.399)、GFR(r=0.902)、Scr(r=-0.430)、PTH(r=-0.341)、UA(r=0.237)、24 h尿蛋白定量(r=-0.372)及尿TGF-β1(r=-0.894)、MCP-1(r=-0867)、TNF(r=-0.899)、IL-6(r=-0.934)水平相关(P<0.05).多元回归分析显示血清1,25(OH)2D与GFR呈正相关;与24 h尿蛋白定量,尿MCP-1、IL-6,血Scr 、PTH呈负相关.结论:CKD 1～4期患者存在1,25(OH)2D水平降低,并与蛋白尿及尿炎症细胞因子水平密切相关.