摘要
目的探讨25-羟维生素D_(3)[25(OH)D_(3)]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)D_(3)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)D_(3)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)D_(3)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)D_(3)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)D_(3)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)D_(3)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)D_(3)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)D_(3)<18.835 ng/ml时,预测患者发生CKD-aP的AUC为0.635;PD患者25(OH)D_(3)<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)D_(3)在透析患者CKD-aP中起重要作用,25(OH)D_(3)水平在预测透析患者发生CKD-aP中具有一定的临床价值。
Objective To investigate the association between 25-hydroxyvitamin D_(3)[25(OH)D_(3)]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)D_(3) 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)D_(3) 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)D_(3) 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)D_(3) 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)D_(3) 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)D_(3) 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)D_(3) decreased with the increase of pruritus in the total population and MHD patients(P<0.05).The 25(OH)D_(3) 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)D_(3) 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)D_(3) 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)D_(3)<18.835 ng/ml in MHD patients and 0.685 when the 25(OH)D_(3)<10.545 ng/ml in PD patients.Conclusions Lower 25(OH)D_(3) may play an important role in CKD-aP in dialysis patients.Moreover,25(OH)D_(3) level has certain clinical value in predicting the occurrence of CKD-aP in dialysis patients.
作者
纪博凡
陈晶晶
麻雪洁
张晓良
汤日宁
JI Bo-fan;CHEN Jing-jing;MA Xue-jie;ZHANG Xiao-liang;TANG Ri-ning(Department of Nephrology,Zhongda Hospital,affiliated with Southeast University,Nanjing 210009,China)
出处
《中国血液净化》
CSCD
2024年第11期807-812,共6页
Chinese Journal of Blood Purification
基金
国家自然科学基金面上项目(82370742)
江苏省卫健委重点项目(ZD2022045)。
作者简介
通讯作者:汤日宁,210009南京,东南大学附属中大医院肾内科,Email:tangrn77@163.com。
