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中华肾病研究电子杂志

中华肾病研究电子杂志 ›› 2022, Vol. 11 ›› Issue (04) : 202 -206. doi: 10.3877/cma.j.issn.2095-3216.2022.04.004

论著

肌注维生素D2治疗维持性血液透析患者25羟维生素D缺乏的临床观察
尤燕华1, 胡玉清1, 梁萌1,†()   
  1. 1. 361000　厦门大学附属成功医院肾内科
  • 收稿日期:2021-12-31 出版日期:2022-08-28
  • 通信作者: 梁萌

Clinical observation of intramuscular injection of vitamin D2 in the treatment of 25-hydroxyvitamin D deficiency in maintenance hemodialysis patients

Yanhua You1, Yuqing Hu1, Meng Liang1,†()   

  1. 1. Department of Nephrology, Chenggong Hospital Affiliated to Xiamen University, Xiamen 361000, Fujian Province, China
  • Received:2021-12-31 Published:2022-08-28
  • Corresponding author: Meng Liang
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尤燕华, 胡玉清, 梁萌. 肌注维生素D2治疗维持性血液透析患者25羟维生素D缺乏的临床观察[J]. 中华肾病研究电子杂志, 2022, 11(04): 202-206.

Yanhua You, Yuqing Hu, Meng Liang. Clinical observation of intramuscular injection of vitamin D2 in the treatment of 25-hydroxyvitamin D deficiency in maintenance hemodialysis patients[J]. Chinese Journal of Kidney Disease Investigation(Electronic Edition), 2022, 11(04): 202-206.

目的

分析维持性血液透析患者的血清25-羟维生素D[25(OH)D]水平，探讨肌注维生素D2注射液治疗25羟维生素D缺乏的作用。

方法

检测我院2020年12月至2021年2月170例维持性血液透析患者空腹血清25(OH)D水平，根据血清25(OH)D水平将患者分为严重缺乏组、缺乏组、不足组和正常组。分析血清25(OH)D水平与患者性别、年龄、透析龄、血红蛋白、白蛋白、血钙、血磷、全段甲状旁腺激素(iPTH)的相关性。其中86例维生素D缺乏或不足的血透患者，随机分为对照组(n＝43)和治疗组(n＝43)，对照组给予常规治疗，治疗组在对照组基础上给予肌注维生素D2 (20万单位，1次/2周)，连续3个月。比较患者治疗前后血清25(OH)D、血红蛋白、白蛋白、钙、磷、iPTH水平的变化，并观察不良反应情况。

结果

170例患者中，维生素D严重缺乏组33例(19.4%)，缺乏组33例(19.4%)，不足组70例(41.2%)，正常组34例(20%)。男性25(OH)D水平显著高于女性(P<0.05)。正常组与维生素D缺乏组和不足组在透析龄、血红蛋白、白蛋白差异方面均具有统计学意义(P<0.05)。血清25(OH)D与年龄、血钙、血磷、甲状旁腺激素无显著相关性(P>0.05)。多元线性逐步回归分析显示，血清25(OH)D与血红蛋白、白蛋白具有相关性(P<0.05)。肌注维生素D2 3月后可使血液透析患者的25(OH)D水平显著上升(P<0.05)，同时血红蛋白、血清白蛋白、磷上升(P<0.05)，对血钙、iPTH无显著影响(P>0.1)。

结论

维持性血液透析患者维生素D缺乏发生率高，血清25(OH)D水平与性别、贫血、营养不良存在密切关系，肌注维生素D2可改善血透患者贫血、营养不良情况，但可能带来血磷升高。

关键词: 血液透析, 25-羟维生素D, 贫血, 营养不良, 维生素D2, 肌肉注射
Objective

To analyze the serum level of 25-hydroxyvitamin D [25(OH)D] in maintenance hemodialysis (MHD) patients, and investigate the effect of intramuscular injection of vitamin D2 in the treatment of 25-hydroxyvitamin D deficiency.

Methods

The fasting serum 25(OH)D level of 170 MHD patients admitted to our hospital from December 2020 to February 2021 was measured. According to the serum 25(OH)D level, the patients were divided into severe deficiency group, deficiency group, insufficiency group, and normal group. The correlation between serum 25(OH)D level and patients′ gender, age, dialysis age, hemoglobin, albumin, serum calcium, serum phosphorus, and intact parathyroid hormone (iPTH) were analyzed. Among the MHD patients with vitamin D deficiency or insufficiency, 86 patients were selected and randomly divided into control group (n=43) and treatment group (n=43). The control group was given routine treatment, and the treatment group was given intramuscular injection of vitamin D2 (200, 000 units, once every 2 weeks) on the basis of the routine treatment for 3 consecutive months. The changes of levels of serum 25(OH)D, hemoglobin, albumin, calcium, phosphorus, and iPTH were compared before and after the treatment, and the occurrence of adverse reactions was also observed.

Results

Among the 170 MHD patients, 33 cases (19.4%) were in the severe deficiency group, 33 cases (19.4%) in the deficiency group, 70 cases (41.2%) in the insufficient group, and 34 cases (20%) in the normal group. The level of 25(OH)D in males was significantly higher than that in females (P<0.05). There were significant differences in dialysis age, hemoglobin, and albumin between the normal group and the deficiency group or the insufficiency group (P<0.05). There was no significant correlation between serum 25(OH)D and age, serum calcium, serum phosphorus, or PTH (P>0.05). Multiple linear stepwise regression analysis showed that serum 25(OH)D was correlated with hemoglobin and albumin (P<0.05). After 3 months of intramuscular injection of vitamin D2, the level of serum 25(OH)D of the patients was significantly increased (P<0.05), and levels of hemoglobin, serum albumin, and phosphorus were also increased (P<0.05), while no significant changes were observed in serum levels of calcium and iPTH (P>0.1).

Conclusions

The incidence of vitamin D deficiency in the MHD patients was high. The serum 25(OH)D level was closely related to gender, anemia, and malnutrition. Intramuscular injection of vitamin D2 could improve anemia and malnutrition of the patients, but might also cause increase of blood phosphorus.

Key words: Hemodialysis, 25-hydroxyvitamin D, Anemia, Malnutrition, Vitamin D2, Intramuscular injection
表1 血透患者血清25(OH)D浓度的相关因素分析(±s)
组别 例数 年龄(岁) 透析龄(月) 白蛋白(g/L) 血红蛋白(g/L) 钙(mmol/L) 磷(mmol/L) 甲状旁腺(pg/ml)
严重缺乏组 34 56.44±16.26 51.11±54.11 37.34±6.68 96.18±15.79 2.19±0.32 1.89±0.57 388.88±288.71
缺乏组 71 57.03±14.59 55.44±59.76 41.20±4.05 100.56±18.29 2.26±0.27 1.96±0.66 418.70±427.08
不足组 33 53.93±15.39 77.45±54.26 42.49±3.41 110.70±15.86 2.35±0.27 2.02±0.67 353.98±308.13
正常组 32 52.53±13.39 79.13±41.44 44.31±3.39 113.36±14.78 2.27±0.45 1.96±0.65 284.69±301.03
F值 0.844 3.222 14.392 8.58 1.311 0.24 1.082
P值 0.471 0.024 <0.001 <0.001 0.273 0.868 0.358
表2 血透患者血25(OH)D浓度相关因素的多元线性逐步回归分析结果
自变量 年龄(岁) 透析龄(月) 白蛋白(g/L) 血红蛋白(g/L) 钙(mmol/L) 磷(mmol/L) 甲状旁腺(pg/ml)
β值 －0.048 0.249 0.91 0.113 －2.776 1.797 －0.004
P值 0.448 0.269 <0.001 0.045 0.353 0.224 0.129
表3 血透患者治疗前后指标比较(±s)
组别 25(OH)D 白蛋白(g/L) 血红蛋白(g/L)
治疗前 治疗后 治疗前 治疗后 治疗前 治疗后
治疗组(n＝43) 12.35±5.67 21.41±6.09ab 40.54±4.77 43.4±4.17ab 106.98±12.81 116.72±13.07ab
对照组(n＝43) 13.01±4.55 11.96±5.12 40.23±5.12 39.92±4.32 105.72±11.91 106.72±12.53
P值 0.323 <0.001 0.276 0.042 0.372 0.024
组别 钙(mmol/L) 磷(mmol/L) 甲状旁腺(pg/ml)
治疗前 治疗后 治疗前 治疗后 治疗前 治疗后
治疗组(n＝43) 2.28±0.22 2.21±0.22 2.01±0.65 2.21±0.63ab 368.14±398.03 332.03±331.54
对照组(n＝43) 2.15±0.32 2.11±0.41 1.99±0.44 1.91±0.55 357.14±365.13 352.92±331.54
P值 0.256 0.152 0.228 0.032 0.453 0.165
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