肾病综合征患儿血清25-羟维生素D的影响因素分析

摘要

目的：了解肾病综合征（ NS）患儿维生素D营养状况，并分析其影响因素。方法以2012年1月1日至12月31日华中科技大学同济医学院附属同济医院儿科收治的初诊或复诊NS患儿为NS组，体检儿童为对照组。根据血清25-羟维生素D[25（OH）D]水平判断维生素D营养状态，≤20 ng·mL-1为维生素D缺乏。从NS患儿病史中截取可能影响25（ OH）D的因素行维生素D缺乏的单因素分析和Logistic回归分析；同时对25（ OH）D的影响因素行多元线性回归分析。结果 NS组139例，男103例，女36例，年龄（6.1±3.7）岁；对照组83例，男49例，女34例，年龄（3.1±2.0）岁。①NS组和对照组血清25（OH）D水平分别为（10.3±7.5）和（29.4±9.9）ng·mL-1，差异有统计学意义（P＜0.0001）。维生素D缺乏检出率NS组和对照组分别为86.3％和19.3％，差异有统计学意义（ P＜0.0001）。②单因素分析结果显示，NS病程、24 h尿蛋白定量、糖皮质激素累积剂量和使用时间、血清钙在维生素 D缺乏和不缺乏 NS 患儿间差异有统计学意义；Logistic回归分析显示，体重Z评分（OR=0.151，95％CI：0.035~0.649）、NS病程（OR=0.143，95％CI：0.035~0.592）和大量24 h蛋白尿（ OR=28.177，95％CI：3.295~240.970）与维生素D缺乏相关。③多元线性回归显示，男性、24 h尿蛋白定量、血清钙和每公斤体重糖皮质激素累积剂量与血清25（OH）D水平相关（P＜0.05）。④27例NS患儿服用阿法骨化醇前和3个月后均行血清25（OH）D水平检测，治疗前和治疗后分别为（7.2±5.0）和（14.9±11.0）ng·mL-1，差异有统计学意义（P=0.001）。结论 NS患儿血清25（OH）D低于健康儿童，有部分可能与蛋白尿水平、NS病程和糖皮质激素累积剂量等因素相关，口服阿法骨化醇可提高血清25（ OH）D水平。%Objective To analyze the serum levels of 25-hydroxy vitamin D[25(OH)D]in children with nephrotic syndrome (NS)and relevant factors. Methods Clinical data of NS paitients hospitalized at Tongji Hospital affiliated to Tongji Medical College of Huazhong University of Science & Technology from January 2012 to December 2012 were retrospectively collected,and healthy children coming for physical examination were enrolled as normal control group. The serum levels of 25( OH )D were defined as deficiency(≤20 ng · mL-1 ). Univariate analysis and multivariable logistic regression analysis were performed to explore the possible influencing factors related to vitamin D deficiency. Meanwhile,multi-regression analysis was used to investigate the potential factors affecting serum 25( OH)D level. Results A total of 222 subjects were enrolled,including 139 patients with NS and 83 healthy children. The serum 25(OH)D level of NS group was siginificantly higher than control group,(10. 3 ± 7. 5)vs (29. 42 ± 9. 85)ng·mL-1 ,P<0. 000 1. The prevalence rates of vitamin D deficiency of NS and control groups were 86. 3% and 19. 3%(P<0. 000 1). The multivariate logistic regression showed that patients with higher weight Z-score(0. 151,95%CI:0. 035-0. 649),longer duation of NS(0. 143,95%CI:0. 035-0. 592),greater 24 h protein amount(28. 177,95%CI:3. 295-240. 970)were significantly assocaited with vitamin D deficiency. Multiple linear regression determined that serum 25( OH)D levels were associated with male,24 h urinary protein amount,cumulative glucocorticoid dosage and serum calcium level( P<0. 05). Serum levels of 25(OH)D were significantly increased after treatment with alfacalcidol for 3 months,(7. 2 ± 5. 0)to (14. 9 ± 11. 0)ng·mL-1 ,P=0. 001. Conclusion Vitamin D deficiency was significantly associated with urine protein amount. Alfacalcidol supplements may improve vitamin D deficiency in nephritic patients.