Association of vitamin D deficiency and endothelial dysfunction in patients with chronic kidney disease
-
摘要: 目的 观察慢性肾脏病（CKD）患者血清25-羟维生素D水平与血管内皮细胞功能异常的相关性。方法 选取病情稳定的非透析CKD患者为研究对象，以血流介导的血管舒张功能（FMD）作为评价血管内皮细胞功能的指标，观察血清25-羟维生素D水平与FMD的相关性。结果 符合条件的139例患者进入本研究，血清25-羟维生素D缺乏、不足及正常的患者分别为71例（51.08%）、58例（41.73%）和10例（7.19%）。25-羟维生素D缺乏与不足患者的肱动脉FMD低于25-羟维生素D水平正常者，并以缺乏组患者的FMD最低。相关分析显示，血清25-羟维生素D与肱动脉FMD呈显著正相关（r=0.623，P<0.01），多因素回归分析显示血清25-羟维生素D水平降低是血管内皮细胞损伤的独立危险因素（β=0.418，P<0.01）。结论 血清25-羟维生素D水平降低是非透析CKD患者血管内皮细胞功能异常的独立危险因素，补充25-羟维生素D可能有助于改善患者的内皮细胞功能。Abstract: Objective To investigate the correlation between vitamin D deficiency and endothelial dysfunction in patients with non-dialysis chronic kidney disease (CKD).Methods Patients with non-dialysis CKD and a stable clinical state were enrolled in this study. Vitamin D status of the patients was determined using serum 25-hydroxyvitamin D. Endothelial function was assessed by brachial artery flow-mediated dilation (FMD).Results Of 139 patients enrolled, there were 71 (51.08%) cases of vitamin D deficiency, 58 (41.73%) cases of vitamin D insufficiency and only 10 had normal vitamin D level. Patients with vitamin D deficiency and insufficiency had lower brachial artery FMD than patients with sufficient vitamin D level with the lowest level observed in vitamin D deficient group. Correlation analysis showed a positive correlation between FMD and 25(OH)D (r=0.623, P<0.01). The multiple regression analysis revealed vitamin D deficiency was an independent risk factor for endothelial dysfunction (β=0.418, P<0.01).Conclusions Vitamin D deficiency was associated with endothelial dysfunction in patients with non-dialysis CKD. Vitamin D supplementation may improve endothelial function in these patients.
-
-
[1] Foley RN, Parfrey PS, Sarnak MJ. Epidemiology of cardiovascular disease in chronic renal disease[J]. J Am Soc Nephrol, 1998, 9(12 Suppl):S16-S23.
[2] Go AS, Chertow GM, Fan D, et al. Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization[J]. N Engl J Med, 2004, 351(13):1296-1305.
[3] Henry RM, Kostense PJ, Bos G, et al. Mild renal insufficiency is associated with increased cardiovascular mortality:the Hoorn Study[J]. Kidney Int, 2002, 62(4):1402-1407.
[4] Levin A, Li YC. Vitamin D and its analogues:do they protect against cardiovascular disease in patients with kidney disease?[J]. Kidney Int, 2005, 68(5):1973-1981.
[5] Amann K, Wanner C, Ritz E. Cross-talk between the kidney and the cardiovascular system[J]. J Am Soc Nephrol, 2006, 17(8):2112-2119.
[6] Hogg RJ, Furth S, Lemley KV, et al. National Kidney Foundation's Kidney Disease Outcomes Quality Initiative clinical practice guidelines for chronic kidney disease in children and adolescents:evaluation, classification, and stratification[J]. Pediatrics, 2003, 111(6 Pt 1):1416-1421.
[7] National Kidney Foundation. K/DOQI clinical practice guidelines for chronic kidney disease:evaluation, classification, and stratification[J]. Am J Kidney Dis, 2002, 39(2 Suppl 1):S1-S266.
[8] Coresh J, Selvin E, Stevens LA, et al. Prevalence of chronic kidney disease in the United States[J]. JAMA, 2007, 298(17):2038-2047.
[9] Chen J, Wildman RP, Gu D, et al. Prevalence of decreased kidney function in Chinese adults aged 35 to 74 years[J]. Kidney Int, 2005, 68(6):2837-2845.
[10] Jiang L, Liang Y, Qiu B, et al. Prevalence of chronic kidney disease in a rural Chinese adult population:the Handan Eye Study[J]. Nephron Clin Pract, 2010, 114(4):c295-302.
[11] Liu BC, Wu XC, Wang YL, et al. Investigation of the prevalence of CKD in 13,383 Chinese hospitalised adult patients[J]. Clin Chim Acta, 2008, 387(1-2):128-132.
[12] Zhang L, Wang F, Wang L, et al. Prevalence of chronic kidney disease in China:a cross-sectional survey[J]. Lancet, 2012, 379(9818):815-822.
[13] Wang TJ, Pencina MJ, Booth SL, et al. Vitamin D deficiency and risk of cardiovascular disease[J]. Circulation, 2008, 117(4):503-511.
[14] Anderson JL, May HT, Horne BD, et al. Relation of vitamin D deficiency to cardiovascular risk factors, disease status, and incident events in a general healthcare population[J]. Am J Cardiol, 2010, 106(7):963-968.
[15] Wolf M, Shah A, Gutierrez O, et al. Vitamin D levels and early mortality among incident hemodialysis patients[J]. Kidney Int, 2007, 72(8):1004-1013.
[16] González EA, Sachdeva A, Oliver DA, et al. Vitamin D insufficiency and deficiency in chronic kidney disease:a single center observational study[J]. Am J Nephrol, 2004, 24(5):503-510.
[17] Cuppari L, Carvalho AB, Draibe SA. Vitamin D status of chronic kidney disease patients living in a sunny country[J]. J Ren Nutr, 2008, 18(5):408-414.
[18] 张锁建, 石永兵, 冯胜. 慢性肾脏病非透析患者25-羟维生素D3水平及其影响因素[J]. 江苏医药, 2013, 39(5):551-553. [19] 王宓, 邵茁, 王梅. 慢性肾脏病229例25羟基维生素D浓度及影响因素分析[J]. 中国实用内科杂志, 2012, 32(2):138-141. [20] 刘书馨, 常明, 郐婷婷, 等. 慢性肾脏病患者25-羟维生素D3检测及其临床相关因素分析[J]. 中国实用内科杂志, 2010, 30(5):447-449. [21] Carrara D, Bruno RM, Bacca A, et al. Cholecalciferol treatment downregulates renin-angiotensin system and improves endothelial function in essential hypertensive patients with hypovitaminosid D[J]. J Hypertens, 2016, 34(11):2199-2205.
[22] Forman JP, Williams JS, Fisher ND. Plasma 25-hydroxyvitamin D and regulation of the renin-angiotensin system in humans[J]. Hypertension, 2010, 55(5):1283-1288.
[23] Martinesi M, Bruni S, Stio M, et al. 1,25-Dihydroxyvitamin D3 inhibits tumor necrosis factor-alpha-induced adhesion molecule expression in endothelial cells[J]. Cell Biol Int, 2006, 30(4):365-375.
[24] Tarcin O, Yavuz DG, Ozben B, et al. Effect of vitamin D deficiency and replacement on endothelial function in asymptomatic subjects[J]. J Clin Endocrinol Metab, 2009, 94(10):4023-4030.
[25] Jablonski KL, Chonchol M, Pierce GL, et al. 25-Hydroxyvitamin D deficiency is associated with inflammation-linked vascular endothelial dysfunction in middle-aged and older adults[J]. Hypertension, 2011, 57(1):63-69.
[26] Shab-Bidar S, Neyestani TR, Djazayery A, et al. Regular consumption of vitamin D-fortified yogurt drink (Doogh) improved endothelial biomarkers in subjects with type 2 diabetes:a randomized double-blind clinical trial[J]. BMC Med, 2011, 9:125.
[27] Sugden JA, Davies JI, Witham MD, et al. Vitamin D improves endothelial function in patients with Type 2 diabetes mellitus and low vitamin D levels[J]. Diabet Med, 2008, 25(3):320-325.
[28] Chitalia N, Recio-Mayoral A, Kaski JC, et al. Vitamin D deficiency and endothelial dysfunction in non-dialysis chronic kidney disease patients[J]. Atherosclerosis, 2012, 220(1):265-268.
[29] London GM, Guérin AP, Verbeke FH, et al. Mineral metabolism and arterial functions in end-stage renal disease:potential role of 25-hydroxyvitamin D deficiency[J]. J Am Soc Nephrol, 2007, 18(2):613-620.
[30] Karakas Y, Sahin G, Urfali FE, et al. Effect of vitamin D supplementation on endothelial dysfunction in hemodialysis patients[J]. Hemodial Int, 2017, 21(1):97-106.
[31] Chitalia N, Ismail T, Tooth L, et al. Impact of vitamin D supplementation on arterial vasomotion, stiffness and endothelial biomarkers in chronic kidney disease patients[J]. PLoS One, 2014, 9(3):e91363.
-
期刊类型引用(3)
1. 蔡忠林，陈晨. 终末期肾病血液透析患者发生动静脉内瘘失功的影响因素分析. 现代医学与健康研究电子杂志. 2025(06): 130-133 . 
百度学术
2. 赵文娟，夏世国. 血清中HMGB1表达水平与慢性肾-心综合征病情严重程度及预后的关系分析. 中国中西医结合肾病杂志. 2023(06): 527-529 . 百度学术
3. 贺志花，王利华. 膜性肾病发病机制研究新进展. 临床肾脏病杂志. 2022(05): 423-428 . 本站查看
其他类型引用(9)
计量
- 文章访问数: 345
- HTML全文浏览量: 0
- PDF下载量: 415
- 被引次数: 12
下载:
.png)