Department of Paediatrics, University of Rostock, Rostock, Germany.
Nephrol Dial Transplant. 2012 Mar;27(3):1107-13. doi: 10.1093/ndt/gfr382. Epub 2011 Jul 12.
Fetuin-A and vitamin D are significant correlates of cardiovascular morbidity in paediatric chronic kidney disease (CKD) patients. It is thus far unknown, whether or not serum fetuin-A is affected by the vitamin D status or treatment with vitamin D preparations in these patients.
In a cross-sectional study, serum concentrations of fetuin-A, 25-hydroxyvitamin D(3) (25OHD) and 1,25-dihydroxyvitamin D(3) (calcitriol) levels were determined in 112 paediatric patients with mild-to-severe CKD (Stages 1-5) and after renal transplantation. A25OHD supplementation and/or calcitriol treatment were given in 64% of the patients.
Fetuin-A levels were clearly reduced in dialysis patients but were comparable to healthy controls in those with moderate CKD and after transplantation. Although 64 and 46% of all patients received 25OHD and/or calcitriol treatment, 48 and 20% of patients were 25OHD and/or calcitriol deficient, respectively. Within the whole patient cohort, fetuin-A correlated with serum calcium and yearly weight-related 25OHD dosage (each P < 0.01) but not with the vitamin D status per se. Multiple regression analysis revealed the need for dialysis treatment and cumulative 25OHD dosage as independent predictors of fetuin-A concentrations (model r(2) = 0.17). In dialysis patients, fetuin-A was inversely correlated with serum C-reactive protein but positively correlated with cumulative calcitriol dosage and serum parathormone (each P < 0.01).
Fetuin-A levels are clearly reduced in children on dialysis but not in those with moderate CKD and after transplantation. Besides the degree of microinflammation, the cumulative intake of 25OHD and calcitriol are significantly correlated to fetuin-A in these patients. The impact of vitamin D treatment appears to be at least partly mediated by serum calcium.
在儿科慢性肾脏病（CKD）患者中，胎球蛋白-A 和维生素 D 是心血管发病率的重要相关因素。到目前为止，尚不清楚血清胎球蛋白-A 是否受维生素 D 状态或维生素 D 制剂治疗的影响。
在一项横断面研究中，测定了 112 例轻度至重度 CKD（1-5 期）和肾移植后的儿童患者的血清胎球蛋白-A、25-羟维生素 D（25OHD）和 1,25-二羟维生素 D（骨化三醇）水平。64%的患者接受了 25OHD 补充和/或骨化三醇治疗。
透析患者的胎球蛋白-A 水平明显降低，但在中度 CKD 患者和移植后与健康对照组相当。尽管所有患者中有 64%和 46%接受了 25OHD 和/或骨化三醇治疗，但分别有 48%和 20%的患者 25OHD 和/或骨化三醇缺乏。在整个患者队列中，胎球蛋白-A 与血清钙和每年体重相关的 25OHD 剂量呈正相关（均 P < 0.01），但与维生素 D 状态本身无关。多元回归分析显示，透析治疗和累积 25OHD 剂量是胎球蛋白-A 浓度的独立预测因素（模型 r（2）= 0.17）。在透析患者中，胎球蛋白-A 与血清 C 反应蛋白呈负相关，与累积骨化三醇剂量和血清甲状旁腺激素呈正相关（均 P < 0.01）。
在透析患者中，胎球蛋白-A 水平明显降低，但在中度 CKD 患者和移植后则不然。除了微炎症程度外，这些患者的 25OHD 和骨化三醇的累积摄入量与胎球蛋白-A 显著相关。维生素 D 治疗的影响至少部分是由血清钙介导的。
