目的 探讨维持性血液透析（maintenance hemodialysis，MHD）患者低水平维生素D与代谢综合征之间的关系。 方法 纳入2016年1月至2017年1月于本院血液净化中心行MHD治疗的患者143例，记录患者临床及实验室检查资料，化学发光仪检测患者血清25羟维生素D3[25(OH)D3]。根据25(OH)D3水平将患者分为3组：充足组（＞30 μg/L）、不足组（15～30 μg/L）和缺乏组（＜15 μg/L），分析各组MHD患者的25(OH)D3水平与代谢综合征及各项代谢异常的关系，代谢异常包括中心性肥胖、三酰甘油升高、高密度脂蛋白胆固醇（HDL-C）降低、收缩压升高、舒张压升高、空腹血糖升高。多因素Logistic回归法分析代谢综合征发生的影响因素及25(OH)D3对各项代谢异常的影响。 结果 143例MHD患者血清25(OH)D3中位数为24.30（12.90，29.50）μg/L，代谢综合征患病率为45.45%（65例）。3组患者代谢综合征比例、腹围、血清三酰甘油差异均有统计学意义，且随25(OH)D3缺乏程度的加重而增加（均P＜0.05）；25(OH)D3 缺乏及不足组患者的体重指数均高于充足组（均P＜0.05）；缺乏组患者收缩压、三酰甘油、空腹血糖均高于充足组及不足组患者，HDL-C低于充足组及不足组患者（均P＜0.05）。患者代谢异常项目越多，25(OH)D3浓度越低（H=61.316，P＜0.001）。患者血清25(OH)D3浓度与代谢综合征的发生呈负相关（OR=0.889，95%CI：0.846～0.934，P＜0.001），同时也与中心性肥胖的发生（OR=0.913，95%CI：0.874～0.953，P＜0.001）、三酰甘油升高（OR=0.932，95%CI：0.894～0.971，P=0.001）、HDL-C降低（OR=0.901，95%CI：0.845～0.959，P=0.001）、收缩压升高（OR=0.898，95%CI：0.847～0.953，P＜0.001）及空腹血糖升高（OR=0.956，95%CI：0.920～0.994，P=0.024）呈负相关。 结论 MHD患者的代谢综合征患病率高，低水平的25(OH)D3可能是MHD患者发生代谢综合征及多项代谢异常的独立危险因素。

Objective To evaluate the relationship between low vitamin D level and metabolic syndrome (MS) in maintenance hemodialysis (MHD) patients. Methods A total of 143 patients who had received MHD from Jan 2016 to Jan 2017 in the dialysis center of our hospital were enrolled. Their clinical and laboratory data were collected. The serum 25(OH)D3 levels were measured by chemiluminescence instrument. According to the levels of 25(OH)D3, patients were divided into three groups: sufficient group (＞30 μg/L), insufficient group (15-30 μg/L) and deficient group (＜15 μg/L) to explore how the 25(OH)D3 were associated with MS and abnormal metabolic parameters, including central obesity, raised triglycerides (TG), reduced high-density lipoprotein cholesterol (HDL-C), raised systolic blood pressure (SBP), raised diastolic blood pressure (DBP) and increased fasting blood glucose (FBG). The risk factors of MS and abnormal metabolic factors were analyzed by multivariate logistic regression model. Results Among the 143 MHD patients, the median of serum 25(OH)D3 was 24.30(12.90, 29.50) μg/L and the prevalence of MS was 45.45%(65 cases). Among 3 groups the prevalence of MS, the abdominal circumference and the serum TG showed statistical differences, and they increased with the severity of 25(OH)D3 deficiency (all P＜0.05). The body mass indexes of patients in the insufficient and deficient groups were elevated compared with that in the sufficient group (all P＜0.05). SBP, TG and FBG in deficient group were significantly higher but HDL-C was lower than those in the other two groups (all P＜0.05). The more abnormal metabolism existed, the lower 25(OH)D3 levels patients had (H=61.316, P＜0.001). Multivariate logistic regression analysis showed that in MHD patients low 25(OH)D3 negatively correlated with MS (OR=0.889, 95%CI 0.846-0.934, P＜0.001) and abnormal metabolic factors central obesity (OR=0.913, 95%CI 0.874-0.953, P＜0.001), raised TG (OR=0.932, 95%CI 0.894-0.971, P=0.001), reduced HDL-C (OR=0.901, 95%CI 0.845-0.959, P=0.001), raised SBP (OR=0.898, 95%CI 0.847-0.953, P＜0.001) and raised FBG (OR=0.956, 95%CI 0.920-0.994, P=0.024). Conclusions The prevalence of MS is high in MHD patients and low levels of 25(OH)D3 may be an independent risk factor for MS and abnormal metabolic factors.