25-羟维生素D对糖尿病肾病维持性血液透析患者心功能的影响

Effect of 25-dihydroxy vitamin D level on cardiac function in patients undergoing maintenance hemodialysis for diabetic nephropathy

目的探讨25-羟维生素D(25(OH)D)水平对糖尿病肾病(diabetic nephropathy,DN)维持性血液透析患者心功能的影响。方法检测30例DN维持性血液透析患者(DN组)的血清25(OH)D、脑钠肽(brain natriuretic peptide,BNP)、Ca2+水平及QT离散度(QT dispersion,QTd)/校正的QT离散度(corrected QT dispersion,QTcd),并与20例体检健康者(对照组)对比分析。结果 DN组维生素D缺乏(25(OH)D≤50.00nmol/L)和不足者(25(OH)D>50.00～75.00nmol/L)29例;DN组血25(OH)D水平((47.93±22.25)nmol/L)较对照组((95.53±18.18)nmol/L)明显降低(P<0.01),QTd及其校正值QTcd较对照组明显延长(P<0.01);DN组中维生素D缺乏患者血25(OH)D、血Ca2+水平均较维生素D不足患者明显下降,BNP、QTd及QTcd均较维生素D不足患者明显上升或延长(P<0.01);DN组25(OH)D与BNP、QTd、QTcd呈负相关(r=-0.66,r=-0.67,P<0.01);BNP与Ca2+、Ca2+与QTd、QTcd呈负相关(r=-0.51,r=-0.47,r=-0.49,P<0.01),25(OH)D与Ca2+呈正相关(r=-0.49,P<0.01)。结论 DN维持性血液透析患者中常见维生素D缺乏和不足;维生素D缺乏对患者心功能有影响,可加剧心室肌复极不同步性及不稳定性。

Objective To investigate the effect of 25-dihydroxy vitamin D（25（OH）D） level on cardiac function in diabetic nephropathy（DN） patients undergoing maintenance hemodialysis.Methods The levels of 25（OH）D,brain natriuretic peptide（BNP） and serum calcium（Ca） as well as QT dispersion/corrected QT dispersion（QTd/QTcd） were detected in 30 DN patients receiving maintenance hemodialysis（DN group）,and were compared with 20 healthy volunteers（control group）.Results In DN group,29 patients were diagnosed vitamin D deficiency（serum 25（OH）D was 50.00 nmol/L or below） or insufficiency（serum 25（OH）D was between 50.00 and 75.00 nmol/L）.The serum 25（OH）D level was significantly lower in DN group（（47.93±22.25）nmol/L） than that in control group（（95.53±18.18）nmol/L）（P0.01）,and QTd/QTcd value was siginificantly longer in DN group than that in control group（P0.01）.Serum 25（OH） D and serum Ca levels were obviously lower,and BNP and QTd/QTcd values were significantly higher or longer in patients with vitamin D deficiency than those in patients with vitamin D insufficiency（P0.01）.In DN group,serum 25（OH）D was negatively correlated with BNP,QTd and QTcd（r=-0.66,r=-0.67,P0.01）,BNP was negatively correlated with serum Ca,serum Ca was negatively correlated with QTd and QTcd（r=-0.51,r=-0.47,r=-0.49,P0.01）,and serum 25（OH）D was positively correlated with serum Ca（r=0.49,P0.01）.Conclusion Vitamin D deficiency and insufficiency are common in DN patients receiving maintenance hemodialysis.Vitamin D deficiency influences cardiac function,and can also aggravates the asynchrony and instability of ventricular repolarization.