老年单纯收缩期高血压患者血清甲状旁腺激素水平及其与血压、大动脉僵硬度的相关性

Serum level of parathyroid hormone in elderly isolated systolic hypertension and its relationship with blood pressure and aortic stiffness

目的观察老年单纯收缩期高血压(ISH)患者血清甲状旁腺激素水平(PTH)及其与血压和大动脉僵硬度的关系。方法 2009年7月至2010年7月江西省人民医院门诊和住院接诊的老年ISH患者组101例,同期年龄匹配的老年对照组69例,中年对照组37例。使用全自动生化分析仪测定血脂、肝肾功能、钙磷水平;采用动脉硬化自动测量仪测定臂踝脉搏波传导速度(baPWV);并使用放射免疫法测血清PTH和25羟维生素D[25(OH)D]。分析3组间baPWV及血清PTH和25(OH)D的差异及PTH与收缩压、baPWV的相关性。结果老年ISH、老年对照和中年对照3组血清PTH水平分别为(53.7±23.4)、(42.0±15.1)、(28.4±7.9)μg/L(P<0.05),baPWV分别为(1926±332)、(1552±145)、(1207±90)cm/s(P<0.05);血清25(OH)D水平分别为(11.8±8.3)、(17.2±7.0)、(30.5±9.1)μg/L(P<0.05)。直线相关分析显示PTH与年龄(r=0.251、P<0.01)、收缩压(r=0.216、P<0.01)及baPWV(r=0.264、P<0.01)呈正相关。多元逐步线性回归分析结果显示:在校正了血脂、体质量指数(BMI)、钙磷水平等因素后,年龄、PTH、25(OH)D是收缩压的独立影响因素(β=0.267、0.239、-0.197,均P<0.01);在校正了血脂、BMI、钙磷水平等因素后,年龄、PTH水平是baPWV的独立影响因素(β=0.550、0.238,均P<0.01)。结论随着年龄的增加,PTH水平也逐渐升高,收缩压和大动脉僵硬度也随之增加;PTH可能与老年ISH的发病相关。

Objective To exam the serum level of parathyroid hormone （PTI-I） in elderly isolated systolic hyperten- sion （ISH） and explore how it is related to blood pressure and aortic stiffness. Methods A total of 101 elderly outpatients and inpatients with ISH form Jiangxi Provincial People＇s Hospital,69 age-matched controls and 37 middle- aged controls were recruited between July,2009 and July,2010. The levels of blood lipids,hepatic and renal func- tion, and serum levels of calcium and phosphorus were measured by fully automatic biochemical analyzer. Brachial-ankle pulse wave velocity （baPWV） was detected by arteriosclerosis automatic measuring instrument. Ser- um levels of PTH and 25 hydroxy vitamin D [-25（OH）D] were measured by radioimmunoassay. The baPWV and serum levels of PTH and 25（OH）D,along with the relevance of PTH to systolic pressure and baPWV, were analyzed in three groups. Results Among the ISH subjects,the elderly controls and the middle-aged controls, PTH levels were （53.7±23.4）,（42.0±15.1）,and （28.4±7.9）μg/L （P〈0.05）,respectively. Besides,baPWV for each group was （ 1926 ± 332 ）, （ 1552 ± 145 ）, and （ 1207 ± 90 ） cm/s （ P 〈 0.05 ）, respectively, and the serum levels of 25{OH）Dwere {ll. 8＋8.3）,{17.2±7.0）,and （30.5±9.1）μg/L （P〈0.05）, respectively. Linear correlation analysis showed that PTH was positively correlated with age （r = 0. 251, P〈 0.01）, systolic blood pressure （ r= 0.216, P〈0.01 ） and baPWV （ r= 0. 264, P〈0.01 ）, respectively. Multiple stepwise linear regression analysis showed that after the adjustment for blood lipid level, body mass index and serum level of calcium and phosphorus, age, PTH level and 25 （OH）D level were independent risk factors of systolic blood pressure （fl= 0.267,0. 239, and -- 0. 197, respectively all P〈0.01）, age and PTH level were independent risk factors of baPWV （β= 0. 550,0. 238, all P〈0.01）. Conclusion The serum level of PTH,systolic blood pressure and aortic stiffness increase with age. PTH may be involved in the pathogenesis of elderly ISH.