非高血压人群维生素D和甲状旁腺激素与血压的关系

Relationship Between Vitamin D,Parathyroid Hormone and Blood Pressure of Non- hypertensive Population

目的：探讨非高血压人群维生素 D 和甲状旁腺激素与血压的关系。方法选择2011年3月—2012年8月宁波大学医学院附属医院体检中心参加健康体检的非高血压成年人271例为研究对象。采用酶联免疫吸附试验（ELISA）法测定血清25羟维生素 D〔25（OH）D〕水平，电化学发光免疫测定（ECLIA）法测定血清全段甲状房腺激素（iPTH）水平。按照血清25（OH）D水平四分位数将受试者分为4组，即1-16μg/ L 组（65例）、17-25μg/ L组（68例）、26-34μg/ L 组（66例）、35-65μg/ L 组（72例）。按照血清 iPTH 水平四分位数将受试者分为4组，即7.8-34.1 ng/ L 组（65例）、34.2-48.4 ng/ L 组（70例）、48. 5-60.2 ng/ L 组（65例）、60.3-109.2 ng/ L 组（71例）。比较各组受试者年龄、性别、收缩压（SBP）、舒张压（DBP）、高血压前期患病率（preHBP）、生化常规〔包含总胆红素（TBIL）、清蛋白（ALB）、丙氨酸氨基转移酶（ALT）、γ-谷氨酰转移酶（γGT）、血尿素氮（BUN）、肌酐（Cr）、血尿酸（BUA）、总胆固醇（TC）、三酰甘油（TG）、高密度脂蛋白胆固醇（ HDL-C）、低密度脂蛋白胆固醇（LDL-C）、空腹血糖（FPG）〕和25（OH）D或 iPTH。结果不同25（OH）D水平组间年龄、SBP、DBP、preHBP、ALB、ALT、Cr、TC、LDL-C、iPTH 比较，差异有统计学意义（ P 〈0.05）。不同 iPTH 水平组间年龄、DBP、ALB、25（OH）D比较，差异有统计学意义（P 〈0.05）。25（OH） D 水平与年龄、SBP、DBP、preHBP、γGT、BUA、TC、LDL-C、iPTH 呈负相关（P 〈0.05）。iPTH 水平与年龄、DBP、preHBP 、TC 呈正相关（P 〈0.05）。简单线性回归分析结果显示，25（OH）D水平与 SBP、DBP 之间存在线性依存关系（P 〈0.05）；iPTH 水平与 DBP 之间存在线性依存关系（P 〈0.05）。多元线性回归分析结果显示，在逐渐调整并增加混杂因素后，25（OH）D与血压水平之间依存程度并无明显变化，随着25（OH）D水平的升高，SBP、DBP 水平逐渐降低，并且这一趋势不受肝功能、肾功能、血脂、血糖、年龄及性别的影响（P 〈0.05）；在逐渐调整并增加混杂因素后，iPTH 水平与 DBP 之间依存程度并无明显变化，随着 iPTH 水平的升高，DBP 水平亦逐渐升高，并且这一趋势不受肝功能、肾功能、血脂、血糖、年龄及性别的影响（P 〈0.05）。结论低25（OH）D 水平和高 iPTH 水平可能是高血压的危险因素。

Objective To explore the relationship between vitamin D,parathyroid hormone and blood pressure of non- hypertensive population. Methods 271 non - hypertensive adults who received physical examination in the physical examination center of the Affiliated Hospital of School of Medicine of Ningbo University from March 2011 to August 2012 were enrolled in the study. ELISA method was used to determine serum 25（OH）D level and ECLIA method was used to examine serum iPTH level. According to the quartiles of serum 25（OH）D level,the subjects were divided into four groups：1- 16 μg/ L group（n = 65）,17 - 25 μg/ L group（ n = 68）,26 - 34 μg/ L group（ n = 66）and 35 - 65 μg/ L group（ n= 72）. According to the quartiles of serum iPTH level,the subjects were divided into four groups：7. 8 - 34. 1 ng/ L group（n= 65）,34. 2 - 48. 4 ng/ L group（ n = 70）,48. 5 - 60. 2 ng/ L group（ n = 65）and 60. 3 - 109. 2 ng/ L group（ n = 71）. Comparison was made among the groups in age,gender,SBP,DBP,preHBP,biochemical indicators（TBIL,ALB,ALT,γGT,BUN,Cr,BUA,TC,TG,HDL-C,LDL-C and FPG）and 25（OH）D or iPTH. Results Groups with different 25（OH）D levels were significantly different in age,SBP,DBP,preHBP,ALB,ALT,Cr,TC,LDL-C and iPTH（ P 〈0. 05）. Groups with different iPTH levels were significantly different in age,DBP,ALB and 25（OH）D（P 〈 0. 05）. There was negative correlation between 25（OH） D and age,SBP,DBP,preHBP,γGT,BUA,TC,LDL-C,iPTH（P 〈 0. 05）. There was positive correlation between iPTH level and age,DBP,preHBP and TC（ P 〈 0. 05）. Simple linear regression analyses showed that with 25（OH）D level had linear dependence relation SBP and DBP（P 〈 0. 05）and iPTH level had linear dependence relation with DBP（ P 〈 0. 05）. Multiple linear regression analyses showed that,after the adjustment and the addition of confounding factors,there was no evident change in the linear dependence relation between 25（OH）D level and blood pressure,and with the rising of 25（OH）D level,SBP and DBP decreased,a trend which was not influenced by liver function,renal function,blood lipid,blood glucose,age and gender（ P 〈 0. 05）;after the adjustment and the addition of confounding factors,there was no evident change in the linear dependence relation between iPTH level and DBP,and with the rising of iPTH level,DBP decreased,a trend which was not influenced by liver function,renal function,blood lipid,blood glucose,age and gender（P 〈 0. 05）. Conclusion Low 25（OH）D level and high iPTH level are potentially risk factors for hypertension.