维生素D与老年人高血压及靶器官损害的相关性研究

Correlation of vitamin D with essential hypertension and its target organ damages in the elderly

目的探讨维生素D与老年人高血压及靶器官损害的相关性。方法回顾性分析，收集2013年1月至2014年2月在我科住院治疗的年龄≥60岁患者365例，高血压组247例，非高血压组118例。比较两组患者25羟基维生素D[25（OH）D]水平，并对高血压相关因素进行分析。根据血清25（OH）D水平将高血压组患者，分为维生素D缺乏组（198例）与非缺乏组（49例），比较两组间靶器官损害指标。结果365例老年患者25（OH）D中位数水平低（35．3nmol／L），77．5％（283例）为缺乏状态。高血压组25（0H）D低于非高血压组（34．0nmol／L比38．7nmol／L，P〈0．05）。高血压患者维生素D缺乏组与非缺乏组肾早期损害、血肌酐、估算肾小球滤过率、脉搏波传导速度、踝臂指数、颈动脉内中膜厚度、Sokolow-Lyon指数、Cornell指数及左心室质量指数比较，差异无统计学意义（均P〉0．05）。高血压合并冠心病患者25（OH）D低于非冠心病患者（P〈0．05），25（OH）D与冠心病呈负相关（B=0．021，P=0．019），冠状动脉双支病变及3支病变患者25（OH）D低于非冠心病患者（P〈O．01）。结论老年患者常见25（0H）D缺乏，老年高血压患者25（OH）D水平低于非高血压患者；高血压合并冠心病患者25（OH）D降低。维生素D缺乏与肾、外周血管、心脏结构等靶器官损害无相关性。

Objective To investigate the correlation of vitamin D with essential hypertension and its target organ damages in the elderly. Methods In the retrospective study, 365 elderly participants aged ≥ 60 years hospitalized in our department during January 2013 to February 2014 were involved,including 247 patients with confirmed essential hypertension（HT）and 118 patients without HT. Serum 25-hydroxy vitamin D[25（OH）D]levels were measured and compared between HT and non-HT group,and binary regression analysis was used to discuss potential influencing factors of HT. The damage index of vitamin D target organ was compared between vitamin D deficiency group（n =198）and vitamin D non deficiency group（n=49）. Results The median serum 25（OH）D level of participants is 35.3 nmol/L,77.5 % （283 cases）were in the insufficient vitamin D status. The level of 25（OH）D was significantly lower in HT group than in non-HT group（34.0 vs. 38.7 nmol/L,P〈： 0.05）. There were not statistically significant differences between vitamin D insufficient group and sufficient group（P〉 0.05） in albumin/creatinine ratio, serum creatinine, estimated glomerular filtration rate,ankle-brachial index,pulse wave velocity,intima media thickness of carotid artery, Sokolow-Lyon index,cornell index and left ventricular mass index. The serum 25（OH）D level was significantly lower in CHD plus HT group than non-CHD（P〈0.05）. The 25（OH）D level was negatively correlated with coronary heart disease（B= =0. 021 ,P=0. 019）. The serum 25（OH）D level was significantly lower in groups with double-and triple-vessel coronary artery disease than in non-CHD group（P〈0.01）. Conclusions Vitamin D insufficiency is common in the elderly. The serum 25 （OH）D level is significantly lower in old patients with HT especially with stage 3 HT than in non-HT ones. The 25（OH）D level is lower in HT patients with comorbid CHD, and more obvious in HT patients with multi-vessel coronary artery disease. An insufficient vitamin D status is not correlated with hypertensive target organ damages including kidney, peripheral vascular and left ventricular cardiac structure.