维生素D水平与血液透析患者心脏功能的相关性研究

Correlation between vitamin D level and cardiac function in hemodialysis patients

目的调查研究血液透析患者血清25-羟维生素D[25 hydroxyvitamin D,25(OH)D]水平与其心血管功能的关系。方法采用横断面调查研究方法,收集战略支援部队特色医学中心血液净化中心109名血液透析患者血清标本测定血清25(OH)D水平、临床指标及心脏彩超结果,应用相关分析及多元回归分析血清25(OH)D水平与心脏功能相关性。结果患者血清25(OH)D平均值为(50.39±22.74)nmol/L,其中低血清25(OH)D者(≤50 nmol/L)共有65人,占59.6%。正常25(OH)D患者与低25(OH)D患者比较,二尖瓣口E峰与二尖瓣环E峰血流速度比值(e/e’)有明显差异(t=2.425,P=0.001)。Spearman分析显示25(OH)D与e/e′呈负相关(r=-0.272,P=0.004)。多元回归分析显示25(OH)D为e/e′的独立相关因素(β=-0.115,95%CI:-0.129~-0.009,P=0.010)。结论维持性血液透析患者普遍血清25(OH)D水平偏低,血清25(OH)D水平与左心室舒张功能独立相关。

Objective To investigate the relationship between serum 25-hydroxyvitamin D(25(OH)D level and cardiovascular function in hemodialysis patients.Methods This was a cross-sectional study.Serum25(OH)D levels were determined from 109 hemodialysis patients treated in the Dialysis Center of the PLA Strategic Support Force Medical Center.Clinical data and cardiac ultrasound results of the 109 hemodialysis patients were collected.Correlation and multivariate regression analyses were used to evaluate the relationship between serum 25(OH)D level and cardiovascular function.Results The average value of 25(OH)D was50.39±22.74 nmol/L in the hemodialysis patients,in which 65 patients(59.6%)were identified as 25(OH)D deficient(≤50 nmol/L).By comparing between 25(OH)D normal group and 25(OH)D deficient group,there were no significant differences in B-type natriuretic peptide(BNP),high-sensitivity C-reactive protein(hsCRP),intact parathyroid hormone(iPTH),hemoglobin,left ventricular mass(LVM),left ventricular mass index(LVMI),ejection fraction(EF),fraction shortening(FS),left ventricular internal dimensions at end-diastole(LVIDd),posterior wall thickness at end-diastole(PWTd),septal wall thickness at end-diastole(SWTd),left ventricular end diastolic diameter(LVED),systolic left ventricular volume(LVES)and the ratio of mitralwave E peak velocity to A peak velocity(e/a),but there was a significant difference in the ratio mitral-wave E peak velocity to mitral annulus velocity E’(e/e)?(t=2.495,P=0.001).Spearman analysis showed that 25(OH)D was negatively correlated with e/e(?r=-0.272,P=0.004).Multivariate regression showed that 25(OH)D was an independent correlation factor for e/e′(β=-0.115,95%CI:-0.129~-0.009,P=0.010).Conclusions Serum25(OH)D level was lower in maintenance hemodialysis patients.25(OH)D level was independently and negatively correlated with left ventricular diastolic function.