原发性高血压患者骨质疏松与25羟维生素D代谢的关系

摘要

目的 探讨25羟维生素D2、25羟维生素D3在原发性高血压患者骨质疏松发生过程中的作用。方法 收集我院老年内科及骨科2008年1月至2010年12月原发性高血压患者311例，其中男147人，年龄45～77岁，平均(47.76±9.75)岁；女164人，年龄48～75岁，平均(45.89±11.34)岁。并选择291例年龄相匹配的健康人群作为对照。采用Lunar DPX型双能X线骨密度检测仪，测定被检个体腰椎(L2～L4)及股骨上端[包括股骨颈(NECK)、华氏三角(Ward)及股骨粗(TROCH)]的骨密度(BMD)值，经放免法测定空腹血清骨钙素(BGP)，采用酶联免疫法测定25羟维生素D2(25-OH-vitD2)、25羟维生素D3(25-OH-vitD3)。结果 EH组腰椎及股骨上端BMD、25-OH-vitD2、25-OH-vitD3均显著低于对照组(P＜0.05)，而BGP却显著高于对照组(P＜0.01)；BMD分别与25-OH-vitD2、25-OH-vitD3呈显著负相关，相关系数分别为r=-0.467，P=0.000；r=-0.286，P=0.029。BGP分别与25-OH-vitD2、25-OH-vitD3呈显著正相关，相关系数分别为r=0.368，P=0.000；r=0.276，P=0.000。结论 原发性高血压患者25-OH-vitD2、25-OH-vitD3的减少可增加骨骼吸收，并延缓骨的形成，因此在预防原发性高血压患者骨质疏松的过程中要注意适量补充钙剂。%Objective To investigate the effect of 25-OH-vitamin D2 and 25-OH-vitamin D, on osteoporosis in patients with essential hypertension ( EH). Methods Three hundred and eleven EH patients were collected from the elderly internal medicine and orthopedic departments from January 2008 to December 2010, including 147 males aged 45-77 (47. 76 ±9.75 years) and 164 females aged 48-75 (45. 89 ± 11. 34 years). Two hundred and ninety-one age-matched healthy volunteers were chosen as controls. Bone mineral density ( BMD) of the lumbar vertebrae L2-L4 and the upper femur including NECK, Ward, and TROCH of the subjects were measured using Lunar DPX dual-energy X-ray bone mineral density detector. The fast serum osteocalcin (BGP) was tested using radioimmunology method. 25-OH-vitamin D2 and 25-OH-vitamin D, were tested using ELISA method. Results BMD of the lumbar vertebrae and the upper femur, 25-OH-vitD2, and 25-OH-vitD3 of the patients with EH were significantly lower than those in the controls ( P < 0. 05). However, BCP in EH patients was significantly higher than that in controls (P < 0. 01 ). 25-OH-vitamin D2 and 25-OH-vitamin D, were negatively correlated with BMD ( r = - 0. 467, P = 0. 000; r = -0.286, P=0.029, repectively). BGP was positively correlated with 25-OH-vitamin D2 and 25-OH-vitamin D3 (r = 0. 368, P = 0. 000; r = 0. 276, P = 0.000, respectively). Conclusion The decrease of 25-OH-vitamin D2 and 25-OH-vitamin D, in EH patients would increase bone absorption and delay bone formation. Therefore appropriate amount of calcium supplement should be drawn attention for prevention of osteoporosisin patients with EH.