维生素D缺乏与维持性血液透析患者心脏功能的关系

摘要

Objective To investigate the effects of vitamin D on cardiac function in patients undergoing maintenance hemodialysis(MHD). Methods Plasma 25(OH) D and B-type natriuretic peptide (BNP) were measured in 43 patients(group MHD) who were treated with MHD for at least 3 months before the study and were in a stable clinic status without signs of cardiovascular disease. Left ventricular ejection fraction(LVEF),left ventricular diameter(LVD),interventricular septal thickness (IVST),left ventricular posterior wall thickness (LVPWT) were evaluated by ultrasonic cardiograph as welL The results were compared to those in 20 healthy people (group C) and the relationship between 25(OH)D deficiency and left heart structure and function was analyzed. Results The mean 25(OH)D level was lower in group MHD than that in group C[(34. 74±16.17) nmol/L vs. (53. 23± 21.85) nmol/L] (F<0. 01). Thirty-five (81. 4%) patients in group MHD were considered to be deficiency of 25 (OH) D, which was <50 nmol/L. Plasma 25(OH)D level was negatively correlated with the levels of BNP, LVM1, but positively correlated with the level of LVEF. Conclusion The prevalence of vitamin D deficiency in MHD patients is significantly higher than that in those with normal renal function. Plasma level of vitamin D is an independent risk factor for heart structure and function.%目的 了解维持性血液透析(MHD)患者维生素D水平与心脏功能的关系.方法 选择43例透析时间＞3个月、病情稳定、已排除急性心血管事件的血液透析患者(MHD组),检测血浆25(OH)D及脑钠肽(BNP)水平,同时应用心脏超声心动图测定左室射血分数(LVEF)、左心室舒张末内径(LVDd)、室间隔厚度(IVST)、左心室后壁厚度(LVPWT),计算左心室心肌重量指数(LVMI),分析MHD患者血浆25(OH)D水平及25(OH)D缺乏与心脏结构和功能的关系.另选择健康人群20例作为对照组.结果 MHD组25(OH)D水平较对照组降低[(34.74±16.17)nmol/Lvs.(53.23±21.85)nmol/L](P＜0.01).以≤50 nmol/L为维生素D缺乏,MHD患者维生素D缺乏患者35例(81.4％).25(OH)D浓度与BNP、LVMI呈负相关,与LVEF值呈正相关.结论 MHD患者维生素D缺乏的患病率较肾功能正常组明显增高,维生素D为影响心脏结构和功能的独立危险因素.