25(OH)维生素D水平与颈动脉内中膜厚度的相关性研究
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摘要
目的探讨25(OH)维生素D水平与颈动脉内-中膜厚度(CIMT)及颈动脉斑块发生的相关性。方法将748例体检人员根据25(OH)维生素D水平分为4组,即Q1组(183例,<8.23 ng/dl)、Q2组(190例,8.23～15.57 ng/dl)、Q3组(194例,15.58～23.99 ng/dl)、Q4组(181例,>23.99 ng/dl)。对比分析4组研究对象临床、生化指标、颈动脉中膜厚度、颈动脉斑块发生率,并进一步分析25(OH)维生素D水平与CIMT及颈动脉斑块发生的关系。结果 4组患者空腹血糖(FPG)、高密度脂蛋白胆固醇(HDL)、低密度脂蛋白胆固醇(LDL)、钙(Ca)、磷(P)、 CIMT比较差异有统计学意义意义(P<0.05)。Q1组CIMT>Q2、Q3组,Q4组CIMT厚度指数最低(P<0.05)。Q1组颈动脉斑块的发生率明显高于其他3组患者,而Q4组最低,差异有统计学意义(P<0.05)。Spearman线性相关分析发现,CIMT与年龄、BMI、吸烟、糖尿病、高血压病、SBp、LDL呈正相关性,与HDL、25(OH)维生素D水平呈负相关性。将与CIMT相关的各变量和颈动脉斑块进行Logistic回归分析显示,年龄、糖尿病、LDL和维生素D是颈动脉斑块发生的危险因素。结论维生素D水平与CIMT密切相关,维生素D缺乏可能是颈动脉斑块发生的危险因素之一。
Objective To investigate the relationship between the level of 25(OH)Vit D and Carotid Intima-Media Thickness(CIMT) and Carotid plaque incidence.Methods 748 medical examinees were divided into four groups according to the levels of 25(OH)Vit D: Q1 group(183 cases,< 8.23 ng/dl),Q2 group(190 cases,8.23～15.57 ng/dl),Q3 group(194 cases,15.58～23.99 ng/dl),Q4 group(181 cases,> 23.99 ng/dl),with a comparative score. Retrospective cross-sectional studies were conducted to examine the relationship 25(OH)Vit D,Carotid Intima Media Thickness and Carotid plaque incidence.Results The comparison of clinical indexes among the four groups showed that there were significant differences in FPG,HDL,LDL,Ca,P and CIMT(P<0.05). The CIMT of Q1 group was higher than that of Q2 and Q3 group. The Q4 group was the lowest(P<0.05). The incidence of carotid plaques in Q1 group was significantly higher than that in the other three groups,and the Q4 group was the lowest(P<0.05). Spearman linear correlation analysis showed that CIMT was positively correlated with BMI,smoking,diabetes mellitus,hypertension and SBp,LDL. There were negative correlations between CIMT and HDL,25(OH)Vit D. The Logistic regression analysis between the variables and carotid plaque showed that age,diabetes mellitus and 25(OH)Vit D were risk factors for carotid plaque incidence.Conclusions 25(OH)Vit D was closed related with carotid intima-media thickness and could be regarded as a risk factor of the carotid plaque incidence.
Objective To investigate the relationship between the level of 25(OH)Vit D and Carotid Intima-Media Thickness(CIMT) and Carotid plaque incidence.Methods 748 medical examinees were divided into four groups according to the levels of 25(OH)Vit D: Q1 group(183 cases,< 8.23 ng/dl),Q2 group(190 cases,8.23～15.57 ng/dl),Q3 group(194 cases,15.58～23.99 ng/dl),Q4 group(181 cases,> 23.99 ng/dl),with a comparative score. Retrospective cross-sectional studies were conducted to examine the relationship 25(OH)Vit D,Carotid Intima Media Thickness and Carotid plaque incidence.Results The comparison of clinical indexes among the four groups showed that there were significant differences in FPG,HDL,LDL,Ca,P and CIMT(P<0.05). The CIMT of Q1 group was higher than that of Q2 and Q3 group. The Q4 group was the lowest(P<0.05). The incidence of carotid plaques in Q1 group was significantly higher than that in the other three groups,and the Q4 group was the lowest(P<0.05). Spearman linear correlation analysis showed that CIMT was positively correlated with BMI,smoking,diabetes mellitus,hypertension and SBp,LDL. There were negative correlations between CIMT and HDL,25(OH)Vit D. The Logistic regression analysis between the variables and carotid plaque showed that age,diabetes mellitus and 25(OH)Vit D were risk factors for carotid plaque incidence.Conclusions 25(OH)Vit D was closed related with carotid intima-media thickness and could be regarded as a risk factor of the carotid plaque incidence.
引文
[1] 赵静,张倩,张环美,等.北京市怀柔区儿童维生素D营养状况及其成分的关系[J].中华流行病学杂志,2010,31(1):34-38.
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[9] 贾灿萍,杨宇,张旭东,等.老年高血压患者维生素D水平与晨峰血压关系的临床分析[J].中华老年医学杂志,2017,36(1):44-48.
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[11] Targher G,Bertolini L,Padovani RA,et al.Serum 25-hydroxyvitamin D3 concentrations and carotid artery intima-media thickness among type 2 diabetic patients[J].Clinical Endocrinology,2006,65(5):593-597.
[12] Reynolds JA,Haque Sahena,Berry JL,et al.25-Hydroxyvitamin D deficiency is associated with increased aortic stiffness in patients with systemic lupus erythematosus[J].Rheumatology,2012,51(3):544-551.
[13] Portilla J,Moreno Perez O,Serna Candel C et al.Vitamin D insufficiency and subclinical atherosclerosis in non-diabetic males living with HIV[J].J Int AIDS Soc,2014,17:18945.
[14] Hao Yaping,Ma Xiaojing,Luo Yuqi,et al.Inverse association of serum vitamin D in relation to carotid intima-media thickness in Chinese postmenopausal women[J].PLOS One,2015,10(3):0122803.
[15] Huff H,Merchant AT,Lonn E,et al.Vintamin D and progression of carotid intima-media thickness in HIV-positive Canadians[J].HIV Medicine,2018,19(2):143-151.
[16] 孙振杰,于锦萍,黄金玮,等.2型糖尿病患者血清25-羟维生素D水平与颈动脉内-中膜厚度的相关性分析[J].中国糖尿病杂志,2017,25(3):199-203.
[17] Rammos G,Tseke P,Ziakka S.Vitamin D,the rennin-angioten- sin system and insulin resistance[J].Int Urol Nephrol,2008,40:419-426.
[18] 林寰,东高键,马慧,等.中老年人群25-羟维生素D与代谢综合征关系的研究[J].中华内分泌代谢杂志,2013,29:840-845.
[19] Orgaz Molina J,Magro Checa C,Rosales Alexander JL et al.Vitamin D insufficiency is associated with higher carotid intima-media thickness in psoriatic patients[J].Eur J Dermatol,2014,24:53-62.
[20] Oruc CU,Akpinar Y,Amikishiyev S,et al.Gurdol F1,Omer B[J].Hypovitaminosis D Is Associated With Endothelial Dysfunction in Patients With Metabolic Syndrome[J].Curr Vasc Pharmacol,2017,15(2):152-157.
[21] Singh J,Merrill ED,Sandesara PB,et al.Vitamin D,Low-Grade inflammation and cardiovascular risk in young children:a pilot study[J].Pediatric Cardiology,2015,36(7):1338-1343.
[2] Gozdzik A,Barta JL,Weir A,et al.Serum 25-hydroxyvitaminD concentrations fluctuate seasonally in young adults of diverse ancestry living in Toronto[J].Journal of Nutrition,2010,140:2213-2220.
[3] Oruc CU,Akpinar YE,Amikishiyev SA,et al.Hypovitaminosis D is Associated with Endothelial Dysfunction in Patients with Metabolic Syndrome[J].Current Vascular Pharmacology,2017,15(2):152-157.
[4] Halilolu ?,Kasaci T,Yavuz D.Seasonal vitamin D status and endothelial function in healthcare workers[J].Turkish Journal of Medical Sciences,2016,46(1):72-78.
[5] Winckler K,Tarnow L,Lundby Christensen LA,et al.Vitamin D,carotid intima-media thickness and bone structure in patients with type 2 diabetes[J].Endocrine Connections,2015,4(2):128-135.
[6] 何瑶,马维青,陈赟,等.2型糖尿病患者血清25-羟维生素D3与颈动脉斑块及内膜中层厚度关系[J].中华实用诊断与治疗杂志,2018,32(2):162-165.
[7] Shaharyar S,Warraich H,McEvoy JW,et al.Ubclinical cardiovascular disease in plaque psoriasis:association or causal link[J].Atherosclerosis,2014,232(1):72.
[8] 代永红,耿艳秋,刘建光,等.2型糖尿病患者血清维生素D水平及影响因素分析[J].临床内科杂志,2014,31(2):132-133.
[9] 贾灿萍,杨宇,张旭东,等.老年高血压患者维生素D水平与晨峰血压关系的临床分析[J].中华老年医学杂志,2017,36(1):44-48.
[10] 褚琳,孙芳,刘杰,等.高龄患者25-羟维生素D水平与代谢综合征的相关性研究[J].中华老年心脑血管病杂志,2014,16(12):1279-1282.
[11] Targher G,Bertolini L,Padovani RA,et al.Serum 25-hydroxyvitamin D3 concentrations and carotid artery intima-media thickness among type 2 diabetic patients[J].Clinical Endocrinology,2006,65(5):593-597.
[12] Reynolds JA,Haque Sahena,Berry JL,et al.25-Hydroxyvitamin D deficiency is associated with increased aortic stiffness in patients with systemic lupus erythematosus[J].Rheumatology,2012,51(3):544-551.
[13] Portilla J,Moreno Perez O,Serna Candel C et al.Vitamin D insufficiency and subclinical atherosclerosis in non-diabetic males living with HIV[J].J Int AIDS Soc,2014,17:18945.
[14] Hao Yaping,Ma Xiaojing,Luo Yuqi,et al.Inverse association of serum vitamin D in relation to carotid intima-media thickness in Chinese postmenopausal women[J].PLOS One,2015,10(3):0122803.
[15] Huff H,Merchant AT,Lonn E,et al.Vintamin D and progression of carotid intima-media thickness in HIV-positive Canadians[J].HIV Medicine,2018,19(2):143-151.
[16] 孙振杰,于锦萍,黄金玮,等.2型糖尿病患者血清25-羟维生素D水平与颈动脉内-中膜厚度的相关性分析[J].中国糖尿病杂志,2017,25(3):199-203.
[17] Rammos G,Tseke P,Ziakka S.Vitamin D,the rennin-angioten- sin system and insulin resistance[J].Int Urol Nephrol,2008,40:419-426.
[18] 林寰,东高键,马慧,等.中老年人群25-羟维生素D与代谢综合征关系的研究[J].中华内分泌代谢杂志,2013,29:840-845.
[19] Orgaz Molina J,Magro Checa C,Rosales Alexander JL et al.Vitamin D insufficiency is associated with higher carotid intima-media thickness in psoriatic patients[J].Eur J Dermatol,2014,24:53-62.
[20] Oruc CU,Akpinar Y,Amikishiyev S,et al.Gurdol F1,Omer B[J].Hypovitaminosis D Is Associated With Endothelial Dysfunction in Patients With Metabolic Syndrome[J].Curr Vasc Pharmacol,2017,15(2):152-157.
[21] Singh J,Merrill ED,Sandesara PB,et al.Vitamin D,Low-Grade inflammation and cardiovascular risk in young children:a pilot study[J].Pediatric Cardiology,2015,36(7):1338-1343.