原发性高血压患者25羟基维生素D水平与血管内皮功能及血浆肾素活性的相关性
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摘要
目的探讨原发性高血压患者25羟基维生素D[25(OH)D]水平与血管内皮功能及血浆肾素活性(PRA)的相关性。方法选择2015年12月至2016年10月在河南省人民医院确诊的原发性高血压患者216例为研究对象。采用电化学发光法测血清25(OH)D水平。根据25(OH)D水平将患者分为两组,维生素D缺乏组[25(OH)D<50 nmol/L(20 ng/mL),n=123]和维生素D非缺乏组[25(OH)D≥50 nmol/L,n=93]。利用Endo-PAT 2000内皮功能检测仪器测定反应性充血指数(RHI),采用化学发光法测定血浆肾素活性。结果维生素D缺乏组的RHI值低于维生素D非缺乏组(1.53±0.30比1.78±0.17,P<0.05),而立位PRA高于维生素D非缺乏组[(3.86±0.78)比(3.35±0.47)μg/(L·h),P<0.05]。相关性分析提示维生素D水平与RHI值呈正相关,与立位PRA呈负相关。多元线性逐步回归分析显示,25(OH)D和总胆固醇是RHI的独立影响因素(β=0.505、-0.173,P<0.01)。25(OH)D和24 h平均心率是立位PRA的独立影响因素(β=-0.565、0.293,P<0.01)。结论原发性高血压患者伴维生素D缺乏者血管内皮功能低于维生素D非缺乏组,而立位PRA高于维生素D非缺乏组,25(OH)D是血管内皮功能及立位PRA的独立影响因素。
Objective To investigate the relationship between 25-hydroxyvitamin D [25(OH)D], endothelial function and plasma renin activity(PRA) in patients with essential hypertension(EH). Methods A total of 216 EH patients in Henan Province People's Hospital were recruited and divided into vitamin D deficiency group [25(OH)D<50 nmol/L(20 ng/mL), n=123] and non-deficiency group [25(OH)D≥50 nmol/L, n=93] according to 25(OH)D measured by electrochemiluminescence. The reactive hyperemia index(RHI) was detected by Endo-PAT 2000 device and the PRA was measured by chemiluminescence. Results Compared with vitamin D non-deficiency group, the RHI was lower(1.53±0.30 vs 1.78±0.17, P<0.05) and PRA was higher [(3.86±0.78) vs(3.35±0.47) μg/(L·h), P<0.05] in deficiency group. Correlation analysis showed that 25(OH)D was correlated with RHI and PRA. Multivariate liner analysis showed that 25(OH)D and total cholesterol were independent influence factors of RHI(β=0.505,-0.173, P<0.01); 25(OH)D and 24 h heart rate were independent influence factors of the PRA(β=-0.565,0.293, P<0.01). Conclusion Vascular endothelial function in patients with essential hypertension and vitamin D deficiency is lower, while standing PRA is higher, than that in vitamin D non-deficiency group.25(OH)D is an independent influence factor of vascular endothelial function and standing PRA.
Objective To investigate the relationship between 25-hydroxyvitamin D [25(OH)D], endothelial function and plasma renin activity(PRA) in patients with essential hypertension(EH). Methods A total of 216 EH patients in Henan Province People's Hospital were recruited and divided into vitamin D deficiency group [25(OH)D<50 nmol/L(20 ng/mL), n=123] and non-deficiency group [25(OH)D≥50 nmol/L, n=93] according to 25(OH)D measured by electrochemiluminescence. The reactive hyperemia index(RHI) was detected by Endo-PAT 2000 device and the PRA was measured by chemiluminescence. Results Compared with vitamin D non-deficiency group, the RHI was lower(1.53±0.30 vs 1.78±0.17, P<0.05) and PRA was higher [(3.86±0.78) vs(3.35±0.47) μg/(L·h), P<0.05] in deficiency group. Correlation analysis showed that 25(OH)D was correlated with RHI and PRA. Multivariate liner analysis showed that 25(OH)D and total cholesterol were independent influence factors of RHI(β=0.505,-0.173, P<0.01); 25(OH)D and 24 h heart rate were independent influence factors of the PRA(β=-0.565,0.293, P<0.01). Conclusion Vascular endothelial function in patients with essential hypertension and vitamin D deficiency is lower, while standing PRA is higher, than that in vitamin D non-deficiency group.25(OH)D is an independent influence factor of vascular endothelial function and standing PRA.
引文
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[14] Ertek S, Akgul E, Arrigo F, et al. 25-Hydroxy vitamin D levels and endothelial vasodilator function in normotensive women[J].Arch Med,2012,8(1):47-52.
[15] Azizah M, Ammar H, Ashor W, et al. Effects of vitamin D supplementation on endothelial function: a systematic review and meta-analysis of randomised clinical trials[J].Eur J Nutr,2016,2(16):1159-1163.
[16] Carrara D, MariaBruno R. Cholecalciferol treatment downregulates rennin angiotensin systemand improves endothelial function in essential hypertensive patients with hypovitaminosid D[J].J Hypertens,2016,34(11):2199-2205.
[17] Bonetti PO, Pumper GM, Higano ST, et al. Noninvasive identification of patients with early coronary atherosclerosis by assessment of digital reactive hyperemia[J].J Am Coll Cardiol,2004,44(11):2137-2141.
[18] Bonetti PO. Research highlights -editorial review of a noninvasive test for endothelial dysfunction[J].Nat Clin Pract Cardiovasc Med,2005,2(1):64-65.
[19] Celermajer DS. Reliable endothelial function testing:at our fingertips?[J].Circulation,2008,117(19):2428-2430.
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[21] 贾瑶,孙宁玲,高竞生,等. 原发性高血压患者血浆25羟基维生素D与血浆肾素活性、血压及动脉弹性的相关性[J].中华高血压杂志,2013,21(11):1023-1027.
[22] Li YC, Kong J, Wei M, et al. 1,25-dihydroxyvitamin D is a negative endocrine regulator of the rennin-angiotensin system[J].J Clin Invest,2002,110(2):229-238.
[2] John P, Forman MD, Jonathan S. Plasma 25-hydroxy vitamin D and regulation of the renin-angiotensin system in humans[J].Hypertension,2010,55(5):283-288.
[3] 中国高血压防治指南修订委员会. 中国高血压防治指南2010[J].中华高血压杂志,2011,19(8):701-743.
[4] FunderJW, Carey RM. The management of primary aldosteronism:case detection, diagnosis,and treatment: an Endocrine Society clinical practice guideline[J].J Clin Endocrinol Metab,2016,2(25):1-30.
[5] Pilz S, Tomaschitz A, Ritz E, et al. Vitamin D status and arterial hypertension: A systematic review[J].Nat Rev Cardiol,2009,6(10):621-630.
[6] Holick MF, Binkley NC. Evaluation,treatment and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline[J].J Clin Endocrinol Metab,2011,96(7):1-20.
[7] Pfotenhauer KM, Shubrook JH. Vitamin D deficiency, its role in health and disease, and current supplementation recommendations[J].J Am Osteopath Assoc,2017,117(5):301-305.
[8] Kuloglu O. Serum 25-hydroxyvitamin D level is associated with arterial stiffness, left ventricle hypertrophy, and inflammation in newly diagnosed hypertension[J].J Investig Med, 2013, 61(6): 989-994.
[9] Reis JP, Von Mublen D. Serum vitamin D, parathyoid hormone levels,and carotid atherosclerosis[J].Atheroscleosis,2011,207(2):585-590.
[10] 陈玉岚,靳晨晨,徐新娟,等. 原发性高血压患者维生素D与动脉僵硬度的相关性研究[J].新疆医科大学学报,2013,36(8):1059-1063.
[11] 何珊珊,王留义,郭雷生,等. 不稳定型心绞痛患者血管内皮功能与同型半胱氨酸及颈动脉内膜中膜厚度相关[J].中国动脉硬化杂志,2016,24(7):705-709.
[12] Cardus A, Parisi E, Gallego C, et al. 1,25-dihydroxy vitamin D stimulates vascular smooth muscle cell proliferation through a VEGF-mediated pathway[J].Kidney Int,2006,69(8):1377-1384.
[13] Tare M, Emmett SJ, Coleman HA, et al. Vitamin D insufficiency is associated with impaired vascular endothelial and smooth muscle function and hypertension in young rats[J].J Physiol,2011,19(8):4777-4786.
[14] Ertek S, Akgul E, Arrigo F, et al. 25-Hydroxy vitamin D levels and endothelial vasodilator function in normotensive women[J].Arch Med,2012,8(1):47-52.
[15] Azizah M, Ammar H, Ashor W, et al. Effects of vitamin D supplementation on endothelial function: a systematic review and meta-analysis of randomised clinical trials[J].Eur J Nutr,2016,2(16):1159-1163.
[16] Carrara D, MariaBruno R. Cholecalciferol treatment downregulates rennin angiotensin systemand improves endothelial function in essential hypertensive patients with hypovitaminosid D[J].J Hypertens,2016,34(11):2199-2205.
[17] Bonetti PO, Pumper GM, Higano ST, et al. Noninvasive identification of patients with early coronary atherosclerosis by assessment of digital reactive hyperemia[J].J Am Coll Cardiol,2004,44(11):2137-2141.
[18] Bonetti PO. Research highlights -editorial review of a noninvasive test for endothelial dysfunction[J].Nat Clin Pract Cardiovasc Med,2005,2(1):64-65.
[19] Celermajer DS. Reliable endothelial function testing:at our fingertips?[J].Circulation,2008,117(19):2428-2430.
[20] Matsuzawa Y, Sugiyama S, Sumida H,et al. Peripheral endothelial function and cardiovascular events in high risk patients[J].J Am Heart Assoc,2013,2(6):e000426.
[21] 贾瑶,孙宁玲,高竞生,等. 原发性高血压患者血浆25羟基维生素D与血浆肾素活性、血压及动脉弹性的相关性[J].中华高血压杂志,2013,21(11):1023-1027.
[22] Li YC, Kong J, Wei M, et al. 1,25-dihydroxyvitamin D is a negative endocrine regulator of the rennin-angiotensin system[J].J Clin Invest,2002,110(2):229-238.
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