补充维生素D对冠心病患者冠状动脉病变程度的影响

目的:探讨维生素D干预对冠心病患者冠状动脉Gensini评分的影响及其相关性。方法:采用前瞻性研究方法,选择109例行冠脉CT的冠心病患者为研究对象。将患者分为对照组和干预组,均给予冠心病二级预防药物治疗,干预组加用维D钙片口服及维生素D2肌肉注射治疗。观察两组患者治疗前后各临床指标及冠状动脉Gensini评分的变化,分析各临床指标、维生素D与冠状动脉Gensini评分的相关性。结果:干预组患者治疗后三酰甘油(TG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、血磷、红细胞沉降率(ESR)、超敏C反应蛋白(hs-CRP)水平和冠状动脉Gensini评分均低于治疗前(P<0.05),高密度脂蛋白胆固醇(HDL-C)、血钙、25羟维生素D25(OH)D]均高于治疗前(P<0.05)。干预组治疗前后TC、LDL-C、钙、25(OH)D、ESR、hs-CRP及冠状动脉Gensini评分的差值大于对照组(P<0.05)。Pearson相关分析显示,补充维生素D与否、年龄、LDL-C、HDL-C、TC、空腹血糖(FPG)、糖化血红蛋白(HbA1c)、hs-CRP、维生素D水平与冠状动脉Gensini评分明显相关,相关系数分别为-0.519、0.357、0.725、-0.632、0.419、0.290、0.327、0.599、-0.478;多因素线性回归分析显示,LDL-C、hs-CRP升高是冠状动脉病变的危险因素(Gensini评分增加),补充维生素D及HDL-C、维生素D水平升高是冠状动脉病变的保护性因素(Gensini评分减小)。结论:血清维生素D水平与冠状动脉严重程度负相关,提高25(OH)D水平可降低冠心病患者冠状动脉病变严重程度。

Effect of vitamin D supplementation on degree of coronary artery disease

Objective: To investigate the effect of vitamin D intervention on the Gensini score of coronary arteries in coronary heart disease (CHD) patients and their correlation. Methods: The data of 109 patients underwent coronary artery CT examine were prospective studied. The patients were divided into the control group and the intervention group. Patients in two groups were treated with secondary prevention of CHD. The intervention group was treated with vitamin D calcium tablets orally and vitamin D2 intramuscularly. The changes in clinical indexes and Gensini score of coronary arteries before and after treatment in the two groups were observed. The correlations between clinical indexes, vitamin D and Gensini score of coronary arteries were analyzed. Results: In experimental group, the levels of triacylglycerol (TG), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), serum phosphorus, erythrocyte sedimentation rate (ESR), high-sensitivity C-reactive protein (hs-CRP), and Gensini score after treatment were all lower than before treatment (P<0.05), while the levels of high-density lipoprotein cholesterol (HDL-C), serum calcium, 25(OH)D were higher after treatment than before treatment (P<0.05). The differences of TC, LDL-C, Ca, 25(OH)D, ESR, hs-CRP, and Gensini score in the control group before and after treatment were higher than those in the experimental group (P<0.05). Pearson correlation analysis results showed that there were significant correlations between taking vitamin D supplements or not, age, LDL-C, HDL-C, TC, fasting plasma glucose (FPG), glycated hemoglobin (HbA_1c), hs-CRP, 25(OH)D, and Gensini score. The correlation coefficients were -0.519,0.357,0.725,-0.632,0.419,0.290,0.327,0.599, and -0.478, respectively. The multivariate linear correlation analysis results showed that the increases of LDL-C and hs-CRP were risk factors of CHD (Gensini score increased), and taking vitamin D supplements, and the levels of HDL-C and 25(OH)D were protecting factors of CHD (Gensini score decreased). Conclusions: 25(OH)D is negatively correlated with Gensini score of coronary arteries and increasing the level of 25(OH)D may alleviate the severity of CHD.