维生素D缺乏与老年非瓣膜性心房颤动的研究

目的探讨血清25-羟维生素D水平缺乏与老年非瓣膜性心房颤动(房颤)的关系。方法选择老年患者902例,其中非瓣膜性房颤患者575例(房颤组)及窦性心律患者327例(对照组)。记录12导联心电图,测定高敏C反应蛋白(hs-CRP)、甲状旁腺激素和肝肾功能指标;化学发光分析仪测定25-羟维生素D和促甲状腺激素,心脏彩色超声检查测定LVEF、左心室收缩末期内径、左心室舒张末期内径、室间隔厚度和左心房内径,对2组各参数进行比较,并对房颤与血清25-羟维生素D水平和超声参数进行多因素逐步logistic回归分析。结果房颤组25-羟维生素D水平较对照组明显降低(14.66±13.01)nmol/L vs (21.02±12.61)nmol/L,P=0.000];房颤组甲状旁腺激素和hs-CRP水平较对照组明显增高,差异有统计学意义(P<0.05,P<0.01)。房颤组左心房内径较对照组明显增大,差异有统计学意义(P<0.01)。多因素逐步logistic回归分析显示,房颤与血清25-羟维生素D水平呈负相关(HR=0.820,95%CI:0.768~0.900,P=0.000),与hs-CRP、左心房内径和年龄呈正相关(HR=1.127,95%CI:1.012~1.228,P=0.000;HR=2.320,95%CI:1.822~3.876,P=0.000;HR=1.150,95%CI:1.057~1.162,P=0.000)。结论维生素D缺乏与老年非瓣膜性房颤有关。

Relationship between vitamin D deficiency and non-valvular atrial fibrillation in the elderly

Objective To study the relationship between vitamin D deficiency and non-valvular AF in the elderly.Methods Nine hundred and two elderly patients admitted to our hospital were divided into AF group(n=575)and control group(n=327).Their 12-lead ECG paprameters,hepatic and renal function were recorded,their serum levels of hs-CRP and parathyroid hormone(PTH),vitamin D and thyroid stimulating hormone,LVEF,left ventricular end systolic diameter,left ventricular end diastolic diameter,ventricular septal thickness and left atrial diameter(LAD)were measured and compared.The incidence of AF,serum vitamin D level and ultrasonographic parameters in two groups were analyzed by stepwise logistic regression analysis.Results The serum levels of vitamin D were significantly lower in AF group than in control group(14.66±13.01 nmol/L vs 21.02±12.61 nmol/L,P=0.000)while those of PTH and hs-CRP were significantly higher and the LAD was significantly longer in AF group than in control group(P<0.05,P<0.01).Multivariate stepwise logistic regression analysis showed that AF was negatively related with serum vitamin D level and positively related with serum hs-CRP level and age(HR=0.820,95%CI:0.768-0.900,P=0.000;HR=1.127,95%CI:1.012-1.228,P=0.000;HR=2.320,95%CI:1.822-3.876,P=0.000;HR=1.150,95%CI:1.057-1.162,P=0.000).Conclusion Vitamin D deficiency is related with non-valvular AF in the elderly.