25羟维生素D水平与心血管疾病关系的Meta分析

目的定量评价25羟维生素D水平与心血管疾病的关系。方法检索以中英文全文发表的,研究体内25羟维生素D水平与心血管疾病关系的定量研究;采用Meta分析方法,应用Stata 11.0软件进行数据处理,对入选的8篇文献进行综合定量分析,并按国家、样本量对研究冠心病的文献进行亚组分析。结果 Meta分析表明25羟维生素D水平与心血管疾病发病相关,冠心病患者血清25羟维生素D水平较普通人群低1.66 ng/ml,心衰病人体内25羟维生素D较普通人群低10.17 ng/ml。25羟维生素D水平与冠心病的亚组分析结果显示,同欧洲冠心病人群相比,北美洲冠心病患者血清25羟维生素D降低的程度更明显(北美:WMD=-2.15;欧洲:WMD=-0.96),且在样本量过千的研究中体现的更加明显(WMD=-2.15,95%CI:-3.32~-0.98)。结论心血管疾病患者体内25羟维生素D水平明显低于正常人,心衰患者降低程度更为明显,提示可通过补充维生素D降低心血管疾病的发病率。     

慢性肾脏病1～3期患者25（OH）D水平的影响因素

目的 通过调查慢性肾脏病（CKD）1～3期患者25（OH）D水平,探讨25（OH）D的影响因素,为CKD患者早期进行维生素D缺乏的预防及治疗提供依据.方法 采用放射免疫法检测89例CKD 1 ～3期患者25（OH）D水平,采用自动生化仪测定血钙、磷、碱性磷酸酶、总蛋白、白蛋白、肌酐,24 h尿蛋白定量及微量清蛋白、尿钙等.采用单因素相关分析探讨25 （OH）D的影响因素.25（OH）D的独立影响因素采用多元线性回归分析.结果 89例CKD患者25（OH）D水平中位数11.0 μg/L,全距3.0 ～ 39.0 μg/L,维生素D不足者占28.1％（25/89）,缺乏者占68.5％（61/89）.CKD1～3期各期间25（OH）D比较差异无统计学意义（P＞0.05）.单因素相关分析提示：25（OH）D与激素使用、校正钙、促甲状腺激素、24 h尿蛋白定量、24 h尿微量白蛋白呈负相关,与总蛋白及白蛋白呈正相关.多元线性回归分析提示：校正钙、白蛋白是25（OH）D水平的独立影响因素.结论 CKD 1 ～3期患者普遍存在维生素D缺乏,校正钙、白蛋白是25（OH）D水平的独立影响因素.     

Effects of vitamin D supplementation on 25-hydroxyvitamin D,high-density lipoprotein cholesterol,and other cardiovascular disease risk markers in subjects with elevated waist circumference

The objective of the present trial was to assess the effects of vitamin D supplementation on serum 25-hydroxyvitamin D [25(OH)D] and high-density lipoprotein cholesterol (HDL-C) in subjects with high waist circumference. Subjects were randomly assigned a daily multivitamin and mineral (MVM) supplement or a MVM supplement plus vitamin D 1,200 IU/day (MVM+D) for 8 weeks. There was a significant difference in mean change for 25(OH)D between the MVM and MVM+D treatment groups ( ? 1.2 ± 2.5 nmol/l vs. 11.7 ± 3.0 nmol/l, respectively; P = 0.003). Vitamin D 1,200 IU/day did not increase 25(OH)D to a desirable level ( ≥ 75 nmol/l) in 61% of participants. There were no significant changes in cardiovascular disease risk markers. Thus, vitamin D supplementation with 1,200 IU/day was insufficient to achieve desirable serum 25(OH)D in most participants and did not affect cardiovascular disease risk markers.     

炎症性肠病老年患者血清25-羟维生素D及维生素D1-α-羟化酶水平相关性

目的 探讨老年炎症性肠病（IBD）患者血清25-羧维生素D与维生素D1-α羟化酶（CYP27B1）表达水平及其与疾病严重程度的相关性。方法 以自贡市第四人民医院消化内科于2015—2018年期间诊治的所有≥60岁IBD患者为研究对象,选择同时期进行健康体检的老年人作为对照组。对病例组和对照组血清25-羟维生素D水平及CYP27B1的表达情况进行分析。结果 本研究共纳入IBD老年患者93例,男性58例,女性35例,平均年龄（64.7 ± 5.1）岁,对照组50人,男性31人,女性19人,平均年龄（63.7 ± 4.8）岁,病例组和对照组平均年龄及性别构成差异均无统计学意义（均P>0.05）。病例明确诊断为溃疡性结肠炎（UC）的48例,克罗恩病（CD ）45例。UC、CD和对照组的25-羟维生素D检测值分别为（11.06 ± 4.14）、（12.51 ± 4.77）、（16.26 ± 5.23）ng/mL,CYP27B1表达IHC评分分别为（9.5 ± 1.1）、（9.3 ± 1.3）、（3.4 ± 0.6）,差异均有统计学意义（均P<0.01）。2组患者25-羟维生素D水平与疾病活动程度评分均呈负相关关系（r=-0.325、-0.382）,CYP27B1表达IHC评分均与疾病活动度评分呈正相关关系（r=0.413、0.371）。结论 老年IBD患者中血清25-羧维生素D水平显著低于正常人群,而CYP27B1表达高于正常人群,并与病情的严重程度相关。     

四川省0~3岁婴幼儿25-羟维生素D营养状况的调查

目的：了解儿童保健门诊0~3岁婴幼儿25-羟维生素D水平及缺乏率。方法对2013年4月至2014年3月在四川省妇幼保健院儿童保健门诊就诊的0~3岁儿童1941例进行维生素D检测。结果0~3岁婴幼儿维生素D平均水平为(34.2±16.9)ng/mL,不同性别差异无统计学意义(t=1.46,P=0.14)。0~3岁婴幼儿维生素D缺乏率分别为3.4%、3.1%、7.0%、18.8%。不同年龄组维生素D水平及维生素D缺乏率差异有统计学意义(t=3.95,χ2=8.1;均P<0.05)。结论研究对象中2~3岁幼儿25-羟维生素D水平相对较低,2岁后维生素D缺乏有逐年升高的趋势,值得关注。     

Serum 25-hydroxyvitamin D levels among Boston trainee doctors in winter

As indoor workers, trainee doctors may be at risk for inadequate vitamin D. All trainee doctors (residents) in a Boston pediatric training program (residency) were invited to complete a survey, and undergo testing for serum 25-hydroxyvitamin D [25(OH)D], PTH, and calcium during a 3-week period in March 2010. We examined the association between resident characteristics and serum 25(OH)D using Chi2 and Kruskal-Wallis test and multivariable linear and logistic regression. Of the 119 residents, 102 (86%) participated. Although the mean serum 25(OH)D level was 67 nmol/L (±26), 25 (25%) had a level <50 nmol/L and 3 (3%) residents had levels <25 nmol/L. In the multivariable model, factors associated with 25(OH)D levels were: female sex (β 12.7, 95% CI 3.6, 21.7), white race (β 21.7, 95% CI 11.7, 31.7), travel to more equatorial latitudes during the past 3 months (β 6.3, 95% CI 2.0, 10.5) and higher daily intake of vitamin D (β 1.1, 95% CI 0.04, 2.1). Although one in four residents in our study had a serum 25(OH)D <50 nmol/L, all of them would have been missed using current Centers for Medicare and Medicaid Services (CMS) screening guidelines. The use of traditional risk factors appears insufficient to identify low vitamin D in indoor workers at northern latitudes.     

血清25-羟维生素D水平与2型糖尿病的关系

目的 研究血清维生素D水平在2型糖尿病发病过程中的作用。方法采用随机分层抽样,共589例志愿者纳入本研究。根据空腹血糖及口服葡萄糖耐量试验结果将志愿者区分为糖尿病人群及非糖尿病人群。共计249例检测了血清25-羟维生素D水平,应用二元Logistic回归分析糖尿病与相关因素的关系,应用Cox—Staurt趋势检验分析各年龄段血清25-羟维生素D水平,按血清25（OH）D四分位值分层,分别计算糖尿病患病优势比OR值及95％置信区间。结果所有年龄段均存在不同程度的25-羟维生素D缺乏,调节年龄、HOMA．IR、BMI后,血清25．羟维生素D水平与糖尿病发病呈剂量依赖的负相关（r=-0．9271,P〈0．01）,当血清25-羟维生素D水平达到94．6nmol／L以上时,糖尿病发病显著降低[OR=0．52,95％CI（0．23—0．78）,P〈0．01]。结论血清25-羟维生素D水平与2型糖尿病发病呈明显负相关,血清25-羟维生素D水平降低增加糖尿病发病风险。     

Evaluation of bone mineral density and 25-hydroxyvitamin D levels in subjects with silica exposure

Objective

The purpose of the study was to evaluate the bone mineral density (BMD) and 25-hydroxyvitamin D (25(OH)D) levels in patients with silica exposure.

Materials and methods

The study included 104 male subjects with silica exposure and 36 healthy subjects. Posterior–anterior radiographs were classified according to the International Labour Office (ILO) Classification. Category 0 patients were classified as Group I (n = 54), category I patients were classified as Group II (n = 25), Category II and III patients were classified as Group III (n = 25).

Results

Femoral neck BMD values were significantly lower in Group III (p = 0.007). Lumbar vertebrae BMD values were significantly lower in all groups with silica exposure than in the control group (p = 0.000). The osteoporosis rate was significantly higher in Group III (p = 0.000). Subjects with silica exposure were determined to have diminished 25(OH)D levels (p = 0.012).

Conclusion

The results of this study demonstrated that subjects with silica exposure have diminished BMD and 25(OH)D levels.

     

血清25羟维生素D3和C反应蛋白与冠心病的相关性

目的　探讨血清25羟维生素D3［25(OH)D3］和C反应蛋白(CRP)与冠心病的相关性。方法　选择本院心脏中心疑似冠心病行冠状动脉造影检查的住院患者416例,冠状动脉狭窄Gensini积分表示冠状动脉病变的严重程度,分别检测血清25(OH)D3和CRP。根据冠状动脉造影结果分为正常冠状动脉组246例、稳定型心绞痛组110例、急性冠状动脉综合征(ACS)组60例。结果　正常冠状动脉组、稳定型心绞痛组、ACS组血清25(OH)D3分别为(33.15±20.95)、(28.93±16.45)、(15.55±5.70)nmol/L,正常冠状动脉组、稳定型心绞痛组与ACS组比较,差异均有统计学意义(均P＜0.001);正常冠状动脉组、稳定型心绞痛组、ACS组血清CRP分别为(4.33±0.12)、(5.68±0.25)、(5.73±0.31)mg/L,ACS组、稳定型心绞痛组与正常冠状动脉组比较,差异均有统计学意义(均P＜0.001)。正常冠状动脉组25(OH)D3与CRP及Gensini评分未见相关性;ACS组25(OH)D3与CRP、Gensini评分呈负相关(r=-0.026,P=0.045;r=-0.256,P=0.048),CRP与Gensini评分呈正相关(r=0.459,P＜0.001);稳定型心绞痛组25(OH)D3与CRP、Gensini评分呈负相关(r=-0.211,P=0.027;r=-0.208,P=0.029),CRP与Gensini评分呈正相关(r=0.574,P＜0.001)。结论　低水平的25(OH)D3与冠状动脉狭窄病变相关,结合CRP,低25(OH)D3可能通过炎症机制参与了冠心病的发病过程。     

Association between serum 25-hydroxyvitamin D levels and adiposity measurements in the general Korean population

BACKGROUND/OBJECTIVES

Obesity, which is a known risk factor for many chronic diseases, has also been associated with vitamin D deficiency. This study explored the relationship between serum 25-hydroxy-vitamin D [25(OH)D] concentrations and adiposity measures in a general Korean population using the most recent, nationally representative survey data.

SUBJECTS/METHODS

The study sample consisted of 4,771 Korean adults (≥ 19 years) who participated in the fifth Korean National Health and Nutrition Examination Surveys. Serum 25(OH)D was determined by radioimmunoassay. Body mass index (BMI), waist circumference (WC) and total body fat content were measured as adiposity measurements. Total body fat content was measured by dual-energy X-ray absorptiometry.

RESULTS

The serum 25(OH)D level was significantly higher in men than in women. Serum 25(OH)D concentration was positively correlated with energy intake, and it was negatively correlated with total body fat content (P < 0.0001) and percentage body fat (P < 0.0001) after adjustment for age in both sexes, while was inversely correlated with BMI only in women. In multivariable regression analysis, serum 25(OH)D was inversely associated with the total body fat content after adjustment for age, BMI, education, region, smoking, alcohol consumption, physical activity, and energy intake only in men (P = 0.0047). However, the serum 25(OH)D concentration was not associated with WC or BMI, indicators of adiposity after adjustment for potential risk factors.

CONCLUSIONS

Serum 25(OH)D concentration was independently associated with the total body fat content in a general Korean population, but it may be not associated with the indicators for estimating adiposity, such as WC or BMI.     

Public health implications of standardized 25-hydroxyvitamin D levels: A decrease in the prevalence of vitamin D deficiency among older women in Germany

Objective.

To compare the public health implications of using unstandardized immunoassay measurements of serum 25-hydroxyvitamin D [25(OH)D] concentrations versus using measurements standardized by liquid chromatography tandem-mass spectrometry (LC-MS/MS) when assessing the prevalence of 25(OH)D insufficiency and deficiency in various subgroups of individuals.

Method.

We standardized immunoassay-based measurements of 25(OH)D with LC-MS/MS in a population-based sample of 5386 women aged 50-74 recruited in 2000-2002 in Germany. We used multivariate regression to assess 25(OH)D determinants and the association of vitamin D deficiency with health status.

Results.

Prevalences of 25(OH)D levels < 50 nmol/L (insufficiency) and < 30 nmol/L (deficiency) decreased considerably by standardization. The decrease in vitamin D deficiency (from 64.4% to 17.9%) was particularly strong in March-May among women aged ≥ 65. Independent of season of blood draw and standardization, women ≥ 70 years, obese, or currently smoking had an increased risk of having 25(OH)D levels < 30 nmol/L.

Conclusion.

The proportion of older women with vitamin D deficiency in Germany is much lower than previously reported, but prevalence of vitamin D insufficiency is high. Standardization of 25(OH)D values by immunoassay methods to LC-MS/MS equivalent values or direct measurement by LC-MS/MS is indispensable in drawing valid conclusions about the health implications of vitamin D deficiency or insufficiency.     

Correlation between 25-hydroxyvitamin D/D3 Deficiency and COVID-19 Disease Severity in Adults from Northern Colorado

Vitamin D deficiency is common in the United States and leads to altered immune function, including T cell and macrophage activity that may impact responses to SARS-CoV-2 infection. This study investigated 131 adults with a history of a positive SARS-CoV-2 nasopharyngeal PCR and 18 adults with no COVID-19 diagnosis that were recruited from the community or hospital into the Northern Colorado Coronavirus Biorepository (NoCo-COBIO). Participants consented to enrollment for a period of 6 months and provided biospecimens at multiple visits for longitudinal analysis. Plasma 25-hydroxyvitamin D levels were quantified by LC-MS/MS at the initial visit (n = 149) and after 4 months (n = 89). Adults were classified as deficient (<30 nM or <12 ng/mL), insufficient (<30–50 nM or 12–20 ng/mL), or optimal (50–75 nM or >20 ng/mL) for 25-hydroxyvitamin D status. Fisher’s exact test demonstrated an association between disease severity, gender, and body mass index (BMI) at baseline. Mixed model analyses with Tukey-Kramer were used for longitudinal analysis according to BMI. Sixty-nine percent (n = 103) of the entire cohort had optimal levels of total 25(OH)D, 22% (n = 32) had insufficient levels, and 9% (n = 14) had deficent levels. Participants with severe disease (n = 37) had significantly lower 25-hydroxyvitamin D (total 25(OH)D) when compared to adults with mild disease (p = 0.006) or no COVID-19 diagnosis (p = 0.007). There was 44% of the cohort with post-acute sequalae of COVID-19 (PASC) as defined by experiencing at least one of the following symptoms after 60 days’ post-infection: fatigue, dyspnea, joint pain, chest pain, forgetfulness or absent-mindedness, confusion, or difficulty breathing. While significant differences were detected in 25-hydroxyvitamin D status by sex and BMI, there were no correlations between 25-hydroxyvitamin D for those without and without PASC. This longitudinal study of COVID-19 survivors demonstrates an important association between sex, BMI, and disease severity for 25-hydroxyvitamin D deficiency during acute stages of infection, yet it is not clear whether supplementation efforts would influence long term outcomes such as developing PASC.     

Serum 25-hydroxyvitamin D concentrations are associated with erythrocyte levels of n-3 PUFA but not risk of CVD

Increasing evidence suggests that the status of vitamin D and n-3 PUFA is associated with the risk of CVD. Major dietary sources of vitamin D include fish and fish products, which are also rich in n-3 PUFA; however, the relationship between serum 25-hydroxyvitamin D levels and tissue contents of n-3 PUFA remains unknown. The present study investigates the hypothesis that serum 25-hydroxyvitamin D and erythrocyte n-3 PUFA levels are positively correlated in patients with CVD. We recruited sixty CVD cases and matched them with sixty healthy controls based on age, sex and season during which blood was drawn for the study. As serum 25-hydroxyvitamin D levels increased, erythrocyte levels of docosapentaenoic acid, DHA, omega-3 index and total n-3 PUFA increased significantly, while erythrocyte levels of stearic acid and total SFA decreased significantly, after adjusting for age, sex, BMI and smoking. Partial correlation analysis also showed that erythrocyte n-3 PUFA levels were positively correlated (r 0·215; P?=?0·021) and total SFA content was negatively correlated (r -?0·263; P?=?0·004) with serum 25-hydroxyvitamin D levels. However, multiple logistic regression analysis showed that serum 25-hydroxyvitamin D levels were not significantly associated with the risk of CVD, after adjusting or not adjusting for age, sex, BMI and smoking. In conclusion, the results of our case-control study suggest that serum 25-hydroxyvitamin D levels are positively related to erythrocyte n-3 PUFA levels, but are not associated with the risk of CVD in this population.     

Low serum levels of 25-hydroxyvitamin D are associated with stroke recurrence and poor functional outcomes in patients with ischemic stroke

Objective

To evaluate the association between serum 25(OH) D levels and functional outcome and stroke recurrence events in a 6-month follow-up study in a cohort of patients with an acute ischemic stroke (AIS).

Methods

From March 2014 to August 2015, consecutive first-ever AIS patients admitted to the Department of Emergency of our hospital were identified. Serum 25(OH) D levels were measured at admission. Functional outcome was evaluated at 6-month using the modified Rankin scale (m-Rankin). We used logistic regression models to assess the relationship between 25(OH) levels and risk of recurrent stroke or functional outcome.

Results

We recorded 277 stroke patients. There were significantly negative correlation between levels of 25(OH) D and NHISS (P<0.001), and the infarct volume (P< 0.001). Thirty-one patients (11.9%) had a stroke recurrence, while 82 patients (29.6) were with poor functional outcomes. In multivariate logistic regression analyses, serum 25(OH) D level was an independent marker of poor functional outcome and stroke recurrence [odds ratio (OR) 2.55 (1.38-3.96) and 3.03(1.65–4.12), respectively, P<0.001 for both, adjusted for NHISS, other predictors and vascular risk factors] in patients with AIS.

Conclusion

Our results demonstrate that low 25(OH) D levels are associated with stroke recurrence and support the hypothesis that 25(OH) D may serve as a biomarker of poor functional outcome after stroke.

     

35~59岁电网职工缺血性心血管病10年发病风险评估

目的 探究电网职工缺血性心血管病（ICVD）危险因素暴露情况,评估未来10年缺血性心血管病发病危险度,为不同风险类型群体的健康管理策略提供科学依据。方法 收集2018年5—9月在山东电力中心医院体检的35~59岁电网职工的年龄、性别、体质指数（BMI）、收缩压（SBP）、总胆固醇（TC）、吸烟和糖尿病等危险因素指标,采用国人ICVD 10年发病危险评估表预测ICVD 10年发病危险并进行统计分析。结果 共研究3 049名电网职工,不同性别及不同年龄层（除BMI外）各主要危险因素差异均有统计学意义（均P<0.01）。男性ICVD 10年发病绝对危险的总中位数[1.50%（P₂₅,P₇₅：0.80%,2.90%）]明显高于女性[0.50%（P₂₅,P₇₅：0.30%,0.80%）]（P<0.01）。发病绝对危险随年龄增加而增大,不同年龄组的绝对危险差异有统计学意义（P<0.01）。男性55~59岁或女性50~59岁人群的绝对危险高于该性别同年龄段人群的平均危险,男性低危组（绝对危险：5%~10%）与中高危组（绝对危险：≥10%）的比例均高于女性（均P<0.01）。结论 男性55~59岁、女性50~59岁人群是ICVD发病的高危人群。应针对主要危险因素,早期发现高危人群,开展个性化健康干预预防心血管疾病的发生。