老年原发性高血压病靶器官损害与25羟基维生素D水平的关系研究

背景　目前医学领域对于25羟基维生素D〔25-（OH）-D〕的研究主要集中在钙稳态和骨代谢、炎性反应、糖脂代谢和免疫等方面，25-（OH）-D水平与老年高血压靶器官损害的关系研究尚少。目的　测定25-（OH）-D水平并探讨其与老年原发性高血压病患者发生左心室肥厚、肾脏损害及颈动脉硬化的关系。方法　选取2016年9月-2018年9月在锦州医科大学附属第一医院心内科、老年科病房住院及门诊就诊的60~79岁原发性高血压病患者325例为研究对象，根据高血压靶器官损害情况，将研究对象分为单纯高血压组68例、单一靶器官损害组124例（包括左心室肥厚组29例、肾脏损害组44例、颈动脉硬化组51例）、复合靶器官损害组133例；根据25-（OH）-D水平，将研究对象分为25-（OH）-D充足组25例、25-（OH）-D不足组58例及25-（OH）-D缺乏组242例。根据不同分组情况，分别比较三组一般临床资料、生化指标。采用多元有序Logistic回归模型分析老年原发性高血压病靶器官损害的影响因素。结果　单纯高血压组、单一靶器官损害组、复合靶器官损害组的年龄、高血压病程、收缩压、舒张压依次升高，25-（OH）-D依次降低，差异有统计学意义（P<0.05）。与25-（OH）-D充足组比较，25-（OH）-D缺乏组的三酰甘油水平明显增高（P<0.05）。Pearson相关分析结果显示：25-（OH）-D水平与三酰甘油水平呈负相关（r=-0.12，P<0.05）。左心室肥厚组、肾脏损害组、颈动脉硬化组25-（OH）-D水平分别低于单纯高血压组，差异均有统计学意义（t=3.019，P=0.003；t=2.660，P=0.009；t=2.437，P=0.016）。多元有序Logistic回归分析结果显示，年龄大、高血压病程长、收缩压高、舒张压高、25-（OH）-D水平低是老年原发性高血压病发生靶器官损害的危险因素（OR值分别为1.10、1.06、1.12、1.07、0.94，P<0.05）。结论　老年原发性高血压病患者常见25-（OH）-D缺乏，25-（OH）-D水平与三酰甘油水平呈负相关。年龄大、高血压病程长、血压高、25-（OH）-D缺乏是老年原发性高血压病发生靶器官损害的独立危险因素。

Target Organ Damage in Elderly Patients with Essential Hypertension and 25-hydroxyvitamin D Level

Background　Current medical research on 25-hydroxyvitamin D〔25-（OH）-D〕mainly focuses on calcium homeostasis and bone metabolism，inflammatory reaction，glycolipid metabolism and immunity.But there are few studies on serum 25-（OH）-D levels and target organ damage in elderly adults with hypertension.Objective　To examine the associations of serum 25-（OH）-D with left ventricular hypertrophy，renal damage and carotid atherosclerosis in elderly patients with essential hypertension.Methods　325 patients with essential hypertension（aged from 60 to 79） were selected from the Cardiovascular Ward，Geriatric Ward and clinics，the First Affiliated Hospital of Jinzhou Medical University between September 2016 and September 2018.They were divided into simple hypertension subgroup（n=68），single target organ damage group（n=124，including 29 coexisted with left ventricular hypertrophy，44 with renal damage，and 51 with carotid atherosclerosis），and multiple target organ damage subgroup（n=133） by the prevalence of target organ damage，and were divided into 25-（OH）-D-sufficient subgroup（n=25），25-（OH）-D-insufficient subgroup（n=58）and 25-（OH）-D-deficient subgroup（n=242）by the level of 25-（OH）-D.General clinical data and biochemical indicators were compared between target organ damage subgroups and 25-（OH）-D subgroups.The influencing factors of target organ damage were explored by multiple ordinal Logistic regression analysis.Results　Mean age，course of hypertension，SBP and DBP increased and mean 25-（OH）-D decreased successively in simple hypertension，single target organ damage and multiple target organ damage subgroups（P<0.05）．In comparison to 25-（OH）-D-sufficient group，the level of TG was significantly higher in 25-（OH）-D-deficient group（P<0.05）．Pearson correlation analysis showed that 25-（OH）-D level was negatively correlated with TG（r=-0.12，P<0.05）．Mean serum 25-（OH）-D level was higher in those without target organ damage than that of those with coexisting left ventricular hypertrophy，renal damage or carotid atherosclerosis（t=3.019，P=0.003；t=2.660，P=0.009；t=2.437，P=0.016）．Multiple ordinal Logistic regression analysis showed that older age，longer duration of hypertension，elevated SBP and DBP，and low 25-（OH）-D increased the risk of target organ damage in essential hypertension（OR=1.10，1.06，1.12，1.07，0.94，respectively；P<0.05）．Conclusion　25-（OH）-D deficiency is common in elderly patients with essential hypertension.The 25-（OH）-D level is negatively correlated with TG.Older age，longer duration of hypertension，elevated blood pressure，and 25-（OH）-D deficiency are independent risk factors for target organ damage.