老年原发性高血压患者血清25-羟维生素D水平与血脂异常的关系

Relationship between serum 25-hydroxyvitamin D level and dyslipidemia in elderly patients with primary hypertension

摘要:

目的：调查老年原发性高血压患者血清25-羟维生素D[25（OH）D]营养状况，探讨老年原发性高血压患者血清25（OH）D水平与血脂异常的关系。方法：入选185例老年原发性高血压患者，测定25（OH）D浓度，同时收集一般资料及血糖、血脂等指标。根据25（OH）D的四分位数从低到高分为4组（Q1-Q4），分析25（OH）D浓度与血脂各项指标的相关性，采用二分类logistic回归分析血脂异常的相关影响因素。并从中选取维生素D缺乏合并血脂异常的患者80名（签署知情同意书后），随机分为补充组和未补充组，2组均给予每晚口服阿托伐他汀钙片20 mg调脂治疗，补充组在生活方式指导的基础上给予补充维生素D3 400 U/d，3个月后再次检测2组血清25（OH）D与血脂各项指标。结果：老年原发性高血压患者25（OH）D缺乏者比例高达70.3%。相对于Q4组，Q1组的甘油三酯（triglyceride，TG）、总胆固醇（total cholesterol，TC）、低密度脂蛋白胆固醇（low density lipoprorein cholesterol，LDL-C）明显升高，高密度脂蛋白胆固醇（high density lipoprotein cholesterol，HDL-C）水平降低，血脂异常发生率明显升高。相关性分析显示，25（OH）D与TG、TC、LDL-C、血脂异常呈负相关，与HDL-C呈正相关。校正其他影响因素后，logistic回归分析发现血清25（OH）D与血脂异常的发生独立相关。3个月后补充组血清25（OH）D明显上升，且补充组血脂各项指标改善情况明显优于未补充组。结论：血清25（OH）D在老年原发性高血压患者中普遍缺乏，25（OH）D水平与血脂异常相关。在老年原发性高血压患者血脂异常的诊治过程中，补充维生素D有助于改善血脂异常。

Abstract:

Objective：To investigate the nutritional status of serum 25-hydroxyvitamin D[25（OH）D] in elderly patients with primary hypertension，and to explore the relationship between 25（OH）D level and dyslipidemia. Methods：A total of 185 elderly patients with primary hypertension were enrolled. The concentration of 25（OH）D was measured，and general information，blood glucose，blood lipids，and other data were collected. Patients were divided into four groups（Q1-Q4） according to the quartiles of their serum 25（OH）D levels. The correlation between serum 25（OH）D level and blood lipid profiles was analyzed，and binary logistic regression analysis was used to analyze the relevant influencing factors for dyslipidemia. Eighty patients with vitamin D deficiency and dyslipidemia were se－lected（after signing informed consent），and were randomly divided into supplemented group and unsupplemented group. Both groups took atorvastatin calcium oral tablets（20 mg per night） to lower lipids，and the supplemented group took additional vitamin D3（400 U per day） based on lifestyle guidance. Serum 25（OH）D levels and blood lipids were measured again 3 months later. Results：The pro－portion of 25（OH）D deficiency cases in elderly patients with primary hypertension was as high as 70.3%. Compared with the Q4（highest） group，the Q1（lowest） group had significantly increased triglyceride（TG），total cholesterol（TC），and low density lipoprotein cholesterol（LDL-C） levels，a significantly reduced high density lipoprotein cholesterol（HDL-C） level，and a significantly increased incidence of dyslipidemia. Correlation analysis showed that serum 25（OH）D was negatively correlated with TG，TC，LDL-C，and dys－lipidemia and was positively correlated with HDL-C. After adjusting for the other influencing factors，logistic regression analysis found that serum 25（OH）D was independently associated with the development of dyslipidemia. Serum 25（OH）D increased significantly in the supplemented group after 3 months，and the improvement in blood lipid profiles in the supplemented group was significantly better than that in the unsupplemented group. Conclusion：Serum 25（OH）D deficiency is common in elderly patients with primary hypertension，and 25（OH）D level is associated with dyslipi－demia. In the diagnosis and treatment of dyslipidemia in elder－ly patients with primary hypertension，vitamin D supplementa－tion can help improve dyslipidemia.