摘要
目的探究维生素D(vitamin D,VD)及钙剂(calcium,Ca)补充对高血压或冠心病POP人群心脑血管类疾病发生的影响。方法将2018年10月至2019年9月在溧阳市人民医院心血管内科诊断为高血压伴原发性骨质疏松症(primary osteoporosis,POP)或冠心病伴POP并符合纳入标准的317例患者纳入研究,分为高血压组224例、冠心病组93例;并根据VD缺乏程度各自分为VD缺乏组(25(OH)D≤20 ng/mL)和极度缺乏组(25(OH)D≤10 ng/mL)。予VD缺乏组碳酸钙D3(钙尔奇D)1片,每天1次;予VD极度缺乏组碳酸钙D3(钙尔奇D)2片,每天1次。连续补充18个月。期间嘱患者记录心绞痛(包括心肌梗死)、动脉粥样硬化(除冠脉外新发)、下肢静脉血栓、脑梗发生并迫使其就医的发作次数和就医时的25(OH)D和血Ca水平,并记录各组发生心脑血管类疾病发生和未发生的总人数。比较各组内以上指标的差异。结果POP高血压组:VD极度缺乏组(19.0%)比VD缺乏组(7.5%)发生心脑血管类疾病的比例较高,P=0.018;2组VD及Ca呈现显著正相关,P<0.001。与VD缺乏组比较,VD极度缺乏组发生心绞痛时的血Ca及VD水平均较高,P<0.05。POP冠心病组:VD极度缺乏组(86.2%)比VD缺乏组(62.7%)发生心血管类疾病的比例较高,P=0.030;2组VD及Ca呈现显著的正相关,P<0.001。与VD缺乏组比较,VD极度缺乏组发生心绞痛时的血Ca及VD水平均较高,P<0.05和P<0.01;发生动脉粥样硬化时血Ca水平较高,P<0.05,而VD有升高趋势。结论对于高血压伴POP并VD极度缺乏的患者来说,适度增加VD并减少Ca补充较为适宜;而对于对应的冠心病患者来说,应当谨慎(一定程度减少)补充VD及Ca剂。
Objective To investigate the vitamin D(VD)and calcium supplement’effect on the occurrence of cardiovascular and cerebrovascular diseases in Primary osteoporosis(POP)patients accompanied with hypertension or coronary heart disease.Methods From October 2018 to September 2019,the 317 cases diagnosed as hypertension or coronary heart disease accompanied with primary osteoporosis diagnosis and complying with inclusion criteria in Cardiovascular department of Liyang Municipal People’s Hospital were recruited,divided into hypertension and coronary heart disease groups,with 224 and 93 participants in each group.Then participants in each group were again divided into VD deficiency(25(OH)D≤20 ng/mL)and severe deficiency(25(OH)D≤10 ng/m L)groups,treated with one Calcium carbonate D3 pill and two pills per day,respectively.Treatment lasts for 18 months,during which the participants should recorded the occurrence times of angina pectoris(including myocardial infarction),atherosclerosis(newly occurrence except for coronary),lower limbs’venous thrombosis and cerebral infarction,which forced the participant to turn to hospital,as well as the VD and Ca concentrations examined during the periods.The occurrence and non-occurrence proportion and VD and Ca concentrations between the two groups among the corresponding group were compared.Results POP hypertension groups:The incidents proportion of heart,cerebral and vessels diseases in VD severe deficiency group(19.0%)was higher than that(7.5%)of VD deficiency group,P=0.018.There was an obviously positive correlation between VD and Ca,P<0.001.Compared with VD deficiency group,the VD and Ca levels of VD severe deficiency group at the occurrence of angina pectoris were higher,P<0.05.POP coronary heart disease groups:The incidents proportion of heart,cerebral and vessels diseases in VD severe deficiency group(86.2%)was higher than that(62.7%)of VD deficiency group,P=0.030.There was an obviously positive correlation between VD and Ca,P<0.001.Compared with VD deficiency group,the VD and Ca levels of VD severe deficiency group at the occurrence of angina pectoris were higher,P<0.05 and P<0.01,respectively.When suffering from atherosclerosis,the Ca level of participants in VD severe deficiency group was higher than that in VD deficiency group,P<0.05,with a increasing trend of VD level.Conclusion Properly added VD and decreased Ca supplement might be suitable for hypertension accompanied with POP patients with VD severe deficiency.For coronary heart disease accompanied with POP patients with VD severe deficiency,decreased VD and Ca supplement may be more fit.
作者
颜玲玲
钱志宏
倪悦
吴煌
YAN Ling-ling;QIAN Zhi-hong;NI Yue;WU Huang(Dept,of Cardiovascular Medicine,Liyang Municipal People's Hospital,Jiangsu Liyang 213300;Dept,of Bone Surgery,The Second People fs Hospital of Three Gorges University,Yichang Municipal Second People fs Hospital,Hubei Yichang 443000,China)
出处
《昆明医科大学学报》
CAS
2021年第10期139-144,共6页
Journal of Kunming Medical University
基金
湖北省自然科学基金资助项目(2017CFB567)。
