Shroff Rukshana, Egerton Martyn, Bridel Michala, Shah Vanita, Donald Ann E, Cole Tim J, Hiorns Melanie P, Deanfield John E, Rees Lesley
Department of Nephrourology, Great Ormond Street Hospital for Children, London, UK.
J Am Soc Nephrol. 2008 Jun;19(6):1239-46. doi: 10.1681/ASN.2007090993. Epub 2008 Mar 12.
In addition to its classical role in calcium-phosphate homeostasis, vitamin D has anti-inflammatory effects that may influence vascular disease. This study examined the impact of vitamin D levels on the vascular phenotype in 61 children who had been on dialysis for >or=3 mo and in 40 age-matched control subjects. All dialysis patients were prescribed daily oral 1-alpha hydroxyvitamin D(3). 92% of patients were deficient in 25-hydroxyvitamin D [25(OH)D]. 1,25-dihydroxyvitamin D [1,25(OH)(2)D] levels were low in 36% and high in 11% of patients. There was a weak correlation between 1 alpha-hydroxyvitamin D(3) dosage and 1,25(OH)(2)D levels. Both carotid intima-media thickness and calcification scores showed a U-shaped distribution across 1,25(OH)(2)D levels: patients with both low and high 1,25(OH)(2)D had significantly greater carotid intima-media thickness (P < 0.0001) and calcification (P = 0.0002) than those with normal levels. Low 1,25(OH)(2)D levels were associated with higher high-sensitivity C-reactive protein (P < 0.0001). Calcification was most frequently observed in patients with the lowest 1,25(OH)(2)D and the highest high-sensitivity C-reactive protein. In contrast, 25(OH)D levels did not correlate with any vascular measure. In conclusion, both low and high 1,25(OH)(2)D levels are associated with adverse morphologic changes in large arteries, and this may be mediated through the effects of 1,25(OH)(2)D on calcium-phosphate homeostasis and inflammation. For optimization of strategies to protect the vasculature of dialysis patients, careful monitoring of 1,25(OH)(2)D levels may be required.
除了在钙磷稳态中发挥经典作用外，维生素D还具有抗炎作用，可能会影响血管疾病。本研究调查了61名已接受透析≥3个月的儿童以及40名年龄匹配的对照受试者中维生素D水平对血管表型的影响。所有透析患者均每日口服1-α羟维生素D(3)。92%的患者25-羟维生素D[25(OH)D]缺乏。36%的患者1,25-二羟维生素D[1,25(OH)(2)D]水平较低，11%的患者水平较高。1-α羟维生素D(3)剂量与1,25(OH)(2)D水平之间存在弱相关性。颈动脉内膜中层厚度和钙化评分在1,25(OH)(2)D水平上均呈U形分布：1,25(OH)(2)D水平低和高的患者的颈动脉内膜中层厚度（P<0.0001）和钙化（P = 0.0002）均显著高于正常水平的患者。低1,25(OH)(2)D水平与较高的高敏C反应蛋白相关（P<0.0001）。钙化最常见于1,25(OH)(2)D水平最低且高敏C反应蛋白最高的患者。相比之下，25(OH)D水平与任何血管指标均无相关性。总之，低和高的1,25(OH)(2)D水平均与大动脉的不良形态学改变相关，这可能是通过1,25(OH)(2)D对钙磷稳态和炎症的影响介导的。为了优化保护透析患者血管的策略，可能需要仔细监测1,25(OH)(2)D水平。
