Andrade Jason, Er Lee, Ignaszewski Andrew, Levin Adeera
Department of Medicine, University of British Columbia, Saint Paul's Hospital, Vancouver, BC, Canada.
Clin J Am Soc Nephrol. 2008 Nov;3(6):1800-6. doi: 10.2215/CJN.00900208. Epub 2008 Oct 15.
Abnormalities in mineral metabolism [calcium, phosphate, and immunoreactive parathyroid hormone (PTH)] and vitamin D have been linked to increases in central arterial stiffness. Central arterial stiffness can be measured using noninvasive technologies, including augmentation index (AIx), a composite measure of arterial stiffness.
DESIGN, SETTING, PARTICIPANTS, AND MEASUREMENTS: In 131 outpatients identified from individual cardiac or kidney disease clinics, we examined conventional demographic and laboratory risk factors, vitamin D levels (1,25-OH2D3 and 25-OHD3), and markers of inflammation or endothelial function [C-reactive peptide (hsCRP), matrix metalloproteinase 2 (MMP-2), matrix metalloproteinase 9 (MMP-9), and IL-6] in relationship to AIx.
The median eGFR was significantly different between clinics (range 25-81 ml/min). Subjects with higher phosphate or MMP-9 levels were found to have a higher AIx (P = 0.02 and 0.07, respectively). Lower 1,25-OH2D3 levels or reduced eGFR were associated with higher AIx (P = 0.002 and 0.005, respectively). The associations between 1,25-OH2D3 and phosphate levels and AIx were observed for values within the normal range. No association was noted for calcium, iPTH, 25-OHD3, or hsCRP and AIx. Adjusting for potential confounders [eGFR, calcium, phosphate, and (log) iPTH] the association of lower 1,25-OH2D3 with AIx remained statistically significant.
This exploratory study demonstrates a significant association between AIx and 1,25-OH2D3 in a diverse group with cardiac, kidney disease, or both. These increasing understanding of the role of vitamin D in vascular health lends a context to these findings and raises questions as to additional modifiable risk factors in complex patients. Further studies are required.
矿物质代谢异常（钙、磷和免疫反应性甲状旁腺激素（PTH））以及维生素D与中心动脉僵硬度增加有关。中心动脉僵硬度可使用非侵入性技术进行测量，包括增强指数（AIx），这是一种动脉僵硬度的综合测量指标。
设计、地点、参与者及测量方法：在从个体心脏病或肾脏病诊所识别出的131名门诊患者中，我们检查了传统的人口统计学和实验室风险因素、维生素D水平（1,25 - 二羟维生素D3和25 - 羟维生素D3）以及炎症或内皮功能标志物[高敏C反应蛋白（hsCRP）、基质金属蛋白酶2（MMP - 2）、基质金属蛋白酶9（MMP - 9）和白细胞介素6]与AIx的关系。
各诊所之间的估算肾小球滤过率（eGFR）中位数有显著差异（范围为25 - 81 ml/min）。发现磷酸盐或MMP - 9水平较高的受试者AIx更高（分别为P = 0.02和0.07）。较低的1,25 - 二羟维生素D3水平或降低的eGFR与较高的AIx相关（分别为P = 0.002和0.005）。在正常范围内的值中观察到了1,25 - 二羟维生素D3和磷酸盐水平与AIx之间的关联。未发现钙、iPTH、25 - 羟维生素D3或hsCRP与AIx之间存在关联。在调整潜在混杂因素[eGFR、钙、磷酸盐和（对数）iPTH]后，较低的1,25 - 二羟维生素D3与AIx之间的关联仍具有统计学意义。
这项探索性研究表明，在患有心脏病、肾脏病或两者皆有的不同人群中，AIx与1,25 - 二羟维生素D3之间存在显著关联。对维生素D在血管健康中作用的日益了解为这些发现提供了背景，并引发了关于复杂患者中其他可改变风险因素的问题。需要进一步研究。
