Zittermann Armin, Schleithoff Stefanie S, Götting Christian, Fuchs Uwe, Kuhn Joachim, Kleesiek Knut, Tenderich Gero, Koerfer Reiner
Klinik für Thorax- und Kardiovaskularchirurgie, Herz- und Diabeteszentrum NRW, Ruhr Universität Bochum, Georgstrasse 11, D-32545 Bad Oeynhausen, Germany.
Transplantation. 2009 Jan 15;87(1):118-24. doi: 10.1097/TP.0b013e31818c2708.
Administration of the vitamin D hormone calcitriol improves survival in solid-organ transplanted experimental animals. We investigated whether lower serum calcitriol concentrations are associated with increased 1-year mortality in cardiac transplant recipients.
We prospectively recruited 171 patients who underwent cardiac transplantation at out institution between May 2004 and April 2006. We assessed calciotropic hormones, inflammation markers, and renal function preoperatively and on postoperative days 6 (t1) and 21 (t2).
Serum creatinine and C-reactive protein increased, whereas calcitriol decreased significantly after transplantation (P<0.001). As determined by multivariable Cox regression analysis, the calcitriol level at t2 was an independent predictor of 1-year mortality. One-year mortality was 3.7 per 100 person-years in the tertile with the highest calcitriol concentrations at t2 (> 18 pg/mL), 13.2 per 100 person-years in the intermediate tertile (11-18 pg/mL), and 32.1 per 100 person-years in the tertile with the lowest calcitriol concentrations at t2 (< 11 pg/mL) (P<0.001). 25-Hydroxyvitamin D deficiency (serum concentrations below 10 ng/mL), renal insufficiency (serum creatinine > or = 1.6 mg/dL), and high serum concentrations of the inflammation markers C-reactive peptide and tumor necrosis factor-alpha were predictors of a serum calcitriol concentration below 11 pg/mL (P=0.037-0.001).
Low postoperative calcitriol concentrations are independently associated with high 1-year mortality in cardiac transplant recipients. A causal relationship has yet to be proven by intervention trials using active vitamin D.
给予维生素D激素骨化三醇可提高实体器官移植实验动物的存活率。我们研究了心脏移植受者较低的血清骨化三醇浓度是否与1年死亡率增加相关。
我们前瞻性招募了2004年5月至2006年4月在我们机构接受心脏移植手术的171例患者。我们在术前以及术后第6天（t1）和第21天（t2）评估了钙调节激素、炎症标志物和肾功能。
移植后血清肌酐和C反应蛋白升高，而骨化三醇显著降低（P<0.001）。通过多变量Cox回归分析确定，t2时的骨化三醇水平是1年死亡率的独立预测因素。t2时骨化三醇浓度最高三分位数组（>18 pg/mL）的1年死亡率为每100人年3.7例，中间三分位数组（11 - 18 pg/mL）为每100人年13.2例，t2时骨化三醇浓度最低三分位数组（<11 pg/mL）为每100人年32.1例（P<0.001）。25 - 羟基维生素D缺乏（血清浓度低于10 ng/mL）、肾功能不全（血清肌酐≥1.6 mg/dL）以及炎症标志物C反应肽和肿瘤坏死因子 - α的高血清浓度是血清骨化三醇浓度低于11 pg/mL的预测因素（P = 0.037 - 0.001）。
心脏移植受者术后骨化三醇浓度低与1年高死亡率独立相关。使用活性维生素D的干预试验尚未证实因果关系。
