Zittermann Armin, Schleithoff Stefanie S, Frisch Sabine, Götting Christian, Kuhn Joachim, Koertke Heinrich, Kleesiek Knut, Tenderich Gero, Koerfer Reiner
Department of Cardio-Thoracic Surgery, Heart Center North Rhine-Westfalia, Ruhr University Bochum, Bad Oeynhausen, Germany.
Clin Chem. 2009 Jun;55(6):1163-70. doi: 10.1373/clinchem.2008.120006. Epub 2009 Apr 9.
Evidence is accumulating that vitamin D supplementation of patients with low 25-hydroxyvitamin D concentrations is associated with lower cardiovascular morbidity and total mortality during long-term follow-up. Little is known, however, about the effect of low concentrations of the vitamin D hormone calcitriol on total mortality. We therefore evaluated the predictive value of circulating calcitriol for midterm mortality in patients of a specialized heart center.
This prospective cohort study included 510 patients, 67.7% with heart failure (two-thirds in end stage), 64.3% hypertension, 33.7% coronary heart disease, 20.2% diabetes, and 17.3% renal failure. We followed the patients for up to 1 year after blood collection. For data analysis, the study cohort was stratified into quintiles of circulating calcitriol concentrations.
Patients in the lowest calcitriol quintile were more likely to have coronary heart disease, heart failure, hypertension, diabetes, and renal failure compared to other patients. They also had low 25-hydroxyvitamin D concentrations and high concentrations of creatinine, C-reactive protein, and tumor necrosis factor alpha. Eighty-two patients (16.0%) died during follow-up. Probability of 1-year survival was 66.7% in the lowest calcitriol quintile, 82.2% in the second quintile, 86.7% in the intermediate quintile, 88.8% in the fourth quintile, and 96.1% in the highest quintile (P < 0.001). Discrimination between survivors and nonsurvivors was best when a cutoff value of 25 ng/L was applied (area under the ROC curve 0.72; 95% CI 0.66-0.78).
Decreased calcitriol levels are linked to excess midterm mortality in patients of a specialized heart center.
越来越多的证据表明，对25-羟基维生素D浓度较低的患者补充维生素D与长期随访期间较低的心血管发病率和总死亡率相关。然而，关于低浓度维生素D激素骨化三醇对总死亡率的影响知之甚少。因此，我们评估了循环骨化三醇对一家专业心脏中心患者中期死亡率的预测价值。
这项前瞻性队列研究纳入了510例患者，其中67.7%患有心力衰竭（三分之二处于终末期），64.3%患有高血压，33.7%患有冠心病，20.2%患有糖尿病，17.3%患有肾衰竭。采血后我们对患者进行了长达1年的随访。为了进行数据分析，研究队列被分为循环骨化三醇浓度的五分位数。
与其他患者相比，骨化三醇浓度最低五分位数的患者更有可能患有冠心病、心力衰竭、高血压、糖尿病和肾衰竭。他们的25-羟基维生素D浓度也较低，肌酐、C反应蛋白和肿瘤坏死因子α浓度较高。82例患者（16.0%）在随访期间死亡。骨化三醇浓度最低五分位数的患者1年生存率为66.7%，第二五分位数为82.2%，中间五分位数为86.7%，第四五分位数为88.8%，最高五分位数为96.1%（P<0.001）。当应用25 ng/L的临界值时，幸存者和非幸存者之间的区分最佳（ROC曲线下面积为0.72；95%CI为0.66-0.78）。
骨化三醇水平降低与一家专业心脏中心患者的中期死亡率过高有关。
