Department of Medicine, University of Tennessee Health Science Center, Memphis, 38163, USA.
Am J Med Sci. 2011 Feb;341(2):113-8. doi: 10.1097/MAJ.0b013e3182058864.
A dyshomeostasis of macro- and micronutrients, including vitamin D and oxidative stress, are common pathophysiologic features in patients with congestive heart failure (CHF). In African Americans (AA) with CHF, reductions in plasma 25(OH)D are of moderate-to-marked severity (<20 ng/mL) and may be accompanied by ionized hypocalcemia with compensatory increases in serum parathyroid hormone (PTH). The management of hypovitaminosis D in AA with CHF has not been established.
Herein, a 14-week regimen: an initial 8 weeks of oral ergocalciferol (50,000 IU once weekly); followed by a 6-week maintenance phase of cholecalciferol (1400 IU daily); and a CaCO₃ (1000 mg daily) supplement given throughout was designed and tested. Fourteen AA patients having a dilated (idiopathic) cardiomyopathy with reduced ejection fraction (EF, <35%) were enrolled: all completed the initial 8-week course; and 12 complied with the full 14 weeks. At baseline, 8 and/or 14 weeks, serum 25(OH)D and PTH; serum 8-isoprostane, a biomarker of lipid peroxidation, and echocardiographic EF were monitored.
Reduced 25(OH)D at entry (14.4 ± 1.3 ng/mL) was improved (P < 0.05) in all patients at 8 weeks (30.7 ± 3.2 ng/mL) and sustained (P < 0.05) at 14 weeks (30.9 ± 2.8 ng/mL). Serum PTH, abnormally increased in 5 patients at baseline (104.8 ± 8.2 pg/mL), was reduced at 8 and 14 weeks (74.4 ± 18.3 and 73.8 ± 13.0 pg/mL, respectively). Plasma 8-isoprostane at entry (136.1 ± 8.8 pg/mL) was reduced at 14 weeks (117.8 ± 7.8 pg/mL; P < 0.05), whereas baseline EF (24.3 ± 1.7%) was improved (31.3 ± 4.3%; P < 0.05).
Thus, the 14-week course of supplemental vitamin D and CaCO₃ led to healthy 25(OH)D levels in AA with heart failure having vitamin D deficiency of moderate-to-marked severity. Albeit a small patient population, the findings suggest that this regimen may attenuate the accompanying secondary hyperparathyroidism and oxidative stress and improve ventricular function.
在充血性心力衰竭（CHF）患者中，宏量和微量营养素（包括维生素 D 和氧化应激）的动态平衡失调是常见的病理生理特征。在充血性心力衰竭的非裔美国人（AA）中，血浆 25（OH）D 减少的程度为中度至重度（<20ng/mL），并且可能伴有离子型低钙血症，伴有甲状旁腺激素（PTH）代偿性增加。AA 充血性心力衰竭患者的维生素 D 缺乏症的管理尚未确定。
本文设计并测试了一种为期 14 周的治疗方案：最初 8 周口服骨化二醇（50000IU，每周一次）；随后是为期 6 周的胆钙化醇（1400IU，每日一次）维持期；并在整个治疗过程中给予碳酸钙（1000mg，每日一次）补充。共有 14 名患有扩张型（特发性）心肌病且射血分数（EF，<35%）降低的 AA 患者入组：所有患者均完成了最初的 8 周疗程；并且 12 名患者完成了整个 14 周的疗程。在基线、8 周和/或 14 周时，监测血清 25（OH）D 和 PTH；血清 8-异前列腺素，一种脂质过氧化的生物标志物，以及超声心动图 EF。
所有患者在 8 周时（30.7±3.2ng/mL）的 25（OH）D 降低得到改善（P<0.05），并在 14 周时（30.9±2.8ng/mL）得到持续改善（P<0.05）。基线时 5 名患者的甲状旁腺激素（PTH）异常升高（104.8±8.2pg/mL），在 8 周和 14 周时降低（分别为 74.4±18.3pg/mL 和 73.8±13.0pg/mL）。基线时（136.1±8.8pg/mL）的血浆 8-异前列腺素在 14 周时降低（117.8±7.8pg/mL；P<0.05），而基线时 EF（24.3±1.7%）改善（31.3±4.3%；P<0.05）。
因此，在维生素 D 缺乏症中度至重度的非裔美国人充血性心力衰竭患者中，补充维生素 D 和碳酸钙 14 周可导致健康的 25（OH）D 水平。尽管患者人群较小，但研究结果表明，该方案可能减轻伴随的继发性甲状旁腺功能亢进和氧化应激，并改善心室功能。
