Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Feldkirch, Austria.
Medical Central Laboratories, Feldkirch, Austria.
J Clin Endocrinol Metab. 2020 Nov 1;105(11). doi: 10.1210/clinem/dgaa512.
Elevated serum levels of parathyroid hormone (PTH), one of the main regulators of calcium homeostasis and vitamin D metabolism, have been proposed as predictors of mortality. The impact of type 2 diabetes mellitus (T2DM) on the putative association between PTH and mortality has not been investigated thus far.
The aim of our study was to investigate the impact of T2DM on the power of PTH to predict mortality risk.
Serum PTH levels were determined in 904 consecutive Caucasian patients referred to coronary angiography for the evaluation of established or suspected stable coronary artery disease (CAD), including 235 patients with T2DM. Prospectively, deaths were recorded over a mean follow-up period of 6.3 years.
PTH at baseline did not differ significantly between patients with and without T2DM (P = .307). Cox regression analysis revealed that the serum PTH level strongly predicted all-cause mortality in patients with T2DM (hazard ratio [HR] = 2.35 [1.37-4.03]; P = .002), whereas PTH did not predict all-cause mortality in patients without T2DM (HR = 1.04 [0.81-1.32]; P = .766). The interaction term PTH × T2DM was significant (P = .006), indicating a significantly stronger impact of PTH on mortality risk in patients with T2DM than in individuals without diabetes. The impact of PTH on mortality risk in patients with T2DM remained significant after adjustment for glycated hemoglobin A1c, diabetes duration, classical cardiovascular risk factors, serum levels of vitamin D, and kidney function (HR = 2.10 [1.10-4.10]; P = .030).
We conclude that PTH is a significantly stronger predictor of all-cause mortality in patients with T2DM than in those without T2DM.
甲状旁腺激素（PTH）是钙稳态和维生素 D 代谢的主要调节剂之一，其血清水平升高已被提出作为死亡率的预测指标。然而，目前尚未研究 2 型糖尿病（T2DM）对 PTH 与死亡率之间假定关联的影响。
本研究旨在探讨 T2DM 对 PTH 预测死亡率风险能力的影响。
在 904 例连续的白人患者中测定了血清 PTH 水平，这些患者因已确诊或疑似稳定型冠状动脉疾病（CAD）而行冠状动脉造影检查，其中包括 235 例 T2DM 患者。前瞻性地记录了平均随访 6.3 年期间的死亡情况。
基线时，有 T2DM 患者和无 T2DM 患者的 PTH 水平无显著差异（P=0.307）。Cox 回归分析显示，血清 PTH 水平强烈预测 T2DM 患者的全因死亡率（危险比 [HR] = 2.35 [1.37-4.03]；P=0.002），而 PTH 并未预测无 T2DM 患者的全因死亡率（HR=1.04 [0.81-1.32]；P=0.766）。PTH×T2DM 的交互项具有统计学意义（P=0.006），表明 PTH 对 T2DM 患者的死亡率风险的影响明显强于无糖尿病患者。在调整糖化血红蛋白 A1c、糖尿病病程、经典心血管危险因素、血清维生素 D 水平和肾功能后，PTH 对 T2DM 患者死亡率风险的影响仍然显著（HR=2.10 [1.10-4.10]；P=0.030）。
我们的结论是，与无 T2DM 患者相比，PTH 是 T2DM 患者全因死亡率的一个更强的预测指标。
