高甲状旁腺激素预示着维生素 D 缺乏的 COPD 患者病情恶化。

High parathyroid hormone predicts exacerbations in COPD patients with hypovitaminosis D.

机构信息

Servicio de Neumología, Hospital Universitario Marqués de Valdecilla, Santander, Spain; Universidad de Cantabria, Santander, Spain.

Servicio Cántabro de Salud, Santander, Spain.

出版信息

Respir Med. 2021 Jun;182:106416. doi: 10.1016/j.rmed.2021.106416. Epub 2021 Apr 17.

DOI:10.1016/j.rmed.2021.106416

PMID:33894440

Abstract

BACKGROUND

Hypovitaminosis D has been linked to deterioration in clinical parameters and lung function in COPD. As a response to low levels of vitamin D serum Parathyroid Hormone (iPTH) is increased in some, but not all, patients. The aim of this study was to determine whether COPD patients with elevated PTH levels are at higher risk of COPD exacerbations and hospitalizations.

METHODS

166 COPD outpatients were randomly preselected. Clinical and analytical characteristics were assessed at baseline. After excluding patients with other conditions known to disturb calcium metabolism 141 patients were identified. Except one, all patients were prospectively followed for 12 months after obtaining the blood samples. Hypovitaminosis D was considered when serum 25(OH)D < 30 ng/mL. Secondary hyperparathyroidism was considered when serum iPTH was higher than normal (50 pg/mL) in patients with hypovitaminosis D. COPD exacerbations and hospital admissions were recorded during the follow-up.

RESULTS

Prevalence of hypovitaminosis D in COPD patients was 89.3%, prevalence of secondary hyperparathyroidism associated with hypovitaminosis D was 22,9%. Cox proportional risk analysis showed that patients belonging to the high iPTH-low 25(OH)D group were at a higher risk of moderate COPD exacerbations (HR 1.81 (CI95% 1.043-3.127), p = 0.035) and hospital admissions (HR 5.45 (CI95% 2.018-14.720), p = 0.002) as compared with those with normal iPTH-low 25(OH)D levels.

CONCLUSIONS

COPD patients with hypovitaminosis D and elevated iPTH have higher risk of moderate exacerbations and hospitalizations than those with hypovitaminosis D and normal iPTH.

摘要

背景

维生素 D 缺乏与 COPD 患者的临床参数和肺功能恶化有关。在一些患者中，血清甲状旁腺激素（iPTH）会因维生素 D 水平降低而升高，但并非所有患者都如此。本研究旨在确定甲状旁腺激素水平升高的 COPD 患者是否有更高的 COPD 加重和住院风险。

方法

随机预选了 166 例 COPD 门诊患者。在基线时评估了临床和分析特征。在排除了其他已知会干扰钙代谢的疾病后，确定了 141 例患者。除了一名患者外，所有患者在获得血液样本后都前瞻性地随访了 12 个月。当血清 25(OH)D<30ng/mL 时，认为存在维生素 D 缺乏症。当维生素 D 缺乏症患者的血清 iPTH 高于正常值（50pg/mL）时，认为存在继发性甲状旁腺功能亢进症。在随访期间记录 COPD 加重和住院情况。

结果

在 COPD 患者中，维生素 D 缺乏症的患病率为 89.3%，与维生素 D 缺乏症相关的继发性甲状旁腺功能亢进症的患病率为 22.9%。Cox 比例风险分析显示，属于高 iPTH-低 25(OH)D 组的患者发生中度 COPD 加重的风险更高（HR 1.81（95%CI95%1.043-3.127），p=0.035）和住院（HR 5.45（95%CI95%2.018-14.720），p=0.002）与 iPTH-低 25(OH)D 水平正常的患者相比。