Endocrinology Division, University Hospital João de Barros Barreto, Federal University of Pará, 4487, Guamá, Belém, Pará, 66073-000, Brazil.
Sci Rep. 2024 Mar 16;14(1):6374. doi: 10.1038/s41598-024-56934-1.
We evaluated the association of cardiovascular autonomic neuropathy (CAN), blood pressure (BP) and Vitamin D (VD) levels before and after high-dose cholecalciferol supplementation (4000/10,000) UI/day) for 12 weeks in patients (N = 67) with type 1 diabetes mellitus (T1DM). Based on this prospective controlled pilot study, patients were divided into group 1 (N = 23 with CAN) and group 2 (N = 44 without CAN). At baseline, group 1 had higher systolic BP (SBP) during sleep (115 ± 14 vs. 107 ± 12 mmHg, p = 0.04) and lower nocturnal dipping (3 ± 5 vs. 8 ± 6%, p = 0.009). Among those with loss of nocturnal dipping, 45.4% (20/44) had CAN, while in normal nocturnal dipping group it occurred only in 13% (3/23) (p = 0.007). Non-dipper group had worse CAN parameters when compared to dipper group [Very low frequency (VLF) (2.5 ± 0.5vs.2.8 ± 0.4 s, p = 0.01), total power (TP) (2.9 ± 0.6 vs. 3.3 ± 0.4 s, p = 0.01), Valsalva coefficient (1.5 ± 0.4 vs. 1.8 ± 0.6, p = 0.06)]. After VD, only group 1 improved CAN parameters [TP (2.5 ± 0.4 vs. 2.8 ± 0.6, p = 0.01) and VLF (2.2 ± 0.4 vs. 2.4 ± 0.5, p = 0.03). Group 1 presented a reduction in morning SBP (120 ± 20 vs. 114 ± 17 mmHg, p = 0.038) and in morning SBP surge (13 ± 13 vs. 5 ± 14, p = 0.04). High-dose VD was associated with improved CAN parameters and reduced awake SBP and morning SBP surge. These findings suggest that VD may benefit patients with cardiovascular autonomic neuropathy. ISRCTN32601947, registration date: 31/07/2017.
我们评估了在 12 周的高剂量胆钙化醇补充（4000/10000 UI/天）后，1 型糖尿病患者（N=67）心血管自主神经病变（CAN）、血压（BP）和维生素 D（VD）水平的变化。基于这项前瞻性对照研究，患者被分为 1 组（N=23 例有 CAN）和 2 组（N=44 例无 CAN）。在基线时，1 组的睡眠时收缩压（SBP）更高（115±14 比 107±12 mmHg，p=0.04），夜间下降幅度更低（3±5 比 8±6%，p=0.009）。在夜间下降幅度丧失的患者中，45.4%（44 例中的 20 例）有 CAN，而在夜间下降幅度正常的组中，只有 13%（23 例中的 3 例）（p=0.007）。与夜间下降幅度正常的患者相比，非夜间下降幅度患者的 CAN 指标更差[低频（VLF）（2.5±0.5 比 2.8±0.4 s，p=0.01），总功率（TP）（2.9±0.6 比 3.3±0.4 s，p=0.01），瓦尔萨尔瓦系数（1.5±0.4 比 1.8±0.6，p=0.06）]。VD 补充后，只有 1 组的 CAN 指标得到改善[TP（2.5±0.4 比 2.8±0.6，p=0.01）和 VLF（2.2±0.4 比 2.4±0.5，p=0.03）]。1 组的早晨 SBP（120±20 比 114±17 mmHg，p=0.038）和早晨 SBP 峰值（13±13 比 5±14，p=0.04）均降低。高剂量 VD 与改善 CAN 指标以及降低清醒时 SBP 和早晨 SBP 峰值有关。这些发现表明 VD 可能对心血管自主神经病变患者有益。ISRCTN32601947，注册日期：2017 年 7 月 31 日。
