Zovko Tanja, Galic Kristina, Vasilj Marina, Pravdic Nikolina, Mikulic Ivanka, Mikulic Vinka, Mandic Ante, Zovko Stanko, Pravdic Danijel
Pulmonary Diseases and Tuberculosis, University Clinical Hospital Mostar, Mostar, BIH.
Neurology, University Clinical Hospital Mostar, Mostar, BIH.
Cureus. 2024 Jul 8;16(7):e64053. doi: 10.7759/cureus.64053. eCollection 2024 Jul.
The aim of this study was to determine the disturbances in the concentration of parathyroid hormone (PTH) and 25-hydroxyvitamin D (vitamin D) in patients with stable chronic obstructive pulmonary disease (COPD) and its correlation with airflow obstruction.
A prospective study included 200 patients with a confirmed diagnosis of COPD in the Department of Lung Diseases and Tuberculosis and Pulmonology Polyclinic of University Clinical Hospital Mostar in the period of three years, between May 2021 and May 2024. Inclusion criteria were a stable phase of COPD, hemodynamically stable patients older than 40 years, forced vital capacities in the first second (FEV1)/forced vital capacities (FVC) <0.7, and patients with PTH, vitamin D, calcium, and phosphate measurements. Exclusion criteria were acute exacerbation of COPD in the last month; current treatment with nutritional supplements, vitamins, and statins; lack of availability of lung function data; use of systemic corticosteroids in the previous three months; chronic renal insufficiency, respiratory diseases other than COPD (asthma, pneumonia, tuberculosis, and bronchiectasis), and other diseases (cancer and parathyroid disease). Medical records about demographic data (age and gender), pulmonary function test (FVC, FEV1, FEV1%FVC, mean expiratory flow (MEF)), body mass index (BMI), COPD assessment test (CAT), Modified Medical Research Council (mMRC) Dyspnea Scale, and serum PTH, vitamin D, calcium, and phosphate levels were obtained.
Patients with higher COPD stage had lower spirometry values, most significantly MEF. The higher the COPD group (Global Initiative for Chronic Obstructive Lung Disease (GOLD) D), the lower vitamin D and the higher PTH levels were. Calcium and phosphate values were the same for all groups. Vitamin D and PTH levels significantly correlated with MEF values. The lower MEF level, the higher PTH levels, and lower vitamin D levels were found (P<0.05).
Our study showed that the patients in the higher COPD group have lower vitamin D levels and higher PTH levels, indicating that they developed secondary hyperparathyroidism. The levels of vitamin D and PTH correlated the most with MEF values while other spirometry parameters did not significantly correlate with vitamin D and PTH levels.
本研究旨在确定稳定期慢性阻塞性肺疾病（COPD）患者甲状旁腺激素（PTH）和25-羟基维生素D（维生素D）浓度的紊乱情况及其与气流阻塞的相关性。
一项前瞻性研究纳入了在三年期间（2021年5月至2024年5月）于莫斯塔尔大学临床医院肺病与结核病及肺病综合门诊确诊为COPD的200例患者。纳入标准为COPD稳定期、年龄大于40岁且血流动力学稳定的患者、第一秒用力肺活量（FEV1）/用力肺活量（FVC）<0.7以及进行了PTH、维生素D、钙和磷测量的患者。排除标准为过去一个月内COPD急性加重；目前正在使用营养补充剂、维生素和他汀类药物治疗；缺乏肺功能数据；过去三个月内使用全身糖皮质激素；慢性肾功能不全、除COPD外的其他呼吸系统疾病（哮喘、肺炎、结核病和支气管扩张症）以及其他疾病（癌症和甲状旁腺疾病）。获取了有关人口统计学数据（年龄和性别）、肺功能测试（FVC、FEV1、FEV1%FVC、平均呼气流量（MEF））、体重指数（BMI）、COPD评估测试（CAT）、改良医学研究委员会（mMRC）呼吸困难量表以及血清PTH、维生素D、钙和磷水平的病历。
COPD分期较高的患者肺量计值较低，其中MEF降低最为显著。COPD组（慢性阻塞性肺疾病全球倡议（GOLD）D组）越高，维生素D水平越低，PTH水平越高。所有组的钙和磷值相同。维生素D和PTH水平与MEF值显著相关。发现MEF水平越低，PTH水平越高，维生素D水平越低（P<0.05）。
我们的研究表明，COPD较高组的患者维生素D水平较低，PTH水平较高，表明他们发生了继发性甲状旁腺功能亢进。维生素D和PTH水平与MEF值的相关性最高，而其他肺量计参数与维生素D和PTH水平无显著相关性。
