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目的探讨25-羟维生素D(25(OH)D)水平对糖尿病肾病(diabetic nephropathy,DN)维持性血液透析患者心功能的影响。方法检测30例DN维持性血液透析患者(DN组)的血清25(OH)D、脑钠肽(brain natriuretic peptide,BNP)、Ca2+水平及QT离散度(QT dispersion,QTd)/校正的QT离散度(corrected QT dispersion,QTcd),并与20例体检健康者(对照组)对比分析。结果 DN组维生素D缺乏(25(OH)D≤50.00nmol/L)和不足者(25(OH)D>50.00～75.00nmol/L)29例;DN组血25(OH)D水平((47.93±22.25)nmol/L)较对照组((95.53±18.18)nmol/L)明显降低(P<0.01),QTd及其校正值QTcd较对照组明显延长(P<0.01);DN组中维生素D缺乏患者血25(OH)D、血Ca2+水平均较维生素D不足患者明显下降,BNP、QTd及QTcd均较维生素D不足患者明显上升或延长(P<0.01);DN组25(OH)D与BNP、QTd、QTcd呈负相关(r=-0.66,r=-0.67,P<0.01);BNP与Ca2+、Ca2+与QTd、QTcd呈负相关(r=-0.51,r=-0.47,r=-0.49,P<0.01),25(OH)D与Ca2+呈正相关(r=-0.49,P<0.01)。结论 DN维持性血液透析患者中常见维生素D缺乏和不足;维生素D缺乏对患者心功能有影响,可加剧心室肌复极不同步性及不稳定性。
Objective To investigate the effect of 25-hydroxyvitamin D (25 (OH) D) on cardiac function in patients with diabetic nephropathy (DN) maintenance hemodialysis. Methods Serum levels of 25 (OH) D, brain natriuretic peptide (BNP), Ca2 + and QT dispersion (QTd) / corrected QT dispersion were measured in 30 patients with DN maintenance hemodialysis (DN) Corrected QT dispersion (QTcd), and compared with 20 healthy subjects (control group). Results There were 29 cases with DN (25 (OH) D≤50.00 nmol / L) and 25 (OH) D> 50.00 ~ 75.00 nmol / L in DN group; ± 22.25) nmol / L was significantly lower than that of the control group (95.53 ± 18.18 nmol / L) (P <0.01), QTd and its corrected value QTcd were significantly longer than those of the control group (P <0.01) The levels of serum 25 (OH) D and blood Ca2 + in patients with DN were significantly lower than those with vitamin D deficiency, and BNP, QTd and QTcd were significantly increased or prolonged compared with patients with vitamin D deficiency (P <0.01) (R = -0.66, r = -0.67, P <0.01). There was a negative correlation between BNP, Ca2 +, Ca2 + and QTd and QTcd (r = -0.51, r = -0.47, r = 0.49, P <0.01). There was a positive correlation between 25 (OH) D and Ca2 + (r = -0.49, P <0.01). Conclusions The common vitamin D deficiency and insufficiency in patients with DN maintenance hemodialysis are rare. The lack of vitamin D can affect the cardiac function of patients and aggravate the asynchronous and instability of ventricular repolarization.