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目的探讨肾功能正常冠心病患者及冠心病高危人群血清甲状旁腺激素(PTH)与大动脉僵硬度的关系。方法选取2007年8月至12月上海交通大学医学院附属瑞金医院心脏科77例具有冠心病危险因素的住院患者,根据无创中心动脉脉压(CPP)是否大于40mmHg将病例分为大动脉僵硬度增高组(35例)和对照组(42例)。所有患者测定全段甲状旁腺激素(iPTH)、钙、磷、高敏C-反应蛋白(hsCRP)等指标,并行冠状动脉造影。结果(1)与对照组比较,大动脉僵硬度增高组平均年龄大、血尿酸增高;入选患者中44例确诊为冠心病,大动脉僵硬度增高组冠心病患者(23例)血清iPTH较对照组(21例)显著增高(P<0.05)。(2)血清iPTH与CPP呈正相关(r=0.262,P=0.022)。(3)多因素Logistic回归分析表明,在调整了年龄、BMI、hsCRP和男性4个因素后,血清iPTH(OR=1.065,95%CI:1.005～1.127,P=0.032)是大动脉僵硬度增高(CPP>40mmHg)的独立危险因素。结论大动脉僵硬度增高的肾功能正常冠心病患者血清PTH增高。血清PTH与大动脉僵硬度呈正相关,并且是大动脉僵硬度增高(CPP>40mmHg)的独立危险因素。
Objective To investigate the relationship between serum parathyroid hormone (PTH) and aortic stiffness in patients with normal renal function and high risk of coronary heart disease. Methods Totally 77 inpatients with coronary heart disease risk factors were enrolled in the Department of Cardiology, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from August 2007 to December 2007. According to whether the noninvasive central arterial pressure (CPP) was greater than 40mmHg, the patients were divided into two groups: (35 cases) and control group (42 cases). All patients were measured parathyroid hormone (iPTH), calcium, phosphorus, high-sensitivity C-reactive protein (hsCRP) and other indicators, parallel coronary angiography. Results (1) Compared with the control group, the mean arterial stiffness in the aorta was increased and the serum uric acid was increased. Serum iPTH in 44 patients diagnosed as CHD and arterial stiffness increased in the selected group was higher than that in the control group 21 cases) was significantly higher (P <0.05). (2) There was a positive correlation between serum iPTH and CPP (r = 0.262, P = 0.022). (3) Multivariate Logistic regression analysis showed that serum iPTH (OR = 1.065, 95% CI: 1.005-1.127, P = 0.032) was increased in arterial stiffness after adjusted for age, BMI, hsCRP and male CPP> 40mmHg) independent risk factors. Conclusion Serum PTH is elevated in patients with normal renal function and coronary arterial stiffness. Serum PTH was positively correlated with arterial stiffness and was an independent risk factor for increased arterial stiffness (CPP> 40 mm Hg).