JCEM：PTH是心脏重构的决定性因素之一

PTH与左室重量和左室射血分数的关系

新的证据提示维生素D和PTH在心脏疾病的发展中发挥作用。为了探讨在横断面下，25羟维生素D（25OHD）和PTH浓度是否与磁共振成像（MRI）的心脏结构和功能相关，来自荷兰阿姆斯特丹自由自由大学健康科学系的A J van Ballegooijen教授及其团队进行了一项研究，该研究发现在老年的白种人群，血清25OHD浓度与MRI测量的心脏结构和功能无关，较高的PTH浓度与更大的LV重量和更低的收缩功能相关。该研究结果在线发表在4月12日的美国《临床内分泌代谢杂志》（The journal of clinical endocrinology & metabolism）上。

该研究中，ICELAND–MI是年龄、基因/环境易感性–雷克雅未克研究的一个亚研究，是一个在2004年至2007年期间采样并测量的糖尿病受试者组成的老年社区居民队列。使用免疫分析法测量血清25OHD浓度（n=992）。采用双位点免疫分析法测量完整PTH浓度(n=203)。共有969例受试者参与这个横断面分析（平均年龄76±5.3岁，女性51%）。平均25OHD为54.2±25.5nmol/l，PTH中位数为4.5pmol/l（范围1.5–18）。使用MRI测量心脏结构和功能。

该研究结果表明，在未校正的分析中，以最高25OHD组相比（≥75nmol/l），最低25OHD组（≤25nmol/l）与更小的左和右心房面积相关；然而，校正协变量后，这个相关性变成没有意义。在完全校正模型中，与PTH最低四分位数相比，PTH最高四分位数与左心室(LV)重量增加7.2g(95%CI 0.8,13.8)和LV射血分数降低5.1%（–9.1，–1.1）显著相关。

该研究发现，在老年白种人群，血清25OHD浓度与MRI测量心脏结构和功能无关。较高的PTH浓度与更高的LV重量和更低的收缩功能相关，可能表明PTH的潜在作用，作为心脏重构的决定性因素之一。

与心脏相关的拓展阅读：

• 刘晋萍：就一篇“应用自体脐带血为新生儿实施心脏手术”的论文提出疑问
• ACE抑制剂与β受体阻滞剂或许可预防化疗导致的心脏毒性
• Circulation：放疗增加癌症患者心脏手术死亡率
• APT：乳糜泻患者中缺血性心脏病的危险因素
• 总结：心脏源性分泌物质（Cardiac Secretome）汇总
• NEJM：痴呆花费已超过癌症和心脏病
更多信息请点击：有关心脏更多资讯

Serum Vitamin D and Parathyroid Hormone in Relation to Cardiac Structure and Function: The ICELAND-MI Substudy of AGES-Reykjavik
Context
Emerging evidence suggests that vitamin D and PTH may play a role in the development of cardiac diseases.
Objective
We investigated whether 25-hydroxyvitamin D (25OHD) and PTH concentrations are cross-sectionally associated with cardiac structure and function using magnetic resonance imaging (MRI).
Design, Setting, and Participants
ICELAND-MI is a substudy of the Age, Gene/Environment Susceptibility-Reykjavik Study, an older-aged community-dwelling cohort with oversampling of participants with diabetes (29%) and measurements between 2004 and 2007. Serum 25OHD concentrations were measured using an immunoassay (n = 992). Intact PTH concentrations were measured using a 2-site immunoassay (n = 203). We included 969 participants for this cross-sectional analysis (mean age 76 ± 5.3 years, 51% female). Mean 25OHD was 54.2 ± 25.5 nmol/L and the median PTH was 4.5 pmol/L (range 1.5–18).
Main Outcomes
MRI to measure cardiac structure and function was the main outcome.
Results
The lowest 25OHD category (<25 nmol/L) compared with the highest category (≥75 nmol/L) was associated with a smaller left and right atrial area in unadjusted analyses; however, the associations became nonsignificant after adjustment for covariates. The highest PTH quartile compared with the lowest quartile was significantly associated with a 7.3 g (95% confidence interval 0.8, 13.8) greater left ventricular (LV) mass and a 5.1% (−9.1, −1.1) lower LV ejection fraction compared with the lowest PTH quartile in the fully adjusted model.
Conclusions
Serum 25OHD concentrations were not associated with MRI measures in an older white population. Higher PTH concentrations were associated with greater LV mass and lower systolic function and may point to a potential role for PTH as a determinant of cardiac remodeling.