冯世栋 田秀娟 王妍 王汉民

【摘要】  慢性肾脏病发病率逐年增高，进展至终末期肾病的患者明显增加，心血管并发症是终末期肾病患者最主要的死因，如何减少终末期肾病患者心血管并发症发生，延缓心血管并发症发展已成为临床医师的当务之急。既往研究证实维生素D缺乏及其信号通路异常是造成患者心血管疾病重要的危险因素之一。维生素D缺乏促进血管内皮损伤及动脉粥样硬化、心室重构、甲状旁腺素过度分泌、心血管微炎症等，导致心血管事件发生。该文将系统阐述终末期肾病患者维生素D缺乏的病理生理机制，维生素D缺乏与心血管结构和功能改变、心血管并发症的关系，从而对预防终末期肾病患者心血管事件发生，改善患者预后有一定临床意义。

【关键词】  维生素D;终末期肾病;心血管保护

【Abstract】  The incidence of chronic kidney disease，especially the end?stage renal disease （ESRD），is increasing annually. Cardiovascular complications are the primary causes of the death of ESRD patients. How to decrease the incidence and prevent the progression of cardiovascular complications in ESRD patients has become an urgent task for clinicians. Previous studies have demonstrated that the vitamin D deficiency and abnormal signaling pathway are important risk factors of cardiovascular events in ESRD patients. Vitamin D deficiency can lead to the incidence of cardiovascular events by promoting the endothelial cell injury and atherosclerosis，ventricular remodeling，hyper?secretion of parathormone，cardiovascular micro?inflammatory state，etc. In this review，the pathophysiological mechanism of vitamin D deficiency and the relationship between vitamin D deficiency and cardiovascular anatomical and functional changes and cardiovascular complications in ESRD patients was systematically analyzed，aiming to provide clinical significance for preventing the incidence of cardiovascular events and improving the clinical prognosis of ESRD patients.

【Key words】 Vitamin D;End?stage renal disease;Cardiovascular protection

维生素D是人体重要的类固醇激素，在维持正常生长发育等方面发挥重要生理功能。既往研究证实维生素D缺乏与佝偻病、骨质软化、骨质疏松等骨代谢异常有关。慢性肾脏病患者维生素D缺乏严重，肾功能下降与维生素D缺乏严重程度呈正相关，80%以上的终末期肾病患者存在严重维生素D缺乏[1?2]。

终末期肾病患者一半以上因心血管并发症死亡，其中38%为心律失常、心脏骤停。研究证实维生素D缺乏是终末期肾病患者心血管结构和功能严重受损的重要危险因素之一。深入了解维生素D缺乏与心血管疾病关系，补充维生素D对心血管结构和功能的保护，减少因维生素D缺乏导致终末期肾病患者死亡成为临床医师关注的焦点。……