Background The temporal sequence between serum calcium and insulin resistance (IR) and their effects on hypertension are unclear. We studied the association between serum calcium and IR, with risk of hypertension events in a longitudinal cohort conducted in China. Methods and Results Data from 8653 subjects aged 20 to 74 years with an average follow‐up of 5.3 years were analyzed. Serum calcium, and fasting and 2‐hour serum glucose and insulin were measured at baseline and follow‐up. Cross‐lagged panel and mediation analysis were used to examine the temporal relationship between serum calcium and IR and its impact on hypertension incidence. The conjoint effects of serum calcium and IR at baseline on hypertension at follow‐up were observed ( P =0.029 for HOMA_IR [hepatic IR] and P =0.009 for Gutt index [peripheral IR]). The cross‐lagged path coefficient (β 2 ) from baseline serum calcium to follow‐up peripheral IR were significantly greater than path coefficient (β 1 ) from baseline peripheral insulin resistance to follow‐up serum calcium (β 2 =−0.354 versus β 1 =−0.005; P =0.027). However, no directional relationships were observed in the serum calcium↔hepatic IR analysis. The mediation effect of peripheral IR on the association of serum calcium at baseline with hypertension at follow‐up was estimated at 16.4% ( P <0.001). Conclusions Our findings demonstrate that higher serum calcium levels probably precede peripheral IR, and this 1‐directional relation plays a role in the development of hypertension.

[目的]探讨经寰枢椎弓根钉联合枢椎椎板钉固定融合治疗寰枢关节不稳或脱位的疗效。[方法]2003年2月~2009年2月收治的寰枢关节不稳或脱位病例7例,男4例,女3例;年龄10~61岁,平均41岁。术前颈椎矢状位CT提示枢椎椎动脉孔高跨3例;C2、3分隔不全,枢椎椎弓根狭小4例。其中4例有脊髓病或脊髓损伤的症状、体征。分别行颈后路经双侧寰椎侧块、一侧枢椎椎弓根钉、一侧枢椎椎板钉寰枢固定4例;经一侧枢椎椎弓根钉、一侧枢椎椎板钉与枕骨行枕颈固定3例。取自体髂骨植骨融合。[结果]手术中无脊髓和椎动脉损伤的病例。本组7例得到随访,随访1~3年,平均13个月,均获得骨性融合,无钉板断裂病例。3例脊髓功能改善明显,1例略有改善。[结论]寰枢椎不稳或脱位,术前枢椎CT提示枢椎椎弓根发育异常,无法采取螺钉固定时,可通过枢椎椎板置钉,实施寰枢融合或枕颈融合术,此技术操作简便,风险小,疗效可靠。