充血性心力衰竭患者血清25-OH-VitD_3水平变化及临床意义
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摘要
目的探讨充血性心力衰竭(CHF)患者血清25羟维生素D_3(25-OH-VitD_3)水平变化及其临床意义。方法收集2015年9月至2017年9月于靖西市人民医院心血管内科收治的141例CHF患者为研究对象,根据NYHA分级标准将其分为NYHAⅠ级(n=32)、NYHAⅡ级(n=43)、NYHAⅢ级(n=37)和NYHAⅣ级(n=29),并于同期随机选取40例健康体检者为对照组。采用酶联免疫吸附法检测血清25-OH-VitD_3、N末端脑钠肽前体(NT-proBNP),采用超声心动图检测左心室收缩末期内径(LVESD)、左心室舒张末期内径(LVEDD)、左室射血分数(LVEF),采用受试者工作特征曲线(ROC)评价25-OH-VitD_3对CHF患者不良预后的预测价值。结果 CHF患者25-OH-VitD_3、LVEF低于健康体检者,NT-proBNP、LVESD、LVEDD高于健康体检者,差异有统计学意义(P<0.05)。随着NYHA分级增加,25-OH-VitD_3、LVEF水平逐渐降低,NT-proBNP、LVESD、LVEDD水平逐渐升高,差异均有统计学意义(P<0.05)。经Pearson积矩相关分析,CHF患者血清25-OH-VitD_3与NT-proBNP呈负相关性(r=-0.728,P<0.05),与超声心动图参数中的LVESD、LVEDD呈负相关性(r=-0.671、-0.629,P<0.05),与LVEF呈正相关(r=0.724,P<0.05)。随访期间,共49例(34.75%)患者发生不良心血管事件,25-OH-VitD_3预测CHF患者不良心血管事件的ROC曲线下面积AUC为0.846(95%CI:0.769～0.923),截断值为13.76μg/L,灵敏度、特异性分别为0.82、0.76,准确性为0.79。25-OH-VitD_3<13.76μg/L组不良心血管事件发生率为49.25%(33/67),高于25-OH-VitD_3≥13.76μg/L组的21.62%(16/74),差异有统计学意义(χ2=11.841,P<0.05)。结论 CHF患者25-OH-VitD_3明显缺乏,并且与心力衰竭严重程度密切相关,早期检测可作为预测CHF患者不良预后的指标。
Objective To explore the changes of serum 25-Dihydroxyvitamin D_3(25-OH-VitD_3) level in patients with congestive heart failure(CHF) and its clinical significance. Methods A total of 141 patients with CHF admitted to department of cardiovascular medicine of Jingxi People's hospital from September 2015 to September 2017 were collected, they were divided into NYHA class Ⅰ(n=32), NYHA class Ⅱ(n=43), NYHA class Ⅲ(n=37) and NYHA class VI(n=29) according to NYHA grading standard. At the same time, 40 healthy volunteers were randomly selected as control group. The serum 25-OH-VitD_3 and N terminal pro-brain natriuretic peptide(NT-proBNP) was detected by enzyme-linked immunosorbent assay. Left ventricular end systolic diameter(LVESD), left ventricular end diastolic diameter(LVEDD), left ventricular ejection fraction(LVEF) was measured by echocardiography. Receiver operating characteristics curve(ROC) was used to evaluate the predictive value of 25-OHVit D_3 in poor prognosis of patients with CHF. Results The 25-OH-VitD_3 and LVEF in CHF patients was lower than those in healthy volunteers, while NT-proBNP, LVESD, LVEDD in CHF patients was higher than those in healthy volunteers, the difference was statistically significant(P<0.05). With the increase of NYHA classification, the level of25-OH-Vit D_3 and LVEF decreased gradually, and NT-proBNP, LVESD, LVEDD increased gradually, the difference was statistically significant(P<0.05). The Pearson product moment correlation analysis showed than serum 25-OHVit D_3 was negatively correlated with NT-proBNP(r=-0.728, P<0.05), negatively correlated with LVESD, LVEDD(r=-0.671,-0.629; P<0.05), and positively correlated with LVEF(r=0.724, P<0.05). During the follow-up period, 49 CHF patients(34.75%) had adverse cardiovascular events, the area under ROC curve of 25-OH-VitD_3 for predicting adverse cardiovascular events in CHF patients was 0.846(95%CI: 0.769～0.923), the cut-off value was 13.76 μg/L,the sensitivity and specificity were 0.82 and 0.76 respectively, and the accuracy was 0.79. The incidence of adverse cardiovascular events in 25-OH-VitD_3<13.76 μg/L group was 49.25%(33/67), which was higher than 21.62%(16/74)in 25-OH-VitD_3≥13.76 μg/L group, the difference was statistically significance(χ2=11.841, P<0.05). Conclusion25-OH-Vit D_3 is obviously deficiency in CHF patients, which is closely related to the severity of heart failure. Early detection can be used as a predictor of poor prognosis in CHF patients.
Objective To explore the changes of serum 25-Dihydroxyvitamin D_3(25-OH-VitD_3) level in patients with congestive heart failure(CHF) and its clinical significance. Methods A total of 141 patients with CHF admitted to department of cardiovascular medicine of Jingxi People's hospital from September 2015 to September 2017 were collected, they were divided into NYHA class Ⅰ(n=32), NYHA class Ⅱ(n=43), NYHA class Ⅲ(n=37) and NYHA class VI(n=29) according to NYHA grading standard. At the same time, 40 healthy volunteers were randomly selected as control group. The serum 25-OH-VitD_3 and N terminal pro-brain natriuretic peptide(NT-proBNP) was detected by enzyme-linked immunosorbent assay. Left ventricular end systolic diameter(LVESD), left ventricular end diastolic diameter(LVEDD), left ventricular ejection fraction(LVEF) was measured by echocardiography. Receiver operating characteristics curve(ROC) was used to evaluate the predictive value of 25-OHVit D_3 in poor prognosis of patients with CHF. Results The 25-OH-VitD_3 and LVEF in CHF patients was lower than those in healthy volunteers, while NT-proBNP, LVESD, LVEDD in CHF patients was higher than those in healthy volunteers, the difference was statistically significant(P<0.05). With the increase of NYHA classification, the level of25-OH-Vit D_3 and LVEF decreased gradually, and NT-proBNP, LVESD, LVEDD increased gradually, the difference was statistically significant(P<0.05). The Pearson product moment correlation analysis showed than serum 25-OHVit D_3 was negatively correlated with NT-proBNP(r=-0.728, P<0.05), negatively correlated with LVESD, LVEDD(r=-0.671,-0.629; P<0.05), and positively correlated with LVEF(r=0.724, P<0.05). During the follow-up period, 49 CHF patients(34.75%) had adverse cardiovascular events, the area under ROC curve of 25-OH-VitD_3 for predicting adverse cardiovascular events in CHF patients was 0.846(95%CI: 0.769～0.923), the cut-off value was 13.76 μg/L,the sensitivity and specificity were 0.82 and 0.76 respectively, and the accuracy was 0.79. The incidence of adverse cardiovascular events in 25-OH-VitD_3<13.76 μg/L group was 49.25%(33/67), which was higher than 21.62%(16/74)in 25-OH-VitD_3≥13.76 μg/L group, the difference was statistically significance(χ2=11.841, P<0.05). Conclusion25-OH-Vit D_3 is obviously deficiency in CHF patients, which is closely related to the severity of heart failure. Early detection can be used as a predictor of poor prognosis in CHF patients.
引文
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[14]Tishkoff DX,Nibbelink KA,Holmberg KH,et al.Function vitamin Dreceptor(VDR)in the t-tubules of cardiac myocytes:VDR knockout cardiomyocyte contractility[J].Endocrinology,2008,149(2):558-64.
[15]曾雪,方小丽,何扬利.血清25-(OH)D3、hsCRP及NT-proBNP与慢性心衰患者心衰程度及预后的关系[J].心血管康复医学杂志,2016,25(4):394-8.
[16]陈燕,柳达,罗文利,等.老年慢性心力衰竭患者血清维生素D水平与病情严重程度及心血管事件的关系[J].中国老年学杂志,2018,38(10):2332-4.
[17]王安恵.慢性心力衰竭患者血清25-(OH)D3、hsCRP级NT-proBNP水平与心力衰竭程度和预后的相关性[J].武警医学,2018,29(4):367-70.
[18]杨红亮,孟利敏.25-(OH)D3、NT-proBNP、PCT对老年慢性阻塞性肺疾病合并心力衰竭患者近期预后的影响[J].中国循证心血管医学杂志,2017,9(4):443-5.
[19]Ramagopalan SV,Heger A,Berlanga AJ,et al.chipseq defined genome-wide map of vitamin D receptor binding:associations with disease and evolution[J].Genome Res,2010,20(10):1352-60.
[2]Shibata A,Sugano Y,Shimouchi A,et al.Decrease in exhaled hydrogen as marker of congestive heart failure[J].Open Heart,2018,5(2):e000814.
[3]宋为娟,杨瑞霞,任真,等.2型糖尿病患者血清2 5-羟维生素D_3与糖代谢指标相关性分析[J].国际检验医学杂志,2018,39(19):2379-82.
[4]李雪琴,方小正,卢正红,等.老年慢性心力衰竭患者血清25羟维生素D3水平与预后的相关性研究[J].安徽医药,2018,22(9):1776-80.
[5]Zhang P,Zhang W,Zhang D,et al.25-Hydroxyvitamin D3-enhanced PTPN2 positively regulates periodontal inflammation through the JAK/STAT pathway in human oral keratinocytes and a mouse model of type 2 diabetes mellitus[J].J Periodontal Res,2018,53(3):467-77.
[6]Liao EY,Zhang ZL,Xia WB,et al.Calcifediol(25-hydroxyvitamin D)improvement and calcium-phosphate metabolism of alendronate sodium/vitamin D3 combination in Chinese women with postmenopausal osteoporosis:a post hoc efficacy analysis and safety reappraisal[J].BMC Musculoskelet Disord,2018,19(1):210.
[7]Muller DC,Scelo G,Zaridze D,et al.Circulating 25-hydroxyvitamin D3 and survival after diagnosis with kidney cancer[J].Cancer Epidemiol Biomarkers Prev,2015,24(8):1277-81.
[8]Wang TJ,Pencina MJ,Booth SL,et al.Vitamin D deficiency and risk of cardiovascular disease[J].Circulation,2008,117(4):503-11.
[9]王喆.《中国心力衰竭诊断和治疗指南2014》解读[J].中国临床医生杂志,2016,44(5):14-6.
[10]刘莉红,董旭,赵芳.维生素D/甲状旁腺激素、髓过氧化物酶与慢性心力衰竭的关系研究[J].河北医药,2018,40(15):2284-7,2291.
[11]付鹏,张琳,牛铁生,等.维生素D、甲状旁腺激素与慢性心力衰竭的相关性分析[J].中国现代医学杂志,2016,26(19):80-4.
[12]王齐增,范云操,叶晨希,等.入院时血清维生素D水平与老年慢性心力衰竭患者近期心血管事件的关系研究[J].浙江医学,2016,38(17):1405-9.
[13]王一凯,赵林凤.维生素D与慢性心力衰竭关系的研究进展[J].实用心脑肺血管病杂志,2016,24(3):3-5.
[14]Tishkoff DX,Nibbelink KA,Holmberg KH,et al.Function vitamin Dreceptor(VDR)in the t-tubules of cardiac myocytes:VDR knockout cardiomyocyte contractility[J].Endocrinology,2008,149(2):558-64.
[15]曾雪,方小丽,何扬利.血清25-(OH)D3、hsCRP及NT-proBNP与慢性心衰患者心衰程度及预后的关系[J].心血管康复医学杂志,2016,25(4):394-8.
[16]陈燕,柳达,罗文利,等.老年慢性心力衰竭患者血清维生素D水平与病情严重程度及心血管事件的关系[J].中国老年学杂志,2018,38(10):2332-4.
[17]王安恵.慢性心力衰竭患者血清25-(OH)D3、hsCRP级NT-proBNP水平与心力衰竭程度和预后的相关性[J].武警医学,2018,29(4):367-70.
[18]杨红亮,孟利敏.25-(OH)D3、NT-proBNP、PCT对老年慢性阻塞性肺疾病合并心力衰竭患者近期预后的影响[J].中国循证心血管医学杂志,2017,9(4):443-5.
[19]Ramagopalan SV,Heger A,Berlanga AJ,et al.chipseq defined genome-wide map of vitamin D receptor binding:associations with disease and evolution[J].Genome Res,2010,20(10):1352-60.