射血分数保留心力衰竭患者中维生素B12缺乏的相关研究

Study on Vitamin B12 Deficiency in Ejection Fraction Retained in the Patients with Heart Failure

目的了解射血分数保留心力衰竭（HFpEF）患者中维生素B12缺乏的患病情况，并探讨其可能的危险因素。方法入选2009年3月～2014年12月在兰州大学第一医院老年心血管病科住院的新诊断HFpEF患者81例，同期住院不合并心力衰竭但有其危险因素的患者82例作为阴性对照，健康成年人82例作为健康对照，测血清维生素B12水平、心功能及其他相关临床指标，了解HFpEF患者中维生素B12缺乏的患病情况，并探讨其可能的危险因素。结果HFpEF组维生素B12缺乏患病率为14．8％，与健康对照组差异显著（P〈0．05）。HFpEF组贫血患病率为17．3％，明显高于对照组（P〈0．01）。HFpEF组中有25％维生素B12缺乏的患者出现了贫血，而21．4％的贫血患者有维生素B12缺乏。维生素B12与平均红细胞体积（MCV）呈负相关（r=-0．010，P〈0．01），与球蛋白（GLB）、左室短轴缩短率（FS）、血管紧张素受体II阻滞剂（ARB）呈正相关（r=0．005～0．457，P〈0．01或0．05）。高密度脂蛋白胆固醇（HDL—C）、左室质量指数（LVMiL）、铁蛋白是维生素B12缺乏的保护因素（P〈0．05，OR=0．001～0．992），MCV、三酰甘油（TG）、N末端B型利钠肽原（NT-proBNP）是维生素B，2缺乏的危险因素（P〈0．05，OR=1．001～2．597）。根据MCV大小分为〈80fL、80-100fL、〉100fL三组时，维生素B12水平均随红细胞体积的增大而呈下降趋势，差异具有统计学意义（P〈0．05）。结论HFpEF患者维生素B12缺乏的患病率显著高于健康人群。维生素B12的缺乏与球蛋白、HDL-C、TC及心功能有关，临床上可通过MCV测定对HFpEF患者维生素B12缺乏进行初步筛选。

Objective To investigate the prevalence of vitamin B12 deficiency in ejection fraction retained in the patients with heart failure and to explore its possible risk factors. Methods 245 Patients in our hospital from March in 2009 to December in 2014 were enrolled. Among them inpatients with heart failure in ejection fraction retained new - diagnosed had 81 cases （ study group）, age -and sex -matched patients without heart failure and with risk factors of heart failure in ejection fraction retained （nega- tive control group） were 82 cases and age and sex- matehe healthy adults （healthy control group） were 82 cases. All subjects＇ ser- um levels of vitamin B12, cardiac function and other related clinical indicators were detected to investigate the prevalence of vitamin B12 deficiency in the patients with heart failure in ejection fraction retained and to explore its possible risk factors. Results The mor- bidity rate of vitamin B12 deficiency in the stuty group was 14. 8%. There was significantly difference compared with that in the healthy control group （ P 〈 0. 05 ）. The morbidity rate of anemia in the sutdy group was significantly higher than that in the control group （ 17. 3%, P 〈0. 01 ）. In the study group, 25% of patients with vitamin B12 deficiency had animia, while 21.4% of patients with anemia had vitamin B12 deficiency. Serum level of vitamin B12 was negatively correlated with Mean Corpuscular Volume （MCV） （ R = -0. 009, P 〈0. 01 ）, and was positively correlated with globulin （ GLB）, fractional shortenting （FS） and angiotensin I1 re- ceptor blocker （ARB） （R=0.005 -0.457, P〈0.01 or0.05）. The levels of high density lipoprotein cholesterol （HDL-C）, left ventricular mass index （LVMI） and ferritin were the protective factors of vitamin B12 deficiency （P 〈 0. 05, OR = 0. 001 ~ 0. 992）. MCV, triglycerie （TG） and B -type natriuretic peptide （NT -proBNP） were the risk factors of vitamin B12 deficiency （ P 〈 0.05, OR = 1. 001 - 2. 597 ）. The levels of vitamin B12 decreased with the increase of MCV （ P 〈 0. 05 ） and according to MCV there were 80fL, 80 - lO0fL and 100fL groups. Conclusions The morbidity of vitamin B12 dificiency in the study group is significantly higher than that in the healthy groups. The deficiency of vitamin B12 is correlated to globulin, HDL - C, TG and cardiac func- tion. MCV is a reliable screening marker of vitamin B12 deficiency in the patients with heart failure in ejection fraction retained.