老年慢性心力衰竭患者血清25羟维生素D_3水平与预后的相关性研究

Association of serum 25-hydroxyvitamin D_3 levels and the prognosis in elderly patients with chronic heart failure

目的观察老年慢性心力衰竭(HF)患者血清25羟维生素D_3(25-OH-Vit D_3)水平与预后的相关性。方法选择108例老年HF患者和68例老年健康体检者,记录两组人群的血清25-OH-Vit D_3水平及一般情况。根据25-OH-Vit D_3水平将HF组分为A组(≥50 nmol·L-1)和B组(<50 nmol·L-1),比较两组在疗效方面的差异。结果老年HF患者血清25-OH-Vit D_3和钙(Ca)水平低于对照组,收缩压、氨基N末端B型利钠肽前体(NT-pro BNP)、甲状旁腺激素(PTH)和抗酒石酸酸性磷酸酶5b(TRACP-5b)水平高于对照组,差异有统计学意义(P<0.05)。A组25-OH-Vit D_3和Ca水平显著高于B组,NT-pro BNP、TRACP-5b和PTH水平显著低于B组,差异有统计学意义(P<0.05)。A组抗高血压药物使用率及左室射血分数(LVEF)显著高于B组,而心功能分级、左室舒张末期内径(LVEDD)、左室收缩末期内径(LVESD)及住院期间事件发生率显著低于B组,差异有统计学意义(P<0.05)。logistic回归分析显示,25-OH-Vit D_3和LVEF是影响老年HF患者预后的独立危险因素,25-OH-Vit D_3与预后不良呈负相关(OR=0.798,95%CI=0.645~0.987,P=0.038)。结论老年HF患者血清25-OH-Vit D_3水平降低,低25-OH-Vit D_3水平可能是影响老年HF患者预后的独立危险因素。

Objective To investigate the association of serum 25-hydroxyvitamin D3（25-OH-Vit D3） levels and the prognosis in elderly patients with chronic heart failure（CHF）. Methods 108 patients with CHF and 68 healthy controls were included,serum 25-OHVit D3 levels and clinical data of who were recorded. The CHF patients were divided into group A（≥50 nmol·L-1） and group B（50 nmol·L-1） according to the levels of 25-OH-Vit D3. The differences of risk factors for HF,past drug history,acute medications and the curative effect were compared between the two subgroups. Results The levels of serum 25-OH-Vit D3 and calcium were lower,and the levels of systolic blood pressure,N-terminal pro b-type natriuretic peptide（NT-pro BNP）,parathyroid hormone（PTH） and tartrate resistant acid phosphatase 5 b（TRACP-5 b） were higher among the HF patients than in control group. The levels of serum 25-OH-Vit D3 and calcuim were higher,the levels of serum NT-pro BNP,TRACP-5 b and PTH were lower in group A than in group B. The antihypertensive drug usage and left ventricular ejection fraction（LVEF） were higher,cardiac function classification,left ventricular end diastolic diameter（LVEDD）,left ventricular end systolic diameter（LVESD） and incidence of in-hospital events was lower in group A than in group B. Logistic regression analysis suggested that serum 25-OH-Vit D3 levels and LVEF were independent risk factors for predicting prognosis among CHF patients,serum 25-OH-Vit D3 levels were inversely correlated with poor prognosis（OR = 0. 798,95% CI = 0. 645-0. 987,P = 0. 038）. Conclusions Serum 25-OH-Vit D3 levels were lower among elderly CHF patients,and low 25-OH-Vit D3 levels might be an independent risk factor for poor prognosis in CHF patients.