25-羟维生素D、血清甲状旁腺激素与射血分数减低心力衰竭的相关性分析

Correlation between 25-hydroxyvitamin D,serum parathyroid hormone and HfrEF

目的:探讨在射血分数减低心力衰竭(HFr EF)患者中,25-羟维生素D[25(OH)D]、血清甲状旁腺激素(PTH)水平与心力衰竭严重程度、心衰生物学标志物BNP、s ST2的相关性。方法:选取南京鼓楼医院2017年9月—2018年2月心内科收治的慢性HFr EF患者152例,另选取心功能正常的对照组31例,电化学发光法检验25(OH)D水平、化学发光法测PTH水平,分析慢性心力衰竭与维生素D缺乏、PTH水平相关性。结果:心力衰竭患者与无心衰的对照组相比,25(OH)D水平显著降低,PTH水平显著升高(P<0.001);在心衰患者中,不同25(OH)D水平患者的心功能分级有着显著性差异(P=0.003),25(OH)D缺乏的患者心衰BNP、s ST2水平显著上升,差异具有统计学意义(P=0.016,P<0.001);相关性分析发现NYHA分级、BNP水平、s ST2水平分别与25(OH)D存在负相关,与PTH存在正相关;与25(OH)D/PTH存在负相关,差异均具有统计学意义。对心衰的独立危险因素进行Logistic多因素回归分析,结果显示25(OH)D及PTH水平均为心力衰竭的独立危险因素。结论:HFr EF患者的25(OH)D水平较无心衰人群低,血清PTH水平较无心衰人群高;在HFr EF患者中,心衰患者25(OH)D水平与心力衰竭严重程度呈负相关,PTH水平与心力衰竭严重程度呈正相关,25(OH)D/PTH水平与心力衰竭严重程度呈负相关;且25(OH)D及PTH水平均为心力衰竭的独立危险因素。

Objective：To investigate the correlation between serum 25-hydroxyvitamin D,serum parathyroid hormone levels and the biomarkers of heart failure（BNP and s ST2）in patients with HFr EF. Methods：A total of 152 patients with HFr EF who were admitted to the Department of Cardiology of Nanjing Drum Tower Hospital from September 2017 to February 2018 were selected and 31 people with normal heart function was selected as the control group. levels of 25-hydroxyvitamin D were measured using electrochemiluminescence,parathyroid hormone levels were measured by chemiluminescence. The condation of chronic heart failure and lack of vitamin D,parathyroid hormone levels was analyzed. Results：Compared with healthy controls,patients with heart failure had significantly lower 25-hydroxyvitamin D levels and significantly increased PTH levels（P 0.001）. Patients in HF with different 25-hydroxyvitamin D levels had a significant difference in heart function classification（P=0.003）. Patients with 25-hydroxyvitamin D deficiency had increased BNP and s ST2 levels significantly,with statistical significance（P=0.016,P 0.001）;Correlation analysis revealed that NYHA grades,BNP levels,s ST2 levels were negative associated with 25-hydroxyvitamin D,VD/PTH respectively and positively correlated with PTH. Logistic multivariate regression analysis of independent risk factors for heart failure revealed that both25-hydroxyvitamin D and PTH levels were independent risk factors for heart failure. Conclusion：The 25-hydroxyvitamin D levels in patients with HFr EF are lower than those in healthy people,and serum parathyroid hormone levels are higher than those in healthy people. The level of 25-hydroxyvitamin D in patients with heart failure was negatively correlated with the severity of cardiac function.PTH levels were positively correlated with the severity of heart function. 25-hydroxyvitamin D/PTH levels were negatively correlated with the severity of heart function;and 25-hydroxyl vitamin D and PTH levels are independent risk factors for heart failure.