骨化三醇治疗对老年慢性心力衰竭患者血清NT-proBNP、MMP-9及心肌细胞凋亡、血管内皮功能和LVMI的影响

Effects of calcitriol treatment on serum NT-proBNP,MMP-9,myocardial cell apoptosis,vascular endothelial function and LVMI in elderly patients with chronic heart failure

目的探讨骨化三醇治疗对老年慢性心力衰竭(CHF)患者血清NT-proBNP、MMP-9及心肌细胞凋亡、血管内皮功能和左心室质量指数(LVMI)的影响。方法将2019年8月至2021年12月于该院就诊的86例老年CHF患者纳入研究,采用随机数字ge法分为常规组和骨化三醇组,每组43例。常规组给予常规治疗,骨化三醇组在常规治疗基础上给予骨化三醇治疗,持续治疗6个月。观察两组治疗前后血清N-末端脑钠肽前体(NT-proBNP)、基质金属蛋白酶-9(MMP-9)、LVMI、心肌细胞凋亡指标[细胞凋亡抑制因子(Fas/APO-1)、可溶性Fas(sFas)、可溶性Fas配体(sFasL)]、血管内皮功能[血清内皮素(ET-1)、血管内皮生长因子(VEGF)、血浆一氧化氮(NO)、肱动脉内皮依赖性舒张功能(FMD)]变化及用药的安全性。结果治疗后,骨化三醇组NT-proBNP、MMP-9水平及LVMI均低于常规组P<0.05),Fas/APO-1、sFas、sFasL水平也均低于常规组(P<0.05)。两组NEGF、NO、FMD水平均较同组治疗前不同程度升高(P<0.05),ET-1较治疗前降低(P<0.05),骨化三醇组各指标水平均优于常规组,差异有统计学意义(P<0.05)。两组心血管事件及药物不良反应发生率比较,差异无统计学意义(P>0.05)。结论骨化三醇治疗能够降低老年CHF患者血清NT-proBNP、MMP-9水平及LVMI,抑制心肌细胞凋亡,改善血管内皮功能,对保护患者心功能具有临床研究价值。

Objective To investigate the effects of calcitriol treatment on serum N-terminal brain natriuretic peptide precursor(NT-proBNP),matrix metalloproteinase-9(MMP-9),myocardial cell apoptosis,vascular endothelial function and left ventricular mass index(LVMI)in elderly patients with chronic heart failure(CHF).Methods A total of 86 elderly patients with CHF who were admitted to the hospital from August 2019 to December 2021 were enrolled in the study.They were divided into routine group and calcitriol group by digital randomization method,with 43 patients in each group.The routine group was given routine treatment,and the calcitriol group was given calcitriol in addition to routine treatment for 6 months.Changes of NT-proBNP,MMP-9,LVMI,cardiac myocyte apoptosis indicators[apoptosis inhibition factor(Fas/APO-1),soluble Fas(sFas),soluble Fas ligand(sFasL)],vascular endothelial function[serum endothelin(ET-1),vascular endothelial growth factor(VEGF),plasma nitric oxide(NO)and endothelium-dependent relaxation function(FMD)]were observed before and after treatment and safety of medication were also observed.Results After treatment,the levels of NT proBNP,MMP-9 and LVMI in calcitriol group were lower than those in routine group(P<0.05),and the levels of Fas/APO-1,sFas and sFasL in calcitriol group were also lower than those in routine group(P<0.05).After treatment,the levels of NEGF,NO and FMD in the two groups were higher than those before treatment(P<0.05),and the levels of ET-1 were lower than those in the same group before treatment(P<0.05).The levels of each index in the calcitriol group were better than those in the conventional group with statistically significant difference(P<0.05).There was no significant difference in the incidence of cardiovascular events and adverse drug reactions between the two groups(P>0.05).Conclusion Calcitriol treatment can reduce the levels of NT proBNP,MMP-9 and LVMI in serum of elderly patients with CHF,inhibit cardiomyocyte apoptosis,improve vascular endothelial function,and has clinical research value in protecting the heart function of patients.