血清25羟维生素D对心脏再同步治疗无反应和远期预后的影响

Effects of Serum 25-Hydroxyvitamin D on Non-Response and Long-Term Prognosis of Patients with Cardiac Resynchronization Therapy

目的探讨血清25羟维生素D水平对心脏再同步治疗(CRT)无反应及远期预后的影响。方法选取2015年1月~2019年9月解放军总医院符合条件的195例CRT患者为研究对象。根据入院后空腹静脉血测量25羟维生素D结果进行分组,<30 nmol/L为维生素D缺乏组(95例),30~49 nmol/L为维生素D不足组(55例),三50 nmol/L为维生素D充足组(45例)。所有患者进行前瞻性随访,术后6个月时进行CRT反应判断。随访截止日期为2020年3月31日,随访终点事件为主要不良心血管事件(MACE)。应用logistic多元回归分析25羟维生素D水平与CRT无反应之间的关系。生存率估算应用Kaplan-Meier法,生存曲线之间的比较采用log-rank检验。应用单因素和多因素Cox比例风险回归分析25羟维生素D水平对MACE的影响。结果73例(37.4%)患者存在CRT无反应现象。多元logistic回归表明25羟维生素D<30 nmol/L是CRT无反应的独立危险因素(P<0.05)。维生素D充足组、维生素D不足组、维生素D缺乏组患者生存曲线比较,差异有统计学意义(P<0.05),其中维生素D缺乏组中位生存时间短于维生素D充足组(P<0.05),其余组间差异均无统计学意义(P>0.05)。随访期间出现MACE 85例,多因素Cox比例风险回归显示25羟维生素D<30 nmol/L为MACE的独立危险因素(P<0.05)。结论维生素D缺乏(25羟维生素D<30 nmol/L)是CRT患者术后无反应的危险因素,并且影响CRT患者的远期心血管事件。

Objective To explore the effects of serum 25-hydroxyvitamin D level on non-response and long-term prognosis of patients undergoing cardiac resynchronization therapy(CRT).Methods A total of 195 CRT patients in the PLA General Hospital From January 2015 to September 2019 were selected as the research objects.The patients were divided into 3 groups according to the level of blood 25-hydroxyvitamin D after admission, including vitamin D deficiency group(95 cases with 25-hydroxyvitamin D<30 nmol/L),vitamin D insufficiency group(55 cases with 25-hydroxyvitamin D 30-49 nmol/L),and vitamin D sufficient group(45 cases with 25-hydroxyvitamin D≥50 nmol/L).All patients were prospectively followed up, and CRT response was evaluated at 6 months after surgery.The follow-up deadline was March 31,2020,and the end-point event of follow-up was major adverse cardiovascular events(MACE).Multivariate logistic regression was used to analyze the relationship between 25-hydroxyvitamin D level and CRT non-response.Kaplan-Meier method was used to estimate survival rate, and log-rank test was performed to compare the survival curves.Univariate and multivariate Cox proportional hazards regression were used to analyze the effect of 25-hydroxyvitamin D level on MACE.Results Seventy-three patients(37.4%) showed non-response to CRT.Multivariate logistic regression analysis showed that serum 25-hydroxyvitamin D<30 nmol/L was an independent risk factor for non-response to CRT(P<0.05).There was significant difference in survival curve among vitamin D sufficient group, vitamin D insufficient group and vitamin D deficiency group(P<0.05).The median survival time of the vitamin D deficiency group was shorter than that of the vitamin D sufficient group(P<0.05),and there was no significant difference between the other groups(P>0.05).MACE occurred in 85 cases during the follow-up period.Multivariate Cox proportional hazards regression analysis showed that the serum 25-hydroxyvitamin D<30 nmol/L was an independent risk factor for MACE.Conclusion Vitamin D deficiency(serum 25-hydroxyvitamin D<30 nmol/L) is a risk factor for non-response, and affects the long-term cardiovascular events in CRT patients.