| 摘要: |
| 目的探讨入院时血清维生素D水平与老年慢性心力衰竭患者短期发生心血管事件的关系。方法选取老年慢性心力衰竭患者132例为观察组，同期老年健康体检者100例为对照组，测定入院或体检时的血清25-羟维生素D3[25-（OH）D3]、N末端脑钠肽前体（NT-proBNP）及超敏C反应蛋白（hs-CRP）；记录观察组患者入院24h内的超声心动图指标；记录3个月随访时是否发生心血管事件。结果与对照组比较，观察组血清25-（OH）D3降低（P＜0.05）；血清25-（OH）D3严重缺乏（＜10滋g/L，n=29）者NT-proBNP及hs-CRP水平、NYHAⅢ～Ⅳ级患者的比例及发生近期心血管事件的比例高于25-（OH）D3缺乏（10~20滋g/L，n=67）、不足（20~30滋g/L，n=20）及充足（＞30滋g/L，n=16）者（均P＜0.05），而LVEF则低于后3者（均P＜0.05）；NYHAⅢ～Ⅳ者及发生心血管事件者的血清25-（OH）D3、NT-proBNP及hs-CRP水平高于NYHAⅠ～Ⅱ者及未发生心血管事件者（均P＜0.01），而LVEF则低于后两者（均P＜0.01）。血清25-（OH）D3水平与LVEF呈正相关（P＜0.01），而与NT-proBNP及hs-CRP水平均呈负相关（P＜0.05或0.01）；低血清25-（OH）D3水平是老年慢性心力衰竭患者发生近期心血管事件的高危因素；血清25-（OH）D3水平预测老年慢性心力衰竭患者发生近期心血管事件的AUC为0.831（95%CI：0.536~0.927，P＜0.05），最佳诊断截点为（15.03±1.94）滋g/L，灵敏度和特异度分别为81.7%和76.3%。结论老年心力衰竭患者血清25-（OH）D3水平明显降低，且心功能越差，水平越低，与近期预后密切相关，早期检测血清25-（OH）D3水平有助于评估老年慢性心力衰竭患者病情严重程度及发生近期心血管事件的可能性。 |
| 关键词: 心力衰竭 25- 羟维生素 D3 危险因素 心血管事件 |
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| Correlation of serum vitamin D level at admission with recent cardiovascular events in elderly patients with chronic heart failure |
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WANG Qizeng, FANG Yuncao, YE Chenxi
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Wenling First People's Hospital
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| Abstract: |
| Objective To assess the correlation of serum vitamin D level at admission with recent cardiovascular events in elderly patients with chronic heart failure (CHF). Methods One hundred and thirty two elderly patients with CHF admitted in our hospital from 2012 July to October 2014 (case group) and100 healthy elderly subjects (control group) were enrolled in the study. Serum 25-hydroxy vitamin D3 [25 (OH)D3], NT-proBNP, hs-CRP at admission were detected; echocardiogram indexes was recorded within 24h after admission; cardiovascular events during the 3 months of follow-up were also documented. Results Compared with control group, serum 25 (OH) D3 level in case group was significantly lower (P＜0.05). NT-proBNP, hs-CRP levels and proportion of NYHA Ⅲ~Ⅳ patients, rate of recent cardiovascular events in patients with D3 ＜10滋g/L were significantly higher than those with D3 , insufficient and abundant group (P ＜0 .05 ), and LVEF was lower than the three groups (P＜0.05). NT-proBNP, hs-CRP, 25 (OH) D3 levels, rate of recent cardiovascular events in NYHA Ⅲ ~ Ⅳ group and cardiovascular event group were higher than those in NYHAⅠ~Ⅱgroup and non-event group (P＜0.01), and LVEF was lower than the two groups(P＜0.01). Pearson correlation analysis showed that the 25 (OH) D3 level was positively correlated with LVEF (P ＜0.01), and were negatively correlated with NT-proBNP and hs-CRP levels (P ＜0.05 or 0.01). Multivariable Logistic regression analysis showed that low serum 25 (OH) D3 level was high risk factor for recent cardiovascular events in patients with CHF; ROC curve analysis showed that: the area under the curve (ROCAUC) of serum 25 (OH) D3 predicting the recent cardiovascular events was 0.831 (95% CI : 0.536 ~ 0.927, P＜0.05), the best diagnostic cut-off value was 15.03 ±1.94滋g/L. sensitivity and specificity were 81.7% and 76.3% respectively. Conclusion Serum 25(OH) D3 level is significantly decreased in the elderly patients with heart failure, and gradually decreased with heart function deterioration, its level is closely related to the recent prognosis, early detection of serum 25 (OH) D3 level could show a certain clinical value in evaluation of severity and re- cent cardiovascular events in CHF patients. |
| Key words: Chronic heart failure 25- hydroxy vitamin D3 Risk factor Cardiovascular events |
