25-羟维生素D缺乏与老年射血分数保留心力衰竭的相关性研究

姜苏蓉; 曹雅茹; 王璎瑛; 王小艳; 洪牮; 郭妍

doi:10.16766/j.cnki.issn.1674-4152.002174

25-羟维生素D缺乏与老年射血分数保留心力衰竭的相关性研究

doi: 10.16766/j.cnki.issn.1674-4152.002174

南京医科大学第一附属医院老年心血管科, 江苏南京 210029

基金项目:

江苏省干部保健科研课题 BJ18017

详细信息

通讯作者:
郭妍，E-mail：guoyan51@hotmail.com

中图分类号: R541.6
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出版历程
- 收稿日期: 2021-03-23
- 网络出版日期: 2022-02-15

Correlation between 25-hydroxyvitamin D deficiency and heart failure with preserved ejection fraction in the elderly

Department of Geriatric Cardiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China

摘要

摘要: 目的探讨血清25-羟维生素D[25(OH)D]水平缺乏与老年射血分数保留心力衰竭(HFpEF)的关系。方法选取2019年1月—2020年12月就诊于南京医科大学第一附属医院老年心血管科的老年患者219例，其中HFpEF患者118例，对照组101例。收集患者一般资料，检测常规生化指标、25(OH)D和N末端B型脑钠肽前体(NT-proBNP)水平；心脏超声检查测定心脏结构和功能，并对血清25(OH)D和HFpEF心脏结构功能指标进行相关分析，就老年HFpEF危险因素进行多因素逐步logistic回归分析。结果老年HFpEF组血清25(OH)D水平[(37.58±12.92)nmol/L]较对照组[(60.82±13.61)nmol/L]明显降低(P < 0.001)；且HFpEF组心脏超声相关指标左房内径(LAD)、左室舒张末期内径(LVDd)、左室收缩末期内径(LVDs)、室间隔厚度(IVS)、左心室质量指数(LVMI)、二尖瓣口E峰流速与二尖瓣环舒张早期峰值速度比值(E/e')、左房容积指数(LAVI)、三尖瓣反流速度(TRV)、肺动脉收缩压(PASP)均高于对照组，左室射血分数(LVEF)、二尖瓣环舒张早期峰值速度(e')平均值低于对照组，差异有统计学意义(均P < 0.05)。Spearman相关分析显示，25(OH)D与LAD、IVS、左室后壁厚度(LVPW)、LVMI、E/e'、LAVI、TRV、PASP、NT-proBNP呈负相关，与e' 平均值呈正相关(均P < 0.05)。多因素逐步logistic回归分析表明：血清25(OH)D水平是老年HFpEF的独立影响因素(OR=0.814，95% CI：0.723~0.916，P=0.001)。结论 25(OH)D缺乏与老年HFpEF有关，是老年HFpEF的独立危险因素。
- 25-羟维生素D /
- 老年 /
- 射血分数保留的心力衰竭 /
- 危险因素
Abstract: Objective To investigate the correlation between serum 25-hydroxyvitamin D [25(OH)D] deficiency and heart failure with preserved ejection fraction in the elderly. Methods A total of 219 elderly patients treated in the Department of Geriatric Cardiology of the First Affiliated Hospital of Nanjing Medical University from January 2019 to December 2020 were enrolled and divided into the HFpEF group (n=118) and control group (n=101). General data, routine biochemical index results, 25(OH)D, NT-ProBNP and echocardiography parameters of all patients were collected and compared. The correlation between serum 25(OH)D level and echocardiographic parameters was analysed, and the risk factors of HFpEF were analysed by multivariate stepwise logistic regression. Results The level of 25(OH)D in the HFpEF group [(37.58±12.92) nmol/L] was significantly lower than that in the control group [(60.82±13.61) nmol/L, P < 0.001]. The HFpEF group had higher echocardiographic parameters such as LAD, LVDd, LVDs, IVS, LVMI, E/e', LAVI, TRV and PASP and lower LVEF and average e' compared with the control group (all P < 0.05). Spearman correlation analysis showed that the 25(OH)D level was negatively correlated with LAD, IVS, LVPW, LVMI, E/e', LAVI, TRV, PASP and NT-proBNP and was positively correlated with average e' (all P < 0.05). Multivariate stepwise logistic regression analysis showed that 25(OH)D level was an independent influence factor for HFpEF in the elderly (OR=0.814, 95% CI: 0.723-0.916, P=0.001). Conclusion 25(OH)D deficiency is related to HFpEF and can be an independent risk factor for elderly HFpEF.
- 25-hydroxyvitamin D /
- The elderly /
- Heart failure with preserved ejection fraction /
- Risk factor

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表 1 2组患者基本临床特征比较

项目	对照组(101例)	HFpEF组(118例)	统计量	P值
男性[例(%)]	67(66.3)	70(59.3)	1.143^a	0.285
年龄[M(P₂₅，P₇₅), 岁]	79.00(73.00, 87.50)	84.50(76.00, 90.00)	-1.960^b	0.052
BMI(x±s)	23.56±2.84	23.28±3.13	0.688^c	0.492
SBP(x±s, mm Hg)	134.02±16.91	135.12±18.19	-0.460^c	0.646
DBP(x±s, mm Hg)	73.13±10.03	70.63±8.83	1.963^c	0.051
HR[M(P₂₅，P₇₅), 次/min]	70.00(66.00, 78.00)	70.00(64.00, 78.00)	-1.167^b	0.243
高血压[例(%)]	71(70.3)	93(78.8)	2.099^a	0.147
糖尿病[例(%)]	35(34.7)	47(39.8)	1.564^a	0.458
冠心病[例(%)]	37(36.6)	54(45.8)	1.867^a	0.172
房颤[例(%)]	15(14.9)	50(42.4)	19.749^a	< 0.001
脑梗死[例(%)]	29(28.7)	43(36.4)	1.473^a	0.225
ACEI/ARB[例(%)]	44(43.6)	45(38.1)	0.665^a	0.415
β受体阻滞剂[例(%)]	46(45.5)	63(53.4)	1.340^a	0.247
Ca²⁺拮抗剂[例(%)]	36(35.6)	40(33.9)	0.073^a	0.787
他汀类[例(%)]	62(61.4)	72(61.0)	0.003^a	0.955
利尿剂[例(%)]	11(10.9)	37(31.4)	13.318^a	< 0.001
TC(x±s, mmol/L)	3.99±1.04	3.81±1.01	1.266^c	0.207
TG[M(P₂₅，P₇₅), mmol/L]	1.16(0.82, 1.78)	1.03(0.74, 1.54)	-1.553^b	0.120
LDL(x±s, mmol/L)	2.30±0.73	2.17±0.82	1.298^c	0.196
HDL(x±s, mmol/L)	1.11±0.26	1.04±0.28	1.788^c	0.075
FBS[M(P₂₅，P₇₅), mmol/L]	4.93(4.43, 5.51)	5.02(4.51, 6.03)	-1.011^b	0.312
ALT[M(P₂₅，P₇₅), U/L]	16.80(12.15, 26.55)	16.15(10.88, 22.85)	-0.956^b	0.339
AST[M(P₂₅，P₇₅), U/L]	21.80(18.50, 25.85)	22.40(18.28, 28.53)	-0.511^b	0.609
Cr[M(P₂₅，P₇₅), μmol/L]	79.20(67.10, 96.70)	90.50(67.38, 114.75)	-1.908^b	0.056
UA(x±s, μmol/L)	348.31±78.44	356.03±88.98	-0.676^c	0.500
HbA1c[M(P₂₅，P₇₅), %]	6.00(5.60, 6.50)	6.02(5.60, 6.53)	-0.210^b	0.834
NT-ProBNP[M(P₂₅，P₇₅), pg/mL]	159.60(87.69, 521.65)	788.10(417.25, 1 674.50)	-7.693^b	< 0.001
Hb(x±s, g/L)	126.57±19.01	117.21±18.03	3.735^c	< 0.001
25(OH)D(x±s, nmol/L)	60.82±13.61	37.58±12.92	14.786^c	< 0.001
Ca[M(P₂₅，P₇₅), mmol/L]	2.21(2.13, 2.30)	2.23(2.13, 2.35)	-0.480^b	0.631
维生素D缺乏症[例(%)]	42(41.6)	82(69.5)	17.256^a	< 0.001
注：^a为χ²值，^b为Z值，^c为t值。1 mm Hg=0.133 kPa。HR为心率；ACEI/ARB为血管紧张素转换酶抑制剂/血管紧张素Ⅱ受体拮抗剂；FBS为空腹血糖；Cr为肌酐；UA为尿酸；HbA1c为糖化血红蛋白。

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表 2 2组患者超声心动图指标比较

项目	对照组(101例)	HFpEF组(118例)	统计量	P值
LAD[M(P₂₅，P₇₅), mm]	34.00(32.00，37.00)	40.00(37.75，45.00)	-8.630^a	< 0.001
LVDd(x±s, mm)	45.61±3.86	46.92±4.93	-2.188^b	0.030
LVDs(x±s, mm)	28.95±2.82	30.29±3.53	-3.078^b	0.002
IVS[M(P₂₅，P₇₅), mm]	9.00(8.00, 10.00)	10.00(9.00, 11.00)	-2.828^a	0.005
LVPW[M(P₂₅，P₇₅), mm]	9.00(8.00, 10.00)	9.00(8.00, 11.00)	-1.862^a	0.063
LVMI[M(P₂₅，P₇₅), g/m²]	81.15(70.56，90.96)	96.71(77.44，114.32)	-4.732^a	< 0.001
RWT(x±s)	0.40±0.06	0.42±0.08	-1.468^b	0.143
LVEF(x±s, %)	65.71±2.87	64.81±3.20	2.170^b	0.031
e' 平均值(x±s, cm/s)	6.93±1.63	5.95±1.83	4.147^b	< 0.001
E/e' [M(P₂₅，P₇₅)]	8.70(7.40, 10.40)	13.50(10.05, 15.13)	-8.014^a	< 0.001
LAVI[M(P₂₅，P₇₅), mL/m²]	24.66(20.93，28.35)	39.60(34.74，48.92)	-11.728^a	< 0.001
TRV[M(P₂₅，P₇₅), m/s]	2.31(2.10，2.56)	2.59(2.38，2.90)	-5.171^a	< 0.001
PASP[M(P₂₅，P₇₅), mm Hg]	26.00(23.00，31.00)	32.00(27.00，40.50)	-5.145^a	< 0.001
^a为Z值，^b为t值。

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表 3 血清25(OH)D与左室结构功能参数及NT-proBNP的相关分析

指标	r值	P值
LAD	-0.560	< 0.001
LVDd	-0.054	0.427
LVDs	-0.103	0.127
IVS	-0.170	0.012
LVPW	-0.141	0.037
LVMI	-0.250	< 0.001
e' 平均值	0.205	0.002
RWT	-0.126	0.062
EF	0.110	0.105
E/e'	-0.446	< 0.001
LAVI	-0.813	< 0.001
TRV	-0.215	0.001
PASP	-0.222	0.001
Ln(NT-proBNP)	-0.404	< 0.001

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表 4 HFpEF的多因素logistic回归分析

项目	B	SE	Wald χ²	P值	OR值	95% CI
LVMI	0.078	0.028	7.963	0.005	1.081	1.024~1.141
E/e'	0.822	0.216	14.462	< 0.001	2.275	1.489~3.476
LAVI	0.473	0.122	15.029	< 0.001	1.604	1.263~2.037
25(OH)D	-0.206	0.061	11.565	0.001	0.814	0.723~0.916
Ln(NT-proBNP)	1.513	0.439	11.898	0.001	4.542	1.922~10.734

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