Relationship between serum 25 hydroxyvitamin D and ejection fraction in patients with heart failure
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摘要: 目的 分析血清25羟维生素D[25(OH)D]与心力衰竭(心衰)患者射血分数的相关性。方法 纳入427例心衰患者，将其分为射血分数降低的心衰(HFrEF)组145例、射血分数中间值的心衰(HFmrEF)组145例和射血分数保留的心衰(HFpEF)组137例。另纳入同期的健康体检者153例为对照组。收集一般临床资料、常规生化指标、血清25(OH)D、N末端B型脑钠肽前体(NT-proBNP)及超声心动图的相关指标，分析不同心衰组患者临床特征及其与血清25(OH)D水平的相关性。结果 对照组血清25(OH)D水平和左室射血分数(LVEF)显著高于各心衰组(均P < 0.05)，NT-proBNP表达水平显著低于各心衰组(均P < 0.05)。HFrEF组25(OH)D水平显著低于HFmrEF组与HFpEF组，NT-proBNP水平显著高于HFmrEF组与HFpEF组(均P < 0.05)；HFmrEF组与HFpEF组间25(OH)D和NT-proBNP水平均差异无统计学意义。Spearman相关性分析显示，血清25(OH)D与RVOT、PAP、NT-proBNP均呈弱负相关性(r=-0.131、-0.105、-0.187，均P < 0.05)，与FS、LVEF、SV均呈弱正相关性(r=0.136、0.128、0.115，均P < 0.05)。多元线性回分析结果显示，HFpEF组血清25(OH)D与LVEF存在线性关系(P < 0.05)。结论 心衰患者普遍缺乏血清25(OH)D，且HFrEF患者血清25(OH)D水平最低。血清25(OH)D水平与LVEF呈弱正相关性。Abstract: Objective To analyze the relationship between serum 25 hydroxyvitamin D (25[OH]D) and ejection fraction in patients with heart failure.Methods A total of 427 heart failure patients were divided into the heart failure with reduced ejection fraction(HFrEF) group(LVEF < 40%, n=145), heart failure with mid-range ejection fraction(HFmrEF) group(40%≤LVEF < 49%, n=145), and heart failure with preserved ejection fraction(HFpEF) group(LVEF≥50%, n=137). Other 153 healthy physical examiners were included into the control group. General clinical data, routine biochemical indexes, serum 25(OH)D, NT-proBNP, and echocardiographic indexes were collected. Clinical characteristics and their correlation with serum 25(OH)D levels in heart failure patients were analyzed.Results The serum 25(OH)D level and LVEF in the control group were significantly higher than those in heart failure groups(all P < 0.05), and the NT-proBNP level was significantly lower than those in heart failure groups(all P < 0.05). The 25(OH)D level in the HFrEF group was significantly lower than those in the HFmrEF group and HFpEF group, and the NT-proBNP level was significantly higher than those in the HFmrEF group and HFpEF group(all P < 0.05); There was no significant difference in 25(OH)D and NT-proBNP levels between the HFmrEF group and HFpEF group. Spearman correlation analysis showed that serum 25(OH)D was weakly negatively correlated with RVOT, PAP, and NT-proBNP(r=-0.131, -0.105, -0.187, all P < 0.05), and weakly positively correlated with FS, LVEF and SV(r=0.136, 0.128, 0.115, all P < 0.05). Multiple linear regression analysis showed that there was a linear relationship between serum 25(OH)D and LVEF in the HFpEF group(P < 0.05).Conclusion Patients with heart failure are generally deficient in serum 25(OH)D, and patients with HFrEF have the lowest serum 25(OH)D levels. There is a weak positive correlation between serum 25(OH)D level and LVEF.
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Key words:
- heart failure /
- 25 hydroxyvitamin D /
- ejection fraction
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表 1 各心衰组一般资料比较
Table 1. General data
例(%), X±S, M(P25, P75) 项目 HFrEF组(145例) HFmrEF组(145例) HFpEF组(137例) 男性 78(53.8) 89(61.4) 63(46.0)2) 年龄/岁 61.24±9.61 60.48±10.77 64.23±10.561)2) BMI/(kg·m-2) 25(23，29) 26(24，29) 27(24，29) 血钙/(mmol·L-1) 2.21(2.13，2.30) 2.22(2.14，2.31) 2.22(2.15，2.33) 血磷/(mmol·L-1) 1.21(1.07，1.36) 1.2(1.04，1.32) 1.16(1.05，1.285) 尿素/(mmol·L-1) 6.63(5.6，8.5) 6.05(4.9，7.2)1) 5.9(4.7，7.4)1) 肌酐/(μmol·L-1) 76.16(62.71，89.36) 69.4(58.28，83.25)1) 72.9(59.00，82.84) eGFR/[mL·min-1·(1.73m2)-1] 84.98(67.72，96.69) 89.5(72.97，102.14) 88.8(70.73，101.37) 尿酸/(μmol·L-1) 355.79(286.06，452.00) 339.30(273.73，411.18) 322.71(279.30，406.00) 空腹血糖/(mmol·L-1) 5.57(4.59，7.17) 5.11(4.48，5.87) 5.04(4.46，6.74) 甘油三酯/(mmol·L-1) 1.15(0.89，1.53) 1.20(0.89，1.73) 1.09(0.85，1.51) 总胆固醇/(mmol·L-1) 3.62±0.97 3.55±1.02 3.43±1.09 HDL-C/(mmol·L-1) 0.86(0.74，1.05) 0.90(0.76，1.06) 0.97(0.76，1.14) LDL-C/(mmol·L-1) 2.34(1.81，3.00) 2.23(1.73，2.90) 2.20(1.58，2.88) AST/(U·L-1) 22.39(17.11，29.99) 20.80(16.38，26.43) 20.40(16.63，27.25) ALT/(U·L-1) 18.40(14.47，31.50) 19.00(14.55，26.34) 17.83(11.87，24.78) 碱性磷酸酶/(U·L-1) 75.55(64.70，95.14) 73.70(56.90，89.78) 70.65(57.00，87.15) NT-proBNP/(ng·L-1) 3415.00(1477.50，6857.50) 956.00(380.50，2330.00)1) 970.50(423.25，2142.50)1) 糖化血红蛋白/% 6.47(6.10，7.60) 6.30(5.80，7.10) 6.10(5.70，7.60)1) 血红蛋白/(g·L-1) 136.0(123.0，148.0) 137.0(125.0，152.0) 133.5(120.0，148.0) 25(OH)D/(nmol·L-1) 25.08(16.57，34.69) 30.48(21.18，40.34)1) 26.82(21.37，43.72)1) 冠心病 86(59.3) 99(68.3) 73(53.3)2) 瓣膜病 17(11.7) 12(8.3) 48(35.0)1)2) 心肌病 43(29.7) 22(15.2)1) 8(5.8)1)2) 心房颤动 17(11.7) 16(11.0) 42(30.7)1)2) 心绞痛 62(42.8) 78(53.8) 49(35.8)2) 室壁瘤 13(9.0) 20(13.8) 6(4.4)2) 高血压 70(48.3) 87(60.0) 97(70.8)1) 糖尿病 51(35.2) 40(27.6) 41(29.9) NYHA心功能分级 Ⅱ级 21(14.5) 49(33.8) 54(39.4) Ⅲ级 120(82.7) 96(66.2) 82(59.9) 用药情况 他汀类 115(79.3) 128(88.3) 116(84.7) ACEI/ARB类 18(12.4) 12(8.3) 48(35.0)1)2) CCB类 35(24.1) 41(28.3) 46(33.6) β受体阻滞剂 137(94.5) 132(91.0) 122(89.1) ARNI 126(86.9) 130(89.7) 60(43.8)1)2) 利尿剂 125(86.3) 70(48.3)1) 46(33.6)1)2) 注：eGFR：估算肾小球滤过率；HDL-C：高密度脂蛋白胆固醇；LDL-C：低密度脂蛋白胆固醇；AST：天门冬氨酸氨基转移酶；ALT：丙氨酸氨基转移酶；ACEI：血管紧张素转换酶抑制剂；ARB：血管紧张素Ⅱ受体拮抗剂；CCB：钙通道阻断剂；ARNI：血管紧张素受体脑啡肽酶抑制剂。与HFrEF组比较，1)P < 0.05；与HFmrEF组比较，2)P < 0.05。 
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表 2 各心衰组超声心电图指标比较
Table 2. Echocardiographic indexes
例(%), X±S, M(P25, P75) 项目 HFrEF组(145例) HFmrEF组(145例) HFpEF组(137例) LA/mm 44(41，49) 40(38，44)1) 42(38，48)1)2) LVEDD/mm 66(61，73) 58(55，61.5)1) 50(46.5，54)1)2) LVESD/mm 54(50，61) 45(42，48)1) 34(31，38)1)2) IVS/mm 9(8，10) 9(9，9) 9(9，10)1) LVPW/mm 9(9，9) 9(9，9) 9(9，10)1) RVOT/mm 30(28，33) 29(27，31)1) 30(27，32)1) RV/mm 20(18，22) 20(18，20) 20(18，32) RA/mm 38(35，44) 35(34，38)1) 36(33.5，44)2) PAP/mm 26(25，30) 25(23，27)1) 25(23，30)1) MV-E 0.85(0.67，1.06) 0.675(0.55，0.92)1) 0.75(0.62，1.03)2) MV-A 0.72±0.27 0.77±0.22 0.81±0.231) MV-E/A 1.15(0.70，1.95) 0.79(0.67，1.25)1) 0.84(0.72，1.25)1) FS/% 18.00(15.89，18.84) 22.64(21.28，23.00)1) 31.37(29.09，33.33)1)2) LVEF/% 36.65(32.69，37.94) 45.00(42.57，46.65)1) 58.98(55.50，61.95)1)2) SV/mL 79.01(65.85，91.82) 75.08(67.59，83.79) 70.00(58.19，81.19)1) CO/(L·min-1) 5.78(5.03，7.26) 5.56(4.98，6.43) 5.365(4.53，6.39)1) 与HFrEF组比较，1)P < 0.05；与HFmrEF组比较，2)P < 0.05。
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表 3 相关性分析结果
Table 3. Correlation analysis results
参数 r P RVOT -0.131 0.007 PAP -0.105 0.03 FS 0.136 0.005 LVEF 0.128 0.008 SV 0.115 0.017 NT-proBNP -0.187 < 0.001
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表 4 HFrEF组多元线性回归分析
Table 4. Multiple linear regression analysis results in the HFrEF group
参数 未标准化系数 标准化系数 t P B SE β LVEDD -0.315 0.05 -0.561 -6.353 < 0.001 IVS -0.645 0.271 -0.157 -2.384 0.019 FS 1.100 0.100 0.645 11.039 < 0.001 SV 0.041 0.014 0.168 2.948 0.004 CO 0.566 0.164 0.221 3.454 0.001 常量 36.011 3.972 9.066 < 0.001
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表 5 HFmrEF组多元线性回归分析
Table 5. Multiple linear regression analysis results in the HFmrEF group
参数 未标准化系数 标准化系数 t P B SE β LVESD -0.207 0.042 -0.440 -4.953 < 0.001 IVS 1.151 0.351 0.554 3.273 0.002 LVPW -1.069 0.393 -0.470 -2.725 0.008 FS 0.591 0.071 0.560 8.316 < 0.001 ACEI/ARB 2.259 0.876 0.225 2.581 0.011 ARNI 1.600 0.734 0.175 2.181 0.032 常量 38.012 4.572 8.313 < 0.001
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表 6 HFpEF组多元线性回归分析
Table 6. Multiple linear regression analysis results in the HFpEF group
参数 未标准化系数 标准化系数 t P B SE β FS 1.431 0.025 0.960 56.639 < 0.001 CO -0.222 0.073 -0.085 -3.058 0.003 利尿剂 -0.351 0.139 -0.043 -2.527 0.014 血清25 (OH)D -0.010 0.005 -0.038 -2.199 0.032 常量 15.197 1.526 9.961 < 0.001
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