口服华法林对心脏瓣膜钙化的影响  

Effects of oral administration of warfarin on valvular calcification

作　　者：王宇玫[1] 孟娟娟[1] 王永刚[2] 陈春鸣[2] 张红[2] 孙伟 

机构地区：[1]解放军总医院第一附属医院心内科,北京市100037 [2]解放军总医院第一附属医院急诊科,北京市100037 [3]总参工程兵第四设计院门诊部,北京市100036

出　　处：《中华老年多器官疾病杂志》2010年第1期27-30,共4页Chinese Journal of Multiple Organ Diseases in the Elderly

摘　　要：目的分析长期应用华法林对心脏瓣膜钙化的影响。方法选取口服华法林1年以上的患者34例,与18例基本病情相仿者对照,用心脏超声的方法评估其心脏瓣膜的状况,同时分析患者的血清钙、磷、甲状旁腺素血管炎症指标(高敏C反应蛋白、低密度脂蛋白胆固醇)和钙化相关基质蛋白(基质Gla蛋白、骨桥蛋白、Fetuin-A)及骨质疏松情况。结果口服华法林组瓣膜钙化的发生率为14.7%,对照组为11.1%,二者差别无统计学意义;血清基质Gla蛋白浓度在华法林组和对照组分别为(3.7±1.9)和(11±4.3)nmol/L,前者明显低于后者,而骨桥蛋白水平分别为(154±56)和(86±35)μg/L,华法林组明显增高;Fetuin-A水平在两组无明显差异。华法林组患者的血清碱性磷酸酶水平高于对照组,分别为(79±10)和(65±8)U/L,但血钙、磷和甲状旁腺素水平无明显差别。华法林组的骨质疏松患者占52.9%,高于对照组的38.9%。结论长期口服华法林并未增加心脏瓣膜钙化的发生,但骨质疏松的发生率略增高,血管炎症与此关系不明显,血液中钙磷浓度在此过程中变化不大,而基质蛋白的改变可能与此有关。Objective To investigate the effects of long-term oral administration of warfarin on cardiac valvular calcification. Methods Thirty-four patients who received oral administration of warfarin for over one year,and 18 disease condition-matched controls were selected. Echocardiography was performed to detect the valvular calcification. Some calcium metablic factors 〔calcium,phosphate,parathyroid hormone （PTH）,alkaline phosphatase （AKP）〕,inflammation indicators 〔including high-sensitive C reactive protein （HsCRP）,low density lipid cholesterol （LDL-C）〕,and calcification related matrix proteins 〔matrix Gla protein （MGP）,osteopontin （OPN）,Fetuin-A〕 were analyzed. The incidence of osteoporosis was recorded. Results The incidence of valvular calcification was 14.7% in warfarin group,and 11.1% in control group,with no significant difference between two groups. Serum MGP concentration was significantly lower in warfarin group 〔（3.7±1.9） nmol/L〕 than in control group 〔（11.0±4.3） nmol/L〕. OPN concentration was significantly higher in warfarin group 〔（154±56 ） μg/L〕 than in control group 〔（86±35） μg/L〕. Fetuin-A level was not different between the two groups. AKP level was significantly higher in warfarin group 〔（79±10） U/L〕 than in control group 〔（65±8） U/L〕. There was no difference in serum calcium,phosphate,PTH between the two groups. The patients suffering from osteoporosis accounted for 52.9% in warfarin group,higher than that in control group （38.9%）. Conclusion Long-term oral administration of warfarin does not add the risk of valvular calcification,but increases the incidence of osteoporosis,which is not obviously associated with arterial inflammation,but might be associated with changes of MGP level.

关 键 词：心脏瓣膜 钙化 华法林 细胞外基质蛋白质量 

分 类 号：R363[医药卫生—病理学] R541[医药卫生—基础医学]