血清甲状旁腺激素表达与慢性心力衰竭患者心肌重构的关系  

Relationship Between Serum Parathyroid Hormone Expression and Myocardial Remodeling in Patients with Chronic Heart Failure

作　　者：张雅男 王晓亮 张梦瑶 董其娟 王敏 张俊杰[3] ZHANG Yanan;WANG Xiaoliang;ZHANG Mengyao;DONG Qijuan;WANG Min;ZHANG Junjie(Department of Cardiovascular Medicine,the Fifth Clinical College of Henan University of Traditional Chinese Medicine(People’s Hospital of Zhengzhou),Zhengzhou 450000,China;Department of Endocrinology,the Fifth Clinical College of Henan University of Traditional Chinese Medicine(People’s Hospital of Zhengzhou),Zhengzhou 450000,China;Department of General Surgery,the Fifth Clinical College of Henan University of Traditional Chinese Medicine(People’s Hospital of Zhengzhou),Zhengzhou 450000,China;Department of General Surgery,Shanghai Pudong Hospital/Fudan University Affiliated Pudong Medical Center,Shanghai 200000,China)

机构地区：[1]河南中医药大学第五临床医学院(郑州人民医院)心血管内科,河南郑州450000 [2]河南中医药大学第五临床医学院(郑州人民医院)内分泌科,河南郑州450000 [3]河南中医药大学第五临床医学院(郑州人民医院)普通外科,河南郑州450000 [4]上海市浦东医院/复旦大学附属浦东医院普通外科,上海200000

出　　处：《河南医学研究》2024年第4期633-636,共4页Henan Medical Research

基　　金：河南省医学科技攻关计划联合共建项目(2018020827)。

摘　　要：目的分析血清甲状旁腺激素(PTH)与慢性心力衰竭(CHF)患者心肌重构的关系,探索心肌重构的预防靶点。方法入选2021年3月至2023年2月收治入院的120例CHF患者作为研究对象,根据超声心动图检查结果计算左心室质量指数及左心房容积指数,根据计算结果将发生心肌重构患者纳入心肌重构组,未发生心肌重构患者纳入未重构组。入院当日即检测血清PTH并且收集患者一般临床资料,采用logistic回归检验血清PTH对CHF患者心肌重构的影响。结果本研究共入选120例CHF患者,血清PTH检测结果为(38.25±5.66)pmol·L^(-1),心肌重构率为30.83%。CHF合并心肌重构患者纽约心脏病协会(NYHA)Ⅲ级、Ⅳ级占比和血清PTH、血浆氨基末端脑钠肽前体(NT-proBNP)水平高于未重构患者,左室射血分数(LVEF)低于未重构患者(P<0.05)。采用logistic回归分析,NYHAⅢ级、Ⅳ级、LVEF降低、血清PTH表达上调可导致CHF患者心肌重构风险增加(P<0.05)。绘制受试者工作特征曲线,血清PTH评估CHF患者心肌重构的曲线下面积为0.797,当血清PTH表达≥36.875 pmol·L^(-1)时,可以考虑CHF患者发生心肌重构。结论血清PTH在CHF合并心肌重构患者中表达上调,血清PTH表达上调导致CHF患者心肌重构风险增加。Objective To analyze the relationship between serum parathyroid hormone(PTH)and myocardial remodeling in patients with chronic heart failure(CHF),and to explore preventive targets for myocardial remodeling.Methods A total of 120 CHF patients admitted from March 2021 to February 2023 were selected as the study subjects.Left ventricular mass index and left atrial volume index were calculated based on the results of echocardiography.According to the calculation results,patients with myocardial remodeling were included in the myocardial remodeling group and those without myocardial remodeling were included in the non-remodeling group.On the day of admission,serum PTH was tested and general clinical data of patients were collected.Logistic regression was used to test the effect of serum PTH on myocardial remodeling in CHF patients.Results A total of 120 CHF patients were selected for this study,with a serum PTH detection result of(38.25±5.66)pmol·L^(-1) and a myocardial remodeling rate of 30.83%.The proportion of New York Heart Association(NYHA)gradeⅢandⅣ,and serum PTH and plasma N-temrina pro-barin natriuretic peptide(NT-proBNP)of patients with CHF combined with myocardial remodeling were higher than those of non-remodeling patients,and left ventricular ejection fraction(LVEF)was lower than that of non-remodeling patients(P<0.05).Logistic regression analysis showed that NYHAⅢ,Ⅳ,decreased LVEF and increased serum PTH expression increased the risk of myocardial remodeling in CHF patients(P<0.05).Receiver operating characteristic curve was drawn.The area under the curve of serum PTH in evaluating myocardial remodeling in CHF patients was 0.797.When serum PTH expression≥36.875 pmol·L^(-1),myocardial remodeling in CHF patients could be considered.Conclusion The expression of serum PTH is up-regulated in CHF patients with myocardial remodeling,and the up-regulation of serum PTH expression leads to an increased risk of myocardial remodeling in CHF patients.

关 键 词：慢性心力衰竭 心肌重构 左室射血分数 甲状旁腺激素 

分 类 号：R541.6[医药卫生—心血管疾病]