血清镁与慢性心力衰竭患者血管内皮细胞分泌功能及不良心血管事件的关系  

The association between serum magnesium and vascular endothelial cell secretion function and adverse cardiovascular events in patients with chronic heart failure

作　　者：张玉鑫 张志良 李京倡[1] ZHANG Yuxin;ZHANG Zhiliang;LI Jingchang(Department of Cardiology,Nanyang Central Hospital,Nanyang,Henan,473000,China)

机构地区：[1]南阳市中心医院心血管内科,河南南阳473000

出　　处：《临床心血管病杂志》2025年第3期219-225,共7页Journal of Clinical Cardiology

摘　　要：目的:探究血清镁与慢性心力衰竭(CHF)患者血管内皮细胞分泌功能及不良心血管事件(MACE)的关系。方法:选择我院心内科2021年2月—2022年2月住院的266例CHF患者为研究对象。根据随访1年内是否发生MACE,将患者分为MACE组(126例)和无MACE组(140例),比较两组临床资料,采用单因素分析筛选影响MACE发生的因素,通过水平分层回归分析各因素对MACE的作用。采用拆分指标、多元线性回归和限制性立方样条分析MACE发生的独立危险因素及剂量反应关系。构建中介效应模型分析血管内皮细胞分泌功能在血清镁和MACE之间的中介效应。结果:与无MACE组比较,MACE组的血清镁、左心室射血分数(LVEF)、血清钠、收缩压及舒张压显著降低(均P<0.05),心率、N-末端脑钠肽前体(NT-proBNP)和左心室舒张末期内径显著增加(均P<0.05),内皮素(ET)、血栓素B2(TXB2)水平显著升高(均P<0.05),一氧化氮(NO)和6-酮-前列腺素Fla(6-Keto-PGF1α)水平显著降低(均P<0.05)。拆分指标校正心率、NT-proBNP、ET、TXB2、6-Keto-PGF1α等协变量后,血清镁水平与MACE仍存在独立相关性(OR=0.54,95%CI 0.33~0.76,P<0.001)。将血清镁转化为二分类变量后,与较高血清镁水平比较,较低的血清镁水平与MACE风险存在独立相关性(OR=0.55,95%CI 0.55~0.91,P<0.001)。多因素线性回归分析显示,血清镁是预测血管内皮细胞分泌功能的独立因素。LOWESS回归分析显示,血清镁浓度与ET、TXB2、6-Keto-PGF1α浓度呈线性变化。限制性立方样条分析显示,血清镁与MACE存在非线性关系(非线性检验P<0.001)。构建中介效应模型,发现ET、TXB2和6-Keto-PGF1α均在血清镁和MACE之间发挥部分中介效应。结论:血清镁是MACE发生的独立保护因素,血管内皮细胞分泌功能在血清镁和MACE之间发挥部分中介效应。Objective To investigate the relationship between serum magnesium and vascular endothelial cell secretion function and adverse cardiovascular events(MACE)in patients with chronic heart failure(CHF).Methods A total of 266 patients with CHF who were hospitalized in the Department of Cardiology of our hospital from February 2021 to February 2022 were selected as the study subjects,and they were divided into the MACE group(n=126)and non-MACE group(n=140)according to whether MACE occurred within 1 year of follow-up.Clinical data was compared between the two groups.Univariate analysis was used to screen for factors that affect the occurrence of MACE,the effect of each factor on MACE was analyzed by horizontal stratified regression.Split indexes,multiple linear regression,and limiting cubic splines were used to analyze the independent risk factors and dose-response relationship affecting the occurrence of MACE.A mediating effect model was constructed to analyze the mediating effect of vascular endothelial cell secretion function between serum magnesium and MACE.Results Compared with the non-MACE group,the blood magnesium,left ventricular ejection fraction(LVEF),serum sodium,systolic blood pressure,and diastolic blood pressure in the MACE group were significantly reduced(all P<0.05),heart rate,N-terminal pro-brain natriuretic(NT-proBNP),and left ventricular end-diastolic diameter were significantly increased(all P<0.05),the levels of endothelin(ET)and thromboxane B2(TXB2)were significantly increased(both P<0.05),and the level of 6-keto-prostaglandin Fla(6-Keto-PGF1α)was significantly decreased(P<0.05).Horizontal stratified regression analysis showed that there was an independent correlation between serum magnesium level and MACE after adjusting for covariates such as heart rate,NT-proBNP,ET,TXB2,and,6-Keto-PGF1α(OR=0.54,95%CI 0.33-0.76,P<0.001).After converting serum magnesium into a dichotomous variable,there was an independent correlation between lower serum magnesium levels and the risk of MACE compared to higher se

关 键 词：血清镁 慢性心力衰竭 血管内皮细胞 不良心血管事件 

分 类 号：R541.6[医药卫生—心血管疾病]