老年慢性心衰患者骨代谢指标和心功能与心血管事件发生风险的相关性

    Correlation between bone metabolism index, cardiac function and risk of cardiovascular events in elderly patients with chronic heart failure

      摘要
    • 摘要:
      目的 探讨老年慢性心力衰竭（chronic heart failure，CHF）患者骨代谢指标和心功能与主要不良心血管事件（major adverse cardiovascular events，MACE）发生风险的相关性。
      方法 回顾性选取2021年10月～2023年10月期间首都医科大学附属北京友谊医院收治的133例老年CHF患者的临床资料，根据有无发生MACE分为MACE组（n=79）和非MACE组（n=54），对比两组一般资料、心功能指标、骨密度(BMD)以及骨代谢指标。采用化学发光免疫法检测骨转化标志物水平，包括血清胎球蛋白A(fetuin-A)、骨特异碱性磷酸酶(BALP)、I型前胶原氨基端延肽（PINP），β-胶原蛋白降解产物（β-CTX），骨钙素N端中分子片段（N-MID）、骨钙素(OC)。采用Logistic回归分析骨代谢指标与心功能和MACE发生风险的相关性。
      结果 与非MACE组比较 ，MACE组心功能Ⅱ、Ⅳ级患者比例显著升高，Ⅲ级患者比例显著降低（均P<0.05），fetuin-A（P<0.01）、PINP（P<0.05）、β-CTX（P<0.01）、OC（P<0.01）及BMD（P<0.01）水平降低，BALP、N-MID水平升高（均P<0.01），LVEDV（P<0.01）、LVESV（P<0.01）、LVSV（P<0.05）以及NT-proBNP（P<0.01）升高，LVEF下降（P<0.01）；Logistic显示：fetuin-A（OR=0.887，95%CI：0.820～0.959）、LVEF（OR=0.922，95%CI：0.864～0.983），BALP（OR=0.021，95%CI：0.001～0.478）、PINP（OR=0.953，95%CI：0.911～0.996）、β-CTX（OR=0.001，95%CI：0.911～0.993）是老年CHF患者发生MACE的保护因素，OC（OR=1.128，95%CI：1.043～1.220）、NT-proBNP（OR=1.074，95%CI：1.029～1.122）、BMD（OR=0.888，95%CI：0.796～0.991）是老年CHF患者发生MACE的危险因素，与MACE的发生具有相关性。
      结论 骨代谢指标及心功能指标和CHF患者MACE的发生具有相关性。

       

      Abstract:
      AIM To explore the correlation between bone metabolism index and cardiac function and the risk of major adverse cardiovascular events in elderly patients with Chronic heart failure CHF.
      METHODS The clinical data of 133 elderly patients with CHF admitted to Beijing Friendship Hospital affiliated to Capital Medical University from October 2021 to October 2023 were retrospectively selected. According to the occurrence of MACE, they were divided into MACE group (n=79) and non-MACE group (n=54), and the general data, cardiac function index, bone mineral density (BMD) and bone metabolism index of the two groups were compared. The levels of bone turnover markers were detected by chemiluminescence immunoassay, including serum fetuin A(fetuin-A), bone-specific alkaline phosphatase (BALP), total type 1 collagen amino-terminal peptide (PINP), β-collagen degradation product (β-CTX), N-terminal molecular fragment of osteocalcin (N-MID) and osteocalcin (OC). Logistic regression was used to analyze the correlation between bone metabolism indexes and cardiac function and the risk of MACE.
      RESULTS Compared with the non MACE group, the proportion of patients with grade II、IV heart function in the MACE group significantly increased, while the proportion of patients with grade III heart function significantly decreased (all P<0.05). Fetuin-A (P<0.01), PINP (P<0.05) β-CTX (P<0.01), OC (P<0.01), and BMD (P<0.01) levels decreased, while BALP and N-MID levels increased (all P<0.01). LVEDV (P<0.01), LVESV (P<0.01), LVSV (P<0.05), and NT proBNP (P<0.01) increased, while LVEF decreased (P<0.01); Logistic analysis showed that fetuin-A (OR=0.887, 95% CI: 0.820～0.959), LVEF (OR=0.922, 95% CI: 0.864～0.983), BALP (OR=0.021, 95% CI: 0.001～0.478), PINP (OR=0.953, 95% CI: 0.911～0.996), β-CTX (OR=0.001, 95% CI: 0.911～0.993) is a protective factor for MACE in elderly CHF patients, while OC (OR=1.128, 95% CI: 1.043～1.220), NT proBNP (OR=1.074, 95% CI: 1.029～1.122), and BMD (OR=0.888, 95% CI: 0.796～0.991) are correlated risk factors for MACE in elderly CHF patients.
      CONCLUSION Bone metabolism index and cardiac function index are related to the occurrence of MACE in CHF patients.

       

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