Cardiology Department, Clinical Medical Center Zvezdara, Belgrade, Serbia.
J Endocrinol Invest. 2011 Mar;34(3):e78-85. doi: 10.1007/BF03347080. Epub 2010 Sep 2.
High PTH levels have been reported in patients with chronic heart failure (CHF). Similarly, its levels increase with aging and are related to impaired survival in elderly adults. However, its relationship with neuroendocrine activation and endothelial dysfunction in CHF has not been previously studied. Seventy-three CHF males with New York Heart Association (NYHA) classes II and III and 20 control subjects aged ≥ 55 yr were recruited. PTH, 25-hydroxyvitamin D [25(OH)D], N-terminal pro-brain natriuretic peptide (NT-pro-BNP), adiponectin, and osteoprotegerin were measured. Endothelial function (brachial flow mediated dilation), echocardiography, physical performance, and quality of life were assessed, as well. CHF patients had markedly increased serum PTH (77 ± 33 vs 40 ± 11 pg/ml, p<0.0001), NT-pro-BNP [1809 (2742) vs 67 (74) pg/ml, p<0.0001], adiponectin (17 ± 9 vs 10 ± 2 μg/ml, p<0.0001), osteoprotegerin, whereas 25(OH)D levels were decreased compared to controls. Increased PTH is positively correlated with NTpro- BNP (r=0.399, p<0.0001), adiponectin (r=0.398, p<0.0001), and osteoprotegerin, whereas negatively with 25(OH)D in CHF patients. Additionally, increased serum PTH was associated with endothelial dysfunction, echocardiographic variables of heart failure progression, impaired physical performance, and deteriorated quality of life. In a multivariate linear regression analysis, increased serum PTH was independently associated with neuroendocrine activation (NT-pro-BNP, adiponectin) and endothelial dysfunction in elderly CHF men (R2=0.455). Additionally, demonstrated relations with other well-established variables of heart failure severity suggest the potential role of serum PTH in the pathogenesis and non-invasive monitoring of heart failure progression. Future studies are needed to evaluate the predictive value of serum PTH for clinical outcomes as well as beneficial potential of PTH suppression in CHF patients.
高甲状旁腺激素（PTH）水平已在慢性心力衰竭（CHF）患者中报告。同样，其水平随年龄增长而增加，并且与老年人的生存能力下降有关。但是，它与 CHF 中的神经内分泌激活和内皮功能障碍之间的关系尚未得到研究。招募了 73 名纽约心脏协会（NYHA）II 级和 III 级的 CHF 男性患者和 20 名年龄≥55 岁的对照组。测量了甲状旁腺激素，25-羟维生素 D [25（OH）D]，N-末端脑利钠肽前体（NT-pro-BNP），脂联素和骨保护素。还评估了内皮功能（肱动脉血流介导的扩张），超声心动图，身体机能和生活质量。CHF 患者的血清 PTH（77±33 vs 40±11 pg/ml，p<0.0001），NT-pro-BNP [1809（2742）vs 67（74）pg/ml，p<0.0001]，脂联素（17±9 vs 10±2μg/ml，p<0.0001）和骨保护素明显增加，而与对照组相比，25（OH）D 水平降低。CHF 患者中，增加的 PTH 与 NT-pro-BNP（r=0.399，p<0.0001），脂联素（r=0.398，p<0.0001）和骨保护素呈正相关，而与 25（OH）D 呈负相关。此外，血清 PTH 升高与内皮功能障碍，心力衰竭进展的超声心动图变量，身体机能下降和生活质量恶化有关。在多元线性回归分析中，增加的血清 PTH与神经内分泌激活（NT-pro-BNP，脂联素）和老年 CHF 男性的内皮功能障碍独立相关（R2=0.455）。此外，与心力衰竭严重程度的其他公认变量的关系表明，血清 PTH 在心力衰竭进展的发病机制和非侵入性监测中具有潜在作用。需要进一步的研究来评估血清 PTH 对临床结局的预测价值以及 CHF 患者中 PTH 抑制的潜在益处。
