Department of Medicine, University of Toronto, Toronto, ON, Canada.
Heart Fail Rev. 2013 Jul;18(4):465-73. doi: 10.1007/s10741-012-9336-9.
Secondary hyperparathyroidism in heart failure is a consequence of renin-angiotensin-aldosterone activation, chronic hyperaldosteronism, and loop diuretic usage, resulting in calcium excretion. The result is an inflammatory state with adverse effects on myocardial remodeling and systemic complications. Recent literature has suggested that elevated parathyroid hormone predicts adverse outcomes in patients with heart failure independent of serum calcium and phosphate, vitamin D deficiency, and renal insufficiency. Parathyroid hormone has been correlated with elevated brain natriuretic peptide levels, an established biomarker of heart failure severity. There are several limitations to the utilization of parathyroid hormone as a biomarker for heart failure, and further prospective studies need to be conducted to assess the value of multiple parathyroid hormone measurements over time and elucidate the role of parathyroid hormone in diastolic dysfunction. Pending further validation, there is promise for parathyroid hormone as a complementary biomarker in heart failure.
心力衰竭中的继发性甲状旁腺功能亢进是肾素-血管紧张素-醛固酮激活、慢性醛固酮增多症和袢利尿剂使用导致钙排泄的结果。其结果是一种炎症状态，对心肌重构和全身并发症有不良影响。最近的文献表明，甲状旁腺激素升高可预测心力衰竭患者的不良预后，与血清钙和磷、维生素 D 缺乏和肾功能不全无关。甲状旁腺激素与升高的脑钠肽水平相关，脑钠肽是心力衰竭严重程度的既定生物标志物。甲状旁腺激素作为心力衰竭生物标志物的应用存在一些局限性，需要进一步进行前瞻性研究，以评估随时间推移多次测量甲状旁腺激素的价值，并阐明甲状旁腺激素在舒张功能障碍中的作用。在进一步验证之前，甲状旁腺激素有望成为心力衰竭的一种补充生物标志物。
