Cubbon Richard M, Thomas Ceri Haf, Drozd Michael, Gierula John, Jamil Haqeel A, Byrom Rowenna, Barth Julian H, Kearney Mark T, Witte Klaus K A
Division of Cardiovascular and Diabetes Research, Leeds Institute of Genetics, Health and Therapeutics, Multidisciplinary Cardiovascular Research Centre, University of Leeds, Clarendon Way, Leeds, LS2 9JT, UK.
J Nephrol. 2015 Apr;28(2):209-15. doi: 10.1007/s40620-014-0075-y. Epub 2014 Mar 11.
Serum calcium (Ca) and inorganic phosphate (Pi) concentrations and calcium-phosphate product (CPP) levels are positively associated with worse outcomes in patients with chronic kidney disease, but there are few data for Pi or Ca and none for CPP in patients with chronic heart failure (CHF).
Unselected, consecutive patients with CHF (left ventricular ejection fraction, LVEF ≤45%) were enrolled in a prospective observational study for the occurrence of hospitalisation and mortality. Blood samples were collected at the time of recruitment and analysed immediately.
Patients (n = 713) were on contemporary optimal treatment and mean (standard error, SE) follow-up was 765 (18.9) days. Mean (SE) Ca was 2.29 (0.004) mmol/l. Median (interquartile range, IQR) Pi was 1.11 (0.98-1.23) mmol/l and median CPP 2.53 (2.21-2.88) mmol(2)/l(2). LVEF correlated inversely with Ca, natural log-transformed (Ln)Pi, and LnCPP. There was no difference in CPP between classes of symptom severity or diabetes status. Ca and LnCPP (but not LnPi) were associated with total mortality. Ca was significantly associated with progressive HF and non-cardiovascular death but not with sudden death. Binary logistic regression analyses showed that LnPi and LnCPP were associated with risk of hospitalisation.
Ca, Pi and CPP could be useful additional variables in determining risk in CHF patients. Further work is required to elucidate the mechanisms underlying the adverse influence and determine whether lowering phosphate levels per se in CHF patients is of benefit.
血清钙（Ca）、无机磷（Pi）浓度及钙磷乘积（CPP）水平与慢性肾脏病患者预后较差呈正相关，但关于慢性心力衰竭（CHF）患者的Pi或Ca的数据较少，关于CPP的数据则没有。
连续入选未经过筛选的CHF患者（左心室射血分数，LVEF≤45%），进行一项关于住院率和死亡率发生情况的前瞻性观察性研究。在招募时采集血样并立即进行分析。
患者（n = 713）接受当代最佳治疗，平均（标准误，SE）随访时间为765（18.9）天。平均（SE）Ca为2.29（0.004）mmol/l。中位数（四分位间距，IQR）Pi为1.11（0.98 - 1.23）mmol/l，中位数CPP为2.53（2.21 - 2.88）mmol²/l²。LVEF与Ca、自然对数转换后的（Ln）Pi及LnCPP呈负相关。不同症状严重程度类别或糖尿病状态的患者之间CPP无差异。Ca和LnCPP（但不是LnPi）与总死亡率相关。Ca与进行性心力衰竭和非心血管死亡显著相关，但与猝死无关。二元逻辑回归分析显示LnPi和LnCPP与住院风险相关。
Ca、Pi和CPP可能是确定CHF患者风险的有用附加变量。需要进一步开展工作以阐明不良影响的潜在机制，并确定降低CHF患者的磷酸盐水平本身是否有益。
