Masson Serge, Barlera Simona, Colotta Francesco, Magnoli Michela, Bonelli Fabrizio, Moro Milena, Marchioli Roberto, Tavazzi Luigi, Tognoni Gianni, Latini Roberto
Department of Cardiovascular Research, IRCCS-Istituto di Ricerche Famacologiche Mario Negri, Milan, Italy.
Department of Cardiovascular Research, IRCCS-Istituto di Ricerche Famacologiche Mario Negri, Milan, Italy.
Int J Cardiol. 2016 Dec 1;224:220-225. doi: 10.1016/j.ijcard.2016.09.014. Epub 2016 Sep 10.
Dysregulation of the vitamin D system promotes renal dysfunction and has direct detrimental effects on the heart. Progressive deterioration of renal function is common in patients with chronic heart failure (HF) and is invariably associated with unfavorable outcomes which can be improved by early identification and timely interventions. We examined the relation between two plasma markers of vitamin D metabolism and worsening of renal function (WRF) in a large cohort of patients with chronic HF.
Plasma levels of 1,25-dihydroxyvitamin D (1,25(OH)D) and parathyroid hormone PTH (1-84) were measured in 1237 patients with clinical evidence of chronic and stable HF enrolled in the multicentre GISSI-HF trial and followed for 3.9years. We examined the relation of 1,25(OH)D, PTH(1-84), and their ratio with WRF, defined as first increase in serum creatinine concentration ≥0.3mg/dL and ≥25% at two consecutive measurements at any time during the study.
Lower 1,25(OH)D/PTH(1-84) ratio was associated with a higher baseline serum concentration of creatinine, winter season, female sex and older age; 335 patients (29.6%) experienced an episode of WRF. After adjustment, a lower 1,25(OH)D/PTH(1-84) ratio remained significantly associated with a higher risk of WRF (HR=0.75 [0.62-0.90], p=0.002) and correctly reclassified events. This ratio also independently predicted mortality and admission to hospital for cardiovascular reasons.
The plasma 1,25(OH)D/PTH(1-84) ratio is a promising indicator of future risk of deterioration of renal function in patients with chronic HF and mild renal impairment, that may serve to optimize therapies and improve outcomes.
维生素D系统失调会促进肾功能障碍，并对心脏产生直接有害影响。在慢性心力衰竭（HF）患者中，肾功能进行性恶化很常见，且总是与不良预后相关，而早期识别和及时干预可改善这种情况。我们在一大群慢性HF患者中研究了两种维生素D代谢血浆标志物与肾功能恶化（WRF）之间的关系。
在多中心GISSI-HF试验中纳入的1237例有慢性稳定HF临床证据的患者中，测量了1,25-二羟维生素D（1,25(OH)D）和甲状旁腺激素PTH（1-84）的血浆水平，并随访3.9年。我们研究了1,25(OH)D、PTH(1-84)及其比值与WRF的关系，WRF定义为在研究期间的任何时间，血清肌酐浓度首次升高≥0.3mg/dL且连续两次测量升高≥25%。
较低的1,25(OH)D/PTH(1-84)比值与较高的基线血清肌酐浓度、冬季、女性和老年相关；335例患者（29.6%）经历了一次WRF发作。调整后，较低的1,25(OH)D/PTH(1-84)比值仍与较高的WRF风险显著相关（HR=0.75[0.62-0.90]，p=0.002），并正确重新分类了事件。该比值还独立预测了死亡率和因心血管原因住院的情况。
血浆1,25(OH)D/PTH(1-84)比值是慢性HF和轻度肾功能损害患者未来肾功能恶化风险的一个有前景的指标，可用于优化治疗并改善预后。
