心力衰竭患者的甲基丙二酸和维生素 B12。

Methylmalonic acid and vitamin B12 in patients with heart failure.

机构信息

Third Department of Cardiology, Athens University School of Medicine, Athens, Greece; First Department of Cardiology, Evagelismos Hospital, Athens, Greece.

First Department of Cardiology, Athens University School of Medicine, Athens, Greece.

出版信息

Hellenic J Cardiol. 2020 Sep-Oct;61(5):330-337. doi: 10.1016/j.hjc.2019.10.010. Epub 2019 Nov 15.

DOI:10.1016/j.hjc.2019.10.010

PMID:31740360

Abstract

OBJECTIVE

Vitamin B12 deficiency among patients with heart failure (HF) may have been underestimated. High serum levels of methylmalonic acid (MMA) have been identified in several studies as an early indicator of vitamin B12 deficiency. Furthermore, MMA seems to constitute a biomarker of oxidative stress and mitochondrial dysfunction. There are scarce data regarding vitamin B12 and MMA in patients with HF. The aim of this study was to investigate vitamin B12 and MMA serum levels in patients with HF.

METHODS

One hundred five consecutive patients admitted to our hospital with symptoms and signs of acute decompensated HF were included in the study. Demographic and clinical characteristics as well as comorbidities and medical treatment before hospital admission were recorded. Transthoracic echocardiography was performed in all patients. Blood samples were collected during the first 24 hours of hospitalization and measured for complete blood count, biochemical profile, vitamin B12, N-terminal prohormone of brain natriuretic peptide, and MMA levels. Finally, 51 healthy individuals constituted the control group.

RESULTS

A total of 43.8% of patients with HF had elevated MMA levels, but only 10.5% had overt vitamin B12 deficiency, defined as serum cobalamin levels below 189 pg/ml. Mean MMA level was higher in patients with HF than in controls (33.0 ± 9.6 vs. 19.3 ± 6.3 ng/ml; p < 0.001). This difference remained significant when adjusted for age, sex, vitamin B12, and folate serum levels and kidney function (B = 14.7 (9.6-19.7); p < 0.001). MMA levels were higher in patients with acutely decompensated chronic HF than in those with newly diagnosed acute HF (34.7 ± 10.5 vs. 30.7 ± 7.8 ng/ml; p = 0.036). Correlation analysis revealed significantly negative correlation between MMA and vitamin B12 levels only in patients without comorbidities.

CONCLUSION

Patients with HF have elevated MMA levels, independent of age, gender, HF category, or comorbidities, possibly indicating subclinical vitamin B12 deficiency. Further research is needed to investigate subclinical vitamin B12 deficiency in patients with HF and/or to clarify whether MMA constitutes a biomarker of oxidative stress.

摘要

目的

心力衰竭（HF）患者的维生素 B12 缺乏可能被低估了。几项研究发现，血液中高水平的甲基丙二酸（MMA）是维生素 B12 缺乏的早期指标。此外，MMA 似乎构成了氧化应激和线粒体功能障碍的生物标志物。关于 HF 患者的维生素 B12 和 MMA 数据很少。本研究旨在调查 HF 患者的维生素 B12 和 MMA 血清水平。

方法

连续纳入 105 例因急性失代偿性 HF 症状和体征而入院的患者。记录人口统计学和临床特征，以及入院前的合并症和药物治疗情况。所有患者均进行经胸超声心动图检查。在入院后 24 小时内采集血样，检测全血细胞计数、生化指标、维生素 B12、脑钠肽前体 N 端、MMA 水平。最后，51 名健康个体构成对照组。

结果

HF 患者中共有 43.8%的 MMA 水平升高，但仅有 10.5%的患者存在明显的维生素 B12 缺乏，定义为血清钴胺素水平低于 189 pg/ml。HF 患者的平均 MMA 水平高于对照组（33.0±9.6 vs. 19.3±6.3 ng/ml；p<0.001）。在校正年龄、性别、维生素 B12 和叶酸血清水平以及肾功能后，这种差异仍然显著（B=14.7（9.6-19.7）；p<0.001）。与新发急性 HF 患者相比，急性失代偿性慢性 HF 患者的 MMA 水平更高（34.7±10.5 vs. 30.7±7.8 ng/ml；p=0.036）。相关性分析显示，仅在无合并症的患者中，MMA 与维生素 B12 水平呈显著负相关。