实用老年医学

实用老年医学 ›› 2021, Vol. 35 ›› Issue (3): 257-260.doi: 10.3969/j.issn.1003-9198.2021.03.012

• 临床研究 • 上一篇    下一篇

补充维生素D对老年慢性心力衰竭病人RAAS及IL-18的影响

邵伟华, 吕彩霞, 姚丽霞, 李芳, 王素星, 李绍冰, 高丽霞   

  1. 050051 河北省石家庄市,河北省人民医院老年病二科
  • 收稿日期:2020-03-27 发布日期:2021-04-02
  • 基金资助:
    河北省自然科学基金(H2016307015);河北省医学科学研究重点课题计划项目(20180201)

Effect of vitamin D on RAAS and IL-18 in elderly patients with chronic heart failure

SHAO Wei-hua, LV Cai-xia, YAO Li-xia, LI Fang, WANG Su-xing, LI Shao-bing, GAO Li-xia   

  1. Geriatrics Second Division, Hebei General Hospital, Shijiazhuang 050051, China
  • Received:2020-03-27 Published:2021-04-02

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摘要： 目的 观察补充维生素D对老年慢性心力衰竭(CHF)病人肾素-血管紧张素-醛固酮系统(RAAS)及炎症因子的影响,为高龄CHF病人的治疗提供新的思路及方法。方法 选取2018年3月至2019年3月就诊于我院老年病科的老年(≥80岁)CHF合并维生素D缺乏病人68例,根据随机数字表法分为对照组34例,观察组34例。对照组根据心衰指南用药,观察组在对照组基础上加用骨化三醇(0.25 μg,2次/d),连续治疗24周。治疗前后测定2组血清25-羟维生素D3[25(OH)D3],血浆肾素活性(PRA)、血管紧张素Ⅱ(AngⅡ)、卧位醛固酮(ALD)、N端脑钠肽前体(NT-proBNP)、IL-18、CRP、TNF-α以及LVEF等指标并比较。结果 观察组治疗后血清25(OH)D3、LVEF较治疗前及对照组升高,差异均有统计学意义(P＜0.05),NT-proBNP、PRA、AngⅡ、ALD、IL-18、CRP、TNF-α较治疗前及对照组降低,差异均有统计学意义(P＜0.05)。结论 常规抗心衰治疗基础上补充维生素D能够改善老年CHF病人的心功能,其机制可能与维生素D抑制RAAS活性、减轻机体炎症反应有关。

关键词: 慢性心力衰竭, 维生素 D, 肾素-血管紧张素-醛固酮系统, 白细胞介素-18, 老年人

Abstract: Objective To observe the effects of vitamin D on renin-angiotensin-aldosterone system (RAAS) and the inflammation factors in the elderly patients with chronic heart failure (CHF),and to provide new ideas and methods for the treatment of CHF. Methods Sixty-eight elderly (≥80 years old) patients with CHF and vitamin D deficiency who were treated in the Geriatrics Department of our hospital from March 2018 to March 2019 were selected and divided into control group and observation group, with 34 cases in each group. The control group was treated according to the guidelines for heart failure, and the observation group was treated with calcitriol (0. 25 μg, twice a day) on the basis of the control group for 24 weeks. The levels of serum 25 (OH) D3, plasma renin activity (PRA), angiotensin Ⅱ (AngⅡ), lying aldosterone (ALD), N-terminal brain natriuretic peptide precursor (NT-proBNP), interleukin-18 (IL-18), C-reactive protein (CRP), tumor necrosis factor-α (TNF-α), and left ventricular ejection fraction (LVEF) were measured before and after treatment and compared between two groups. Results The levels of serum 25 (OH) D3 and LVEF 24 weeks after in the observation group were higher than those before treatment and in the control groups (P<0. 05). The levels of NT-proBNP, PRA, AngⅡ, ALD, IL-18, CRP, TNF-α in the observation group were lower than those before treatment and in the control groups (P<0. 05). Conclusions Vitamin D supplementation on the basis of conventional anti-heart failure treatment can improve the heart function of the elderly patients with CHF. The mechanism may be related to vitamin D inhibiting renin-angiotensin-aldosterone system activity and reducing the body’s inflammatory response.

Key words: chronic heart failure, vitamin D, renin-angiotensin-aldosterone system, interleukin-18, aged

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