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Advances in Clinical Medicine
Vol. 12  No. 05 ( 2022 ), Article ID: 51368 , 5 pages
10.12677/ACM.2022.125597

血清25-(OH)D、FIB、MPV/PLT水平 与慢性心力衰竭的相关性研究

胡菲菲，韩吉祥

青海大学附属医院，青海 西宁

收稿日期：2022年4月16日；录用日期：2022年5月11日；发布日期：2022年5月18日

摘要

慢性心力衰竭(Chronic Heart Failure)是终末期心血管疾病。此外，CHF的病理生理机制极其复杂，包括血流动力学异常、神经内分泌激活、心肌损伤和心室重塑。心力衰竭的特征是由心脏结构或功能异常引起的一系列临床综合征，导致心室充盈和/或射血受损。

关键词

血清25-(OH)D，FIB，MPV/PLT，慢性心力衰竭

Correlation Studies of Serum 25-(OH)D, FIB, MPV/PLT Levels and Chronic Heart Failure

Feifei Hu, Jixiang Han

The Affiliated Hospital of Qinghai University, Xining Qinghai

Received: Apr. 16th, 2022; accepted: May 11th, 2022; published: May 18th, 2022

ABSTRACT

Chronic heart failure (CHF) is an end-stage cardiovascular disease. Furthermore, the pathophysiology of CHF is extremely complex, including hemodynamic abnormalities, neuroendocrine activation, myocardial injury, and ventricular remodeling. Heart failure is characterized by a series of clinical syndromes caused by structural or functional abnormalities of the heart, resulting in impaired ventricular filling and/or ejection.

Keywords:Serum 25-(OH)D, FIB, MPV/PLT, Chronic Heart Failure

Copyright © 2022 by author(s) and Hans Publishers Inc.

This work is licensed under the Creative Commons Attribution International License (CC BY 4.0).

http://creativecommons.org/licenses/by/4.0/

1. 引言

慢性心力衰竭(CHF)是一个影响全球2300多万人的主要公共卫生问题。最近的一项大型流行病学研究，包括来自德国的300万人，至少有两次记录在案的HF相关诊断，显示仅在德国，患病率为3.96%，每10万人中有655例新病例有HF风险 [1]。HF是一种复杂的临床综合征，包括呼吸急促和外周水肿等非特异性症状，因此需要进一步的侵入性和非侵入性诊断工具 [2]。目前的HF分类基于左心室射血分数(LVEF)分为1) 射血分数保留的HF，伴有HF的体征和症状，超声心动图显示舒张异常，2) HFpEF临界或HF伴中程射血分数(HFmrEF)，EF为41%~49%和3) HF伴射血分数降低(HFrEF)，EF ≤ 40%。特别是对于HFpEF，其发病机制，诊断和最佳治疗方法仍然存在相当大的不确定性 [3] [4]。内皮功能障碍、炎症、心肌细胞功能障碍和心肌纤维化被认为是CHF发展的关键因素 [5] [6] [7]。

近年来，CHF的预后明显改善，5年生存率从43%提高到52%。CHF的主要治疗药物仍为β阻滞剂、血管紧张素转换酶抑制剂、血管紧张素受体阻滞剂和醛固酮受体拮抗剂 [8]。虽然众所周知，这些药物可以降低心脏不良事件的发生率并改善心脏功能，但HF仍然是全球死亡的主要原因 [9]。目前，有多种血清指标与老年心力衰竭患者的严重程度相关，但关于老年心力衰竭患者的诊断与预后预测仍然不够准确，因此，继续探索补充治疗方法从而能够为早期评估CHF患者的病情变化提供有效依据，从而为心衰程度评判和临床用药提供参考依据，进行早期干预，提高患者生存质量。本文简单总结了目前血清25-(OH)D、FIB、MPV/PLT水平与慢性心力衰竭的研究现状。

2. 维生素D与慢性心力衰竭

大约90%的慢性HF患者维生素D水平不足，即使在阳光明媚的气候下也是如此 [10] [11]。血清25-(OH)D在慢性HF病理学中具有多效性作用 [12]。在HF中，由于心肌细胞中Ca2+离子过载，心脏收缩和松弛受到影响。缺乏维生素D可能会干扰心肌细胞中Ca2+的功能，导致心肌细胞肥大、组织内炎症反应和纤维化 [13] [14]。维生素D抑制心脏肾素–血管紧张素系统和利钠肽的激活，调节细胞外基质更新、钙通量和心肌收缩力，影响心肌细胞的分化和增殖，可介导维生素D的抗肥厚和抗高血压作用，防止心肌功能障碍。低维生素D水平可能激活肾素-血管紧张素系统 [15]，引起炎症反应并导致内皮功能障碍 [16] [17]。维生素D受体系统性敲除的小鼠随着心脏肾素–血管紧张素系统的激活增加而发展为心脏肥大和功能障碍，并且在维生素D缺乏的大鼠中，心脏肥大，心肌胶原蛋白含量增加和QT间期缩短也被证明 [18] [19]。维生素D对心血管系统的影响还通过甲状旁腺激素水平升高来介导 [20]。几项研究证实了甲状旁腺激素水平与年龄相关的升高 [21]。

3. 纤维蛋白原与慢性心力衰竭

纤维蛋白原(Fibrinogen)主要由肝细胞合成，属于一种血浆糖蛋白，所分泌的分子量大约在340 KDa，而分子的长大约是450A的可溶性糖蛋白；纤维蛋白原是由两个相同的亚基来组成的，且每一个亚基都含有三条肽链，其内部则是由多个二硫键进行衔接，从而形成完善的二聚体结构。当纤维蛋白原经凝血酶裂解释放FPA与FPB片段之后，其就会形成纤维蛋白单体，这时的单体就会形成一个有组织结构的纤维蛋白多聚体MPV，从而与其它的凝血因子形成稳定的交联纤维蛋白凝块，并促进血栓的形成 [22]。其不仅能够介导血小板凝聚，而且还能参与凝血过程的后期阶段；其次，它在对抗炎症时也有着非常关键的作用，且两者通过互相影响还能有效降低心血管疾病的发生。有相关研究数据显示，FIB可以通过与炎性细胞表面的CD11b相互作用，从而激活信号通道，这可以起到调节固有免疫细胞活化的作用，还能直接与粘附分子共同参与到炎症反应过程中。越来越多的证据表明，纤维蛋白原是心血管疾病的不良预后预测指标。纤维蛋白原可能通过血小板聚集、血浆粘度和纤维蛋白形成增加心血管风险 [23]。慢性心衰患者纤维蛋白原水平升高 [24] [25] [26]。

4. 平均血小板体积与血小板计数比值与慢性心力衰竭

平均血小板(Average Platelet)是反映血小板体积大小的指标，反映骨髓巨核细胞增生与代谢活性及血小板生成状况。血小板平均体积(MPV)可有效反映血小板活化功能，在正常情况下维持在稳定状态，但当其升高后可介导急性心肌梗死、脑梗死、心绞痛、心力衰竭等多种疾病的发生 [27]。临床研究发现，MPV升高可能与线粒体、血小板的α-颗粒、致密体等多种细胞器增加相关，释放更多的血小板颗粒蛋白、血栓素A2以及5-羟色胺等物质，增加单核细胞、内皮细胞黏附功能，诱导血小板聚集，最终促进血栓形成 [28] [29]。目前已有研究表明，MPV在心力衰竭发生后明显升高 [30] [31]，而MPV升高与下列多种因素相关：① 心力衰竭发生会促使血栓素、二磷酸腺苷(ADP)、凝血酶、花生四烯酸等血小板激动剂含量增加；② 心力衰竭发生后机体处于缺氧、缺血状态，损伤血管内皮细胞，暴露管壁胶原纤维，诱导血小板聚集；③ 心力衰竭发生后会损伤心肌细胞，增加细胞中游离钙的含量。上述因素均会导致血小板聚集、黏附、释放等。经一系列的反应产生体积大、活性高的血小板。大体积血小板的代谢和功能比较活跃，对胶原黏附性强于体积小者，极易形成血栓。心力衰竭程度越重，血小板激活程度越明显。一方面可能促进血栓形成，另一方面也可通过炎症免疫系统，对心衰的发生发展和预后起关键作用 [32] [33] [34]。血小板(Blood Platelet)是血液循环中最小的血细胞，没有细胞核，却有活跃的酶活性和重要的生理功能。血小板数量、大小或体积一方面反映骨髓巨核细胞的增生与代谢活性、新生血小板生成情况以及循环血中血小板的年龄。另一方面反映血小板的超微结构、酶活性及功能状况。血小板在血栓形成和心脑血管疾病的发病机制中发挥重要作用。研究认为，心力衰竭时患者体内存在持续的血小板激活，伴随着血栓形成和血栓栓塞的危险性增加。同时异常的血小板激活在某种程度上参与了心力衰竭并发症的病理生理过程 [35] [36]。

综上所述，25-(OH)D、FBI、MPV/PLT与慢性心力衰竭可能存在一定的相关性，因此探讨25-(OH)D、FBI、MPV/PLT指标水平与慢性心衰的相关性，从而可以为心衰患者的风险预测提供更多的指标，同时为心衰患者提供早期干预，减少心血管不良事件的发生率及提高生存质量。

文章引用

胡菲菲,韩吉祥. 血清25-(OH)D、FIB、MPV/PLT水平与慢性心力衰竭的相关性研究
Correlation Studies of Serum 25-(OH)D, FIB, MPV/PLT Levels and Chronic Heart Failure[J]. 临床医学进展, 2022, 12(05): 4122-4126. https://doi.org/10.12677/ACM.2022.125597

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