Circulation:维生素K补剂有效减缓主动脉瓣钙化进程

2017-05-25 cailingrui MedSci原创

钙化性主动脉瓣狭窄(CAS)以持续的主动脉瓣钙化(AVC)为特征,是一种常见的退行性疾病。到目前为止,几乎没有有效的治疗手段来延缓钙化进程。流行病学数据分析显示,维生素K可能是潜在的心血管健康保护因子,尤其是在防止钙化方面。基质GLA蛋白(matrix Gla-protein,MGP)是一种强有力的心血管钙化抑制剂,它的合成依赖于维生素K来完成转译后的羧化作用,从而形成具有完全生物活性的蛋白质。因

钙化性主动脉瓣狭窄(CAS)以持续的主动脉瓣钙化(AVC)为特征,是一种常见的退行性疾病。到目前为止,几乎没有有效的治疗手段来延缓钙化进程。流行病学数据分析显示,维生素K可能是潜在的心血管健康保护因子,尤其是在防止钙化方面。基质GLA蛋白(matrix Gla-protein,MGP)是一种强有力的心血管钙化抑制剂,它的合成依赖于维生素K来完成转译后的羧化作用,从而形成具有完全生物活性的蛋白质。因此,维生素K补剂可能起到延缓主动脉瓣钙化(AVC)的作用。非磷酸化未羧化的MGP(dp—ucMGP)可以作为检测维生素K缺乏的生化标志物。

研究人员对此进行了为期12个月的单中心,开放性,随机实验。他们募集了99个主动脉瓣钙化(AVC)患者,随机分成了维生素K补剂组和安慰剂组,每天口服用药。在实验开始和结束时均做心脏CT,以明确主动脉瓣钙化(AVC)程度。补剂组和安慰剂组在实验结束时,主动脉瓣钙化(AVC)进程有着显著差异。同时,研究人员还监控了血液中dp—ucMGP水平作为辅助。实验结束时,维生素K补剂组的主动脉瓣钙化(AVC)程度增加了10.0%,安慰组增加了22%,维生素K补剂显著的减缓了主动脉瓣钙化(AVC)的进程。同时,维生素K补剂组血液中的dp—ucMGP浓度降低了45%(P<0.001)。

本实验是第一例采用随机对照试验,以人为试验对象来验证维生素K补剂可能减缓主动脉瓣钙化进程假设的。试验结果具有临床意义,且强有力的证明了主动脉瓣钙化(AVC)程度与主动脉瓣功能显著相关。因此,延缓钙化进程有望应用于钙化性主动脉瓣狭窄(CAS)病患,稳定动脉瓣功能。与此同时,维生素K治疗也会诱发血液中dp—ucMGP水平的显著下降,意味着维生素K生物活性增强。

简要来说,维生素K补剂可能成为治疗异位性钙化相关心血管疾病的安全而有效的方法。

原始出处

VM Brandenburg, et al. Slower Progress of Aortic Valve Calcification With Vitamin K Supplementation. Circulation. 2017;135:2081-2083

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