血清25羟基-维生素D对急性缺血性脑卒中急诊患者结局的预测价值

doi:10.3969/j.issn.1006-9771.2020.07.018

《中国康复理论与实践》 ›› 2020, Vol. 26 ›› Issue (7): 830-835.doi: 10.3969/j.issn.1006-9771.2020.07.018

血清25羟基-维生素D对急性缺血性脑卒中急诊患者结局的预测价值

刘慧珍^1,^2a,郭树彬³(),商娜^1,^2a,李芳^1,^2b,刘芦姗^1,^2a,李培兰^1,^2a,陈敬绵^1,^2a,王丰容^1,^2a,李俊玉^1,^2a

1.首都医科大学康复医学院,北京市 100068
2.中国康复研究中心北京博爱医院,a. 急诊科;b. 神经内科,北京市 100068
3.首都医科大学北京朝阳医院急诊医学临床研究中心,心肺脑复苏北京市重点实验室,北京市 100020

收稿日期:2020-04-02 修回日期:2020-05-06 出版日期:2020-07-25 发布日期:2020-07-24
通讯作者: 郭树彬 E-mail:guoshubin@bjcyh.com
作者简介:刘慧珍(1983-),女,汉族,山东诸城市人,硕士,博士研究生,主治医师,主要研究方向：危重症与血液净化。|郭树彬(1963-),男,博士,教授,博士研究生导师,主要研究方向：心肺脑复苏、重症感染的病理生理学。

Prediction of Serum 25-Hydroxyvitamin D for Outcome of Acute Ischemic Stroke in Emergency

LIU Hui-zhen^1,^2a,GUO Shu-bin³(),SHANG Na^1,^2a,LI Fang^1,^2b,LIU Lu-shan^1,^2a,LI Pei-lan^1,^2a,CHEN Jing-mian^1,^2a,WANG Feng-rong^1,^2a,LI Jun-yu^1,^2a

1. Capital Medical University School of Rehabilitation Medicine, Beijing 100068, China
2. a. Department of Emergency Medicine; b. Department of Neurology, Beijing Bo'ai Hospital, China Rehabilitation Research Center, Beijing 100068, China
3. Emergency Medicine Clinical Research Center, Beijing Chaoyang Hospital, Capital Medical University, Beijing Key Laboratory of Cardiopulmonary Cerebral Resuscitation, Beijing 100020, China

Received:2020-04-02 Revised:2020-05-06 Published:2020-07-25 Online:2020-07-24
Contact: GUO Shu-bin E-mail:guoshubin@bjcyh.com

摘要/Abstract

摘要：

目的观察急诊科急性缺血性脑卒中(AIS)患者血清25-羟基维生素D〔25(OH)D〕水平变化及其对结局的预测价值。方法 2017年10月至2019年9月,急诊科AIS患者224例(病例组)和体检中心健康体检者240例(对照组),分别于入组后24 h内检测血清25(OH)D水平;病例组入院时采用美国国立卫生研究院卒中量表(NIHSS)和营养风险筛查2002 (NRS2002)进行评定,24 h内采集静脉血行生化分析;发病后180 d随访,根据改良Rankin量表(mRS)评分分为预后良好组(mRS ≤ 2, n = 106)和预后不良组(mRS > 2, n = 118)。多因素Logistic回归分析结局的影响因素;受试者工作特征(ROC)曲线评价血清25(OH)D对AIS结局的预测能力。结果病例组血清25(OH)D显著低于对照组(Z = 4.296, P< 0.001);预后不良组血清25(OH)D显著低于预后良好组(Z = 5.876, P< 0.001);校正年龄、性别、营养风险、梗死体积和NIHSS评分等因素后,25(OH)D仍是AIS结局的独立保护因素(OR = 0.925,P < 0.05)。ROC曲线下面积为0.795 ( P < 0.001),预测切点13.17 ng/ml,约登指数0.548,敏感性0.746,特异性0.802。结论血清25(OH)D水平能在较好预测AIS 180 d的结局,可能有助于AIS急诊患者的危险分层。

关键词: 急性缺血性脑卒中, 25-羟基维生素D, 预后

Abstract:

Objective To explore the change of serum 25-hydroxyvitamin D [25(OH)D] and prediction for outcome of acute ischemic stroke in emergency.Methods From October, 2017 to September, 2019, 224 patients with acute ischemic stroke in emergency and 240 healthy controls were detected serum 25(OH)D within 24 hours after enrollment. The patients were assessed with National Institute of Health Stroke Scale (NIHSS) and Nutritional Risk Screening 2002 (NRS2002), and measured biochemics within 24 hours after admission. They were assessed with modified Rankin Scale (mRS) 180 days after stroke, and divided into favourable group (mRS ≤ 2, n = 106) and unfavourable group (mRS > 2, n = 118). The factors related with the outcome were analyzed with Logistic regression, and the prediction of 25(OH)D for the outcome were analyzed with receiver operator characteristic (ROC) curve.Results Serum 25(OH)D was less in the patients than in the controls (Z = 4.296, P< 0.001), and less in the unfavourable group than in the favourable group (Z = 5.876, P< 0.001). Serum 25(OH)D (OR = 0.925,P< 0.05) was related with the outcome even controlling the impacts of age, sex, nutritional risk, infarct volume, scores of NIHSS, etc. The area under curve for serum 25(OH)D predicting outcome was 0.795 (P< 0.001). The cut-off point of prediction was 13.17 ng/ml, with the Yoden index of 0.548, which yielded a sensitivity of 0.746 and a specificity of 0.802.Conclusion Serum 25-hydroxyvitamin D may predict the outcome 180 days after acute ischemic stroke, which may help for risk stratification in emergency.

Key words: acute ischemic stroke, 25-hydroxyvitamin D, prognosis

中图分类号:

R743.3

刘慧珍,郭树彬,商娜,李芳,刘芦姗,李培兰,陈敬绵,王丰容,李俊玉. 血清25羟基-维生素D对急性缺血性脑卒中急诊患者结局的预测价值[J]. 《中国康复理论与实践》, 2020, 26(7): 830-835.

LIU Hui-zhen,GUO Shu-bin,SHANG Na,LI Fang,LIU Lu-shan,LI Pei-lan,CHEN Jing-mian,WANG Feng-rong,LI Jun-yu. Prediction of Serum 25-Hydroxyvitamin D for Outcome of Acute Ischemic Stroke in Emergency[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2020, 26(7): 830-835.

图/表 6

表1

表2

表3

图1

表4

表5

参考文献 28

[1]	Krishna S M. Vitamin D as a protector of arterial health: potential role in peripheral arterial disease formation[J]. Int J Mol Sci, 2019, 20(19): E4907.
[2]	van der Schueren B J, Verstuyf A, Mathieu C. Straight from D-Heart: vitamin D status and cardiovascular disease[J]. Curr Opin Lipidol, 2012, 23(1): 17-23. doi: 10.1097/MOL.0b013e32834d7357 pmid: 22123672
[3]	Giustina A, Adler R A, Binkley N, et al. Controversies in vitamin D: summary statement from an international conference[J]. J Clin Endocrinol Metab, 2019, 104(2): 234-240. doi: 10.1210/jc.2018-01414 pmid: 30383226
[4]	Wrzosek M, Lukaszkiewicz J, Jakubczyk A, et al. Vitamin D and the central nervous system[J]. Pharmacol Rep, 2013, 65(2): 271-278. doi: 10.1016/S1734-1140(13)71003-X
[5]	DeLuca H F. Overview of general physiologic features and functions of vitamin D[J]. Am J Clin Nutr, 2004, 80(6): 1689S-1696S. doi: 10.1093/ajcn/80.6.1689S
[6]	Cekic M, Sayeed I, Stein D G. Combination treatment with progesterone and vitamin D hormone may be more effective than monotherapy for nervous system injury and disease[J]. Front Neuroendocrinol, 2009, 30(2): 158-172. doi: 10.1016/j.yfrne.2009.04.002
[7]	王琪, 卢艳慧, 李春霖, 等. 北京地区老年男性维生素D营养状态调查及与心血管危险因素相关性初探[J]. 中华保健医学杂志, 2015, 17(1): 10-13.
	Wang Q, Lu Y H, Li C L, et al. Preliminary study on serum 25 (OH) D level and its relationship with cardiovascular risk factors in aged males in Beijing[J]. Chin J Health Care Med, 2015, 17(1): 10-13.
[8]	中华医学会神经病学分会. 中国急性缺血性脑卒中诊治指南2018[J]. 中华神经科杂志, 2018, 51(9): 666-682.
	Chinese Society of Neurology. Chinese Guidelines for Diagnosis and Treatment of Acute Ischemic Stroke 2018[J]. Chin J Neurol, 2018, 51(9): 666-682.
[9]	Pilz S, Verheyen N, Grubler M R, et al. Vitamin D and cardiovascular disease prevention[J]. Nat Rev Cardiol, 2016, 13(7): 404-417. doi: 10.1038/nrcardio.2016.73
[10]	Brondum-Jacobsen P, Nordestgaard B G, Schnohr P, et al. 25-hydroxyvitamin D and symptomatic ischemic stroke: an original study and meta-analysis[J]. Ann Neurol, 2013, 73(1): 38-47. doi: 10.1002/ana.23738
[11]	Daubail B, Jacquin A, Guilland J C, et al. Association between serum concentration of vitamin D and 1-year mortality in stroke patients[J]. Cerebrovasc Dis, 2014, 37(5): 364-367. doi: 10.1159/000362534
[12]	Turetsky A, Goddeau R P, Henninger N, et al. Low serum vitamin D is independently associated with larger lesion volumes after ischemic stroke[J]. J Stroke Cerebrovasc Dis, 2015, 24(7): 1555-1563. doi: 10.1016/j.jstrokecerebrovasdis.2015.03.051
[13]	Gholami F, Moradi G, Zareei B, et al. The association between circulating 25-hydroxyvitamin D and cardiovascular diseases: a meta-analysis of prospective cohort studies[J]. BMC Cardiovasc Disord, 2019, 19(1): 248. doi: 10.1186/s12872-019-1236-7
[14]	Khazai N, Judd S E, Tangpricha V. Calcium and vitamin D: skeletal and extraskeletal health[J]. Curr Rheumatol Rep, 2008, 10(2): 110-117. doi: 10.1007/s11926-008-0020-y
[15]	Witham M D, Dove F J, Sugden J A, et al. The effect of vitamin D replacement on markers ofvascular health in stroke patients-a randomized controlled trial[J]. Nutr Metab Cardiovasc Dis, 2012, 22(10): 864-870. doi: 10.1016/j.numecd.2010.11.001 pmid: 21194910
[16]	Poole K E, Loveridge N, Barker P J, et al. Reduced vitamin D in acute stroke[J]. Stroke, 2006, 37(1): 243-245. doi: 10.1161/01.STR.0000195184.24297.c1
[17]	Tu W J, Zhao S J, Xu D J, et al. Serum 25-hydroxyvitamin D predicts the short-term outcomes of Chinese patients with acute ischaemic stroke[J]. Clin Sci, 2014, 126(5): 339-346. doi: 10.1042/CS20130284
[18]	Mozos I, Marginean O. Links between vitamin D deficiency and cardiovascular diseases[J]. Biomed Res Int, 2015, 2015:109275.
[19]	Park K Y, Chung P W, Kim Y B, et al. Serum vitamin D status as a predictor of prognosis in patients with acute ischemic stroke[J]. Cerebrovasc Dis, 2015, 40(1-2): 73-80.
[20]	Ji W, Zhou H, Wang S, et al. Low serum levels of 25-hydroxyvitamin D are associated with stroke recurrence and poor functional outcomes in patients with ischemic stroke[J]. J Nutr Health Aging, 2017, 21(8): 892-896. doi: 10.1007/s12603-016-0846-3 pmid: 28972241
[21]	Liu H, Wang J, Xu Z. Prognostic utility of serum 25-hydroxyvitamin D in patients with stroke: a meta-analysis[J]. J Neurol, 2019. doi: 10.1007/s00415-019-09599-0.[Epub ahead of print]. doi: 10.1007/s00415-019-09599-0
[22]	Kim C, Lee S H, Lim J S, et al. Impact of 25-hydroxyvitamin D on the prognosis of acute ischemic stroke: machine learning approach[J]. Front Neurol, 2020, 11:37. doi: 10.3389/fneur.2020.00037
[23]	Jackson J L, Judd S E, Panwar B, et al. Associations of 25-hydroxyvitamin D with markers of inflammation, insulin resistance and obesity in black and white community-dwelling adults[J]. J Clin Transl Endocrinol, 2016, 5:21-25.
[24]	Wang Q, Zhu Z, Liu Y, et al. Relationship between serum vitamin D levels and inflammatory markers in acute stroke patients[J]. Brain Behav, 2018, 8(2): e00885. doi: 10.1002/brb3.2018.8.issue-2
[25]	Li Y R, Li H.[Protective effects of exogenous vitamin D on nerve injury in mice with cerebral ischemia/reperfusion][J]. [in Chinese]. Zhongguo Ying Yong Sheng Li Xue Za Zhi, 2019, 35(4): 300-303.
[26]	Skaaby T, Thuesen B H, Linneberg A. Vitamin D, cardiovascular disease and risk factors[J]. Adv Exp Med Biol, 2017, 996:221-230. doi: 10.1007/978-3-319-56017-5_18 pmid: 29124703
[27]	Sugden J A, Davies J I, Witham M D. Vitamin D improves endothelial function in patients with type 2 diabetes mellitus and low vitamin D levels[J]. Diabet Med, 2008, 25(3): 320-325. doi: 10.1111/dme.2008.25.issue-3
[28]	Swart K M, Lips P, Brouwer I A, et al. Effects of vitamin D supplementation on markers for cardiovasculardisease and type 2 diabetes: an individual participant data meta analysis of randomized controlled trials[J]. Am J Clin Nutr, 2018, 107(6): 1043-1053.

项目	对照组(n = 240)	病例组(n = 224)	Z/χ²/t值	P值
年龄(岁)	68(59, 78)	70.5(60, 82.5)	1.682	0.093
性别(男/女, n)	140/100	139/85	0.669	0.413
BMI (kg/m²)	23.96±3.87	24.56±3.91	1.649	0.100
高血压(n)	78	149	53.656	< 0.001
糖尿病(n)	42	91	30.301	< 0.001
房颤(n)	11	42	22.982	< 0.001
25(OH)D (ng/ml)	15.00(9.65, 22.68)	11.23(7.05, 16.58)	4.296	< 0.001

项目	预后良好组(n = 106)	预后不良组(n = 118)	Z/χ²/t值	P值
年龄(岁)	65(57.5, 76)	76.5(65, 86)	5.481	< 0.001
性别(男/女, n)	77/29	62/56	9.580	0.002
BMI (kg/m²)	25.1±3.62	24.21±3.98	1.735	0.084
高血压(n)	68	81	0.506	0.477
糖尿病(n)	42	49	0.084	0.772
房颤(n)	9	33	13.903	< 0.001
营养风险(n)	38	73	15.118	< 0.001
梗死体积(cm³)	0.84 (0.32, 1.66)	7.49 (1.75, 32.2)	8.833	< 0.001
NIHSS评分	2(1, 2)	6(4, 11)	10.266	< 0.001
TG (mmol/L)	1.17 (0.91, 1.7)	1.07 (0.78, 1.53)	1.467	0.142
TCH (mmol/L)	4.24±0.92	4.1±1.1	1.079	0.282
HDL (mmol/L)	1.12±0.24	1.09±0.28	0.943	0.347
LDL (mmol/L)	2.6±0.69	2.53±0.91	0.675	0.501
HCY (μmol/L)	16(11.3, 21.4)	14.8(11.73, 22.1)	0.380	0.704
UA (μmol/L)	339.5(283.8, 413.5)	322(258, 404)	1.142	0.253
hsCRP (mg/dl)	0.19(0.09, 0.4)	0.58(0.21, 3.15)	5.675	< 0.001
25(OH)D (ng/ml)	13.95(9.24, 20.58)	9.45(5.81, 14.18)	5.876	< 0.001

变量	B	SE	Wald	OR	95% CI	P值
年龄	0.046	0.021	4.855	1.047	1.005~1.090	0.028
性别	-0.237	0.546	0.188	0.789	0.270~2.303	0.665
BMI	0.052	0.074	0.493	1.053	0.912~1.216	0.483
高血压	0.006	0.568	< 0.001	1.006	0.330~3.061	0.992
糖尿病	-0.190	0.502	0.143	0.827	0.309~2.211	0.705
房颤	1.209	0.674	3.220	3.351	0.894~12.559	0.073
营养风险	1.001	0.480	4.355	2.721	1.063~6.968	0.037
梗死体积	0.009	0.028	0.114	1.009	0.956~1.065	0.736
NIHSS	0.886	0.147	36.367	2.426	1.819~3.237	< 0.001
hsCRP	0.186	0.087	4.555	1.205	1.015~1.430	0.033
25(OH)D	-0.078	0.033	5.700	0.925	0.868~0.986	0.017
常数	-7.489	2.735	7.496	0.001		0.006

变量	AUC (95%CI)	切点	约登指数	敏感性	特异性	Z值	P值
25(OH)D	0.795 (0.736~0.846)	13.170	0.548	0.746	0.802	9.628	< 0.001
hsCRP	0.746 (0.683~0.801)	0.435	0.457	0.636	0.821	7.444	< 0.001
联合变量	0.825 (0.769~0.872)	0.545	0.603	0.773	0.830	11.324	< 0.001

对比组1	对比组2	差异	Z值	P值
25(OH)D	hsCRP	0.049	1.155	0.248
联合变量	25(OH)D	0.030	1.713	0.087
联合变量	hsCRP	0.079	2.308	0.021

血清25羟基-维生素D对急性缺血性脑卒中急诊患者结局的预测价值

Prediction of Serum 25-Hydroxyvitamin D for Outcome of Acute Ischemic Stroke in Emergency

RichHTML

PDF (PC)

可视化

摘要/Abstract

引用本文

使用本文

图/表 6

参考文献 28

相关文章 15

Metrics

本文评价

推荐阅读 0

[1]	邓婷, 陈敬绵, 刘小蒙, 姚晓华, 刘芦姗, 何威, 张通, 芦海涛. 轻中度急性缺血性脑卒中并发卒中相关性肺炎的危险因素分析[J]. 《中国康复理论与实践》, 2023, 29(6): 708-713.
[2]	郭霜, 谢咏祺, 张良, 张春佳, 彭润, 杨德刚, 杨明亮. 舞蹈致儿童无骨折脱位型脊髓损伤神经学预后的影响因素及预测模型[J]. 《中国康复理论与实践》, 2023, 29(5): 582-589.
[3]	朱烈烈, 夏建宁, 蒲新宇, 邵湘芝, 张嘉诚, 吴登宠. 老年营养风险指数对脑卒中后神经功能预后的效能[J]. 《中国康复理论与实践》, 2023, 29(11): 1346-1352.
[4]	刘慧珍, 商娜, 李俊玉, 王娜, 李芳, 刘小蒙, 郭树彬. 血清25-羟维生素D与急诊病房卒中相关性肺炎发生及预后的相关性[J]. 《中国康复理论与实践》, 2023, 29(10): 1214-1220.
[5]	张春龙, 刘福亮, 商娜, 李芳, 刘慧珍. 血清脂联素、超敏C-反应蛋白与急性缺血性脑卒中短期预后的相关性[J]. 《中国康复理论与实践》, 2023, 29(10): 1221-1226.
[6]	高飞,刘丽旭,陈予东,杨宇琦,厉含之,胡雪艳,山磊,吴晓莉,叶长青. 脑卒中后Holmes震颤发生率及其预后[J]. 《中国康复理论与实践》, 2022, 28(1): 50-54.
[7]	张缨,周红俊,刘根林,郑樱,逯晓蕾,康海琼,郝春霞,卫波,王一吉,袁媛,蒙倩茹,李建军. 脊髓损伤儿童神经功能预后和并发症的调查[J]. 《中国康复理论与实践》, 2021, 27(6): 706-711.
[8]	王娜,李培兰,刘芦姗,王丰容. 不同评分系统预测急性缺血性脑卒中患者的短期和长期死亡风险比较[J]. 《中国康复理论与实践》, 2021, 27(3): 256-260.
[9]	谢运娟, 廖伶艺, 高强. 弥散张量成像在脑卒中患者运动功能预后评估中的研究进展[J]. 《中国康复理论与实践》, 2019, 25(5): 546-549.
[10]	张玉峰, 陈兵, 井峰. 血栓弹力图在脑梗死预后中的价值[J]. 《中国康复理论与实践》, 2019, 25(4): 460-464.
[11]	蔡亚飞, 洪毅, 王方永. 脊髓损伤神经功能变化随访与预测模型[J]. 《中国康复理论与实践》, 2019, 25(10): 1120-1124.
[12]	王娜,刘芦姗,王丰容. 四种评分系统对缺血性脑卒中相关性肺炎的预测价值比较[J]. 《中国康复理论与实践》, 2018, 24(6): 696-701.
[13]	刘宏炜, 李军, 杜良杰. 肝癌膈下动脉化疗栓塞术致脊髓损伤康复治疗1例报道[J]. 《中国康复理论与实践》, 2018, 24(4): 472-476.
[14]	高修明, 康硕, 刘苏玮, 江水华, 项洁. 异己手综合征8例临床特征分析[J]. 《中国康复理论与实践》, 2018, 24(3): 342-346.
[15]	王娜，王丰容，刘芦姗. 急诊病房脑卒中相关性肺炎的危险因素及预后分析[J]. 《中国康复理论与实践》, 2017, 23(8): 932-936.