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

doi:10.3969/j.issn.1006-9771.2023.10.014

《中国康复理论与实践》 ›› 2023, Vol. 29 ›› Issue (10): 1214-1220.doi: 10.3969/j.issn.1006-9771.2023.10.014

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

刘慧珍¹^,^2a, 商娜¹^,^2a, 李俊玉¹^,^2a, 王娜¹^,^2a, 李芳¹^,^2b, 刘小蒙¹^,^2a, 郭树彬³()

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.首都医科大学附属北京朝阳医院急诊医学临床中心，心肺脑复苏北京市重点实验室，北京市 100020

收稿日期:2023-01-30 修回日期:2023-06-20 出版日期:2023-10-25 发布日期:2023-11-16
通讯作者: 郭树彬(1963-)，男，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。E-mail： shubin007@yeah.net
作者简介:刘慧珍(1983-)，女，汉族，山东诸城市人，博士，副主任医师，主要研究方向：老年衰弱综合征、危重症血液净化。
基金资助:
中国康复研究中心青年基金项目(2018zx-Q6);心肺脑复苏北京市重点实验室开放课题(2020XFN-KFKT-01)

Association of serum 25-hydroxy vitamin D with the occurrence and outcome of stroke-associated pneumonia in patients in emergency ward

LIU Huizhen¹^,^2a, SHANG Na¹^,^2a, LI Junyu¹^,^2a, WANG Na¹^,^2a, LI Fang¹^,^2b, LIU Xiaomeng¹^,^2a, GUO Shubin³()

1. Capital Medical University School of Rehabilitation Medicine, Beijing 100068, China
2a. 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:2023-01-30 Revised:2023-06-20 Published:2023-10-25 Online:2023-11-16
Contact: GUO Shubin, E-mail: shubin007@yeah.net
Supported by:
Youth Foundation of China Rehabilitation Research Center(2018zx-Q6);Open Project of Beijing Key Laboratory of Cardiopulmonary Cerebral Resuscitation(2020XFN-KFKT-01)

摘要/Abstract

摘要：

目的研究血清25-羟维生素D〔25(OH)D〕与急诊病房急性缺血性脑卒中(AIS)患者卒中相关性肺炎(SAP)发生及预后的相关性。
方法收集2019年1月至2021年12月北京博爱医院急诊病房256例AIS患者的临床资料。24 h内检测血常规、生化指标和血清25(OH)D水平，进行美国国立卫生研究院卒中量表(NIHSS)评分、A2DS2评分。根据住院期间是否发生肺炎分为非SAP组(n = 164)和SAP组(n = 92)。采用多因素Logistic回归模型分析SAP的影响因素;采用受试者操作特征曲线评价血清25(OH)D、A2DS2对SAP的预测能力。随访SAP组28 d生存情况。采用多因素Cox比例风险回归模型分析维生素D营养状况与SAP 28 d全因死亡的相关性。
结果 SAP组血清25(OH)D显著低于非SAP组(Z = 6.896, P < 0.001)。调整年龄、性别、梗死体积、A2DS2评分等因素后，低血清25(OH)D水平(OR = 0.934, 95%CI 0.884~0.986, P = 0.014)是SAP的独立危险因素。血清25(OH)D、A2DS2评分及二者联合产生的预测值预测SAP的曲线下面积(95%CI)依次为0.774 (0.718~0.824)、0.832 (0.781~0.876)、0.851 (0.802~0.893) (P < 0.001)，最佳截断值依次为25(OH)D < 10.2 ng/mL、A2DS2 > 5.0分、联合预测值> 0.207，约登指数依次为0.493、0.662、0.616;联合A2DS2评分可提高血清25(OH)D的预测效能 (Z = 2.106, P = 0.035)。调整年龄、性别、梗死体积、NIHSS评分后，维生素D缺乏(HR = 2.871, 95%CI 1.004~8.208, P = 0.049)是SAP发生28 d全因死亡的独立危险因素。
结论血清25(OH)D与急诊病房AIS患者SAP的发生和预后独立相关，可作为SAP的独立预测因子。

关键词: 脑卒中, 卒中相关性肺炎, 25-羟维生素D, 预后

Abstract:

Objective To investigate the association between serum 25-hydroxy vitamin D [25(OH)D] and the occurrence and outcome of stroke-associated pneumonia (SAP) in patients with acute ischemic stroke (AIS) in emergency ward.
Methods The clinical data of 256 patients with AIS from January, 2019 to December, 2021 were collected in the emergency department of Beijing Bo'ai Hospital. Blood routine, biochemical indicators and serum concentration of 25(OH)D were detected within 24 hours after enrollment; meanwhile, National Institute of Health Stroke Scale (NIHSS) and A2DS2 score were evaluated. The patients were divided into non-SAP group (n = 164) and SAP group (n = 92) according to whether pneumonia occurred during hospitalization. Multivariable logistic regression model was used to analyze the influencing factors of SAP. The predictive ability of serum 25(OH)D and A2DS2 for SAP were evaluated by receiver operating characteristic (ROC) curves. The 28-day survival of patients with SAP was followed up. Multivariable Cox proportional hazard regression model was used to investigate the association between vitamin D nutritional status and 28-day all-cause mortality.
Results Serum 25(OH)D was significantly lower in the SAP group than that in the non-SAP group (Z = 6.896, P < 0.001). After adjusting age, sex, infarct volume, A2DS2 score and other factors, lower serum 25(OH)D level (OR = 0.934, 95%CI 0.884 to 0.986, P = 0.014) was an independent risk factor for SAP. The areas under curve (95%CI) of serum 25(OH)D, A2DS2 score and their combined model for predicting SAP were 0.774 (0.718 to 0.824), 0.832 (0.781 to 0.876) and 0.851 (0.802 to 0.893) (P < 0.001), respectively; and the optimum cut-off values were 25(OH)D < 10.2 ng/mL, A2DS2 score > 5 points, combined prediction > 0.207, and the Youden index were 0.493, 0.662 and 0.616, respectively. A2DS2 score could improve the prediction efficiency of serum 25(OH)D (Z = 2.106, P = 0.035). After adjusting age, sex, infarct volume and NIHSS score, vitamin D deficiency was an independent risk factor for all-cause mortality after 28 days of SAP (HR = 2.871, 95%CI 1.004 to 8.208, P = 0.049).
Conclusion Serum 25(OH)D is independently associated with the occurrence and outcome of SAP in patients with AIS in emergency ward, which could serve as an independent predictor for SAP.

Key words: stroke, stroke-associated pneumonia, 25-hydroxy vitamin D, outcome

中图分类号:

R743.3

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.

LIU Huizhen, SHANG Na, LI Junyu, WANG Na, LI Fang, LIU Xiaomeng, GUO Shubin. Association of serum 25-hydroxy vitamin D with the occurrence and outcome of stroke-associated pneumonia in patients in emergency ward[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2023, 29(10): 1214-1220.

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参考文献 36

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变量	SAP组 (n = 92)	非SAP组 (n = 164)	Z/χ²/t值	P值
年龄/岁	82.0 (71.5, 87.0)	65.0 (56.0, 79.0)	6.913	< 0.001
女性/n	52	54	13.524	< 0.001
BMI/(kg·m^-2)	23.72±4.58	25.13±3.36	2.444	0.016
高血压/n	65	103	1.609	0.205
糖尿病/n	35	69	0.397	0.529
房颤/n	26	21	9.393	0.002
梗死体积/cm³	8.50 (0.97, 43.20)	1.04 (0.35, 4.60)	5.390	< 0.001
A2DS2评分	7.0 (5.0, 8.0)	4.0 (3.0, 5.5)	8.379	< 0.001
WBC/(10⁹·L^-1)	8.26±2.56	7.31±2.33	2.856	0.005
ALB/(g·L^-1)	35.85±4.88	40.16±4.04	6.046	< 0.001
HCY/(μmol·L^-1)	16.0 (12.3, 23.8)	14.4 (10.9, 20.9)	1.466	0.143
尿酸/(μmol·L^-1)	334 (248, 403)	330 (281, 409)	0.411	0.681
hs-CRP/(mg·L^-1)	14.40 (2.50, 39.60)	2.10 (1.10, 4.10)	5.502	< 0.001
25(OH)D/(ng·mL^-1)	9.4 (5.5, 14.0)	15.2 (10.3, 22.6)	6.896	< 0.001

变量	B值	S.E.	Wald值	df	P值	OR值	95%CI
年龄	0.048	0.016	8.923	1	0.003	1.049	1.017~1.083
性别
男性(参照)	0.000					1.000
女性	0.584	0.400	2.128	1	0.145	1.793	0.818~3.930
梗死体积	0.017	0.011	2.314	1	0.128	1.017	0.995~1.039
A2DS2评分	0.150	0.113	4.862	1	0.027	1.162	1.008~1.503
hs-CRP	0.258	0.081	10.129	1	0.001	1.294	1.104~1.517
25(OH)D	-0.069	0.028	6.026	1	0.014	0.934	0.884~0.986
常数	-4.465	1.266	12.444	1	< 0.001	0.012

变量	AUC(95%CI)	截断值	YI	敏感性	特异性	Z值	P值
25(OH)D	0.774(0.718~0.824)	< 10.2 ng/mL	0.493	0.781	0.712	7.076	< 0.001
A2DS2评分	0.832(0.781~0.876)	> 5.0 分	0.662	0.829	0.833	8.102	< 0.001
联合变量	0.851(0.802~0.893)	> 0.207	0.616	0.775	0.841	10.714	< 0.001

变量	B值	S.E.	Wald值	df	P值	HR值	95%CI
年龄	0.074	0.038	3.694	1	0.055	1.076	0.999~1.160
性别
男性(参照)	0.000					1.000
女性	0.216	0.983	0.048	1	0.826	1.241	0.181~8.524
梗死体积	0.005	0.005	1.195	1	0.274	1.005	0.995~1.014
维生素D缺乏
无(参照)	0.000					1.000
有	1.055	0.536	3.872	1	0.049	2.871	1.004~8.208
NIHSS评分	0.106	0.044	5.875	1	0.015	1.112	1.020~1.211

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

Association of serum 25-hydroxy vitamin D with the occurrence and outcome of stroke-associated pneumonia in patients in emergency ward

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