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

Abstract

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

CLC Number:

R743.3

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.

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References 28

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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

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

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