血清25-羟维生素D水平对急性期缺血性脑卒中患者短期预后及炎性反应的影响

Effect of serum 25hydroxyvitamin D level on short-term prognosis and inflammatory response in patients with acute ischemic stroke

目的探讨血清25-羟维生素D[25(OH)D]水平对急性期缺血性脑卒中(AIS)患者短期预后及炎性反应的影响。方法选取于2017年5月至2020年5月于山东国欣颐养集团肥城医院神经内科住院治疗的符合纳入、排除标准的AIS患者90例,根据患者血清25(OH)D水平将患者分为25(OH)D缺乏组(n=48)和非缺乏组(n=42),观察并对比两组患者炎性反应指标,入院及出院时NIHSS评分,入院、出院及出院后90d时mRS评分。结果(1)两组PCT、IL-10水平比较,差异无统计学意义(P>0.05);与非缺乏组相比,缺乏组血清WBC、ESR、hs-CRP、IL-6水平均升高,且差异具有统计学意义(P<0.05);进一步行多元线性回归分析发现AIS患者25-(OH)D水平与hs-CRP(B=-0.609,P<0.01)、IL-6(B=-0.521,P=0.037<0.05)水平呈负相关。(2)两组患者入院及出院时NIHSS评分、入院时mRS评分比较,P>0.05,差异无统计学意义;缺乏组出院后及出院后90d后mRS评分均高于非缺乏组(P<0.05),且行Spearman秩相关分析发现AIS患者出院后90d后mRS评分与25(OH)D水平呈负相关(r=-0.313,P=0.015)(3)与预后良好组相比,预后不良组血清25(OH)D水平降低、WBC、hs-CRP及IL-6炎性指标升高(P<0.05),多因素分析显示年龄、血清25(OH)D水平、hs-CRP及IL-6炎性指标与AIS患者短期预后密切相关。结论血清25(OH)D缺乏可加重AIS患者炎症反应,是AIS患者90d预后的独立影响因素,且提示短期预后不良。

Objective To investigate the effect of serum 25 hydroxyvitamin D[25(OH)D]level on short-term prognosis and inflammatory response in patients with acute ischemic stroke(AIS).Methods 90 AIS patients,from May2017 to May 2020,who met the inclusion and exclusion criteria were selected and divided into 25(OH)D deficiency group(n=48)and non deficiency group(n=42)according to the serum 25(OH)D level.The inflammatory reaction indexes,NIHSS scores at admission and discharge,and Mrs scores at admission,discharge and 90 days after discharge were observed and compared between the two groups.Results(1)There was no significant difference in PCT and IL-10 levels between the two groups(P>0.05).Compared with the non deficiency group,the serum WBC,ESR,hs-CRP,IL-6 in the deficiency group were significantly higher,and the difference was statistically significant(P<0.05).Further multiple linear regression analysis showed that 25-(OH)D level was negatively correlated with hs CRP(B=-0.609,P<0.01)and IL-6(B=-0.521,P=0.037<0.05)in AIS patients.(2)There was no significant difference in NIHSS score at admission and discharge and mRS score at admission between the two groups(P>0.05);mRS score of deficiency group was higher than that of non deficiency group after discharge and 90 days after discharge(P<0.05),and Spearman rank correlation analysis showed that mRS score was negatively correlated with 25(OH)D level 90 days after discharge(r=-0.313,P=0.015).(3)Compared with the good prognosis group,the serum 25(OH)D level was decreased and the WBC,hs CRP and IL-6 inflammatory indexes were increased in the poor prognosis group(P<0.05).Multivariate analysis showed that age,serum 25(OH)D level,hs-CRP and IL-6 inflammatory indexes were closely related to the short-term prognosis of AIS patients.Conclusion Serum 25(OH)D deficiency can aggravate the inflammatory reaction in AIS patients,which is an independent factor influencing the 90 day prognosis of AIS patients,and indicates that the short-term prognosis is poor.