血清维生素D水平对维持性血液透析患者下肢肌力减退的预测作用

The prediction of serum vitamin D level on lower limb strength reduction in maintenance hemodialysis patients

目的探讨维持性血液透析(MHD)患者血清维生素D水平对下肢肌力减退的预测作用。方法横断面研究设计,选择2018年9月至10月于战略支援部队特色医学中心血液净化中心的95例MHD患者,检测其血清25-羟维生素D3[25(OH)D_(3)]水平,采用5次站立-坐下实验(5-STS)评价其下肢肌力。根据5-STS完成时间将MHD患者分为下肢肌力正常组(n=85)与减退组(n=10),比较两组患者人口学特征、实验室指标。采用多因素Logistic回归分析下肢肌力减退的影响因素,绘制受试者工作特征(ROC)曲线分析上述因素预测MHD患者发生下肢肌力减退的特异度和敏感度。结果95例MHD患者血清25(OH)D_(3)水平为11.00~99.50 nmol/L,中位数31.23(19.90~43.30)nmol/L;5-STS完成时间为3.55 s~18.71 s,中位数9.81(7.12,12.43)s,下肢肌力减退者10例(10.53%)。多因素Logistic回归分析显示,血清25(OH)D_(3)是MHD患者下肢肌力减退的保护性因素[OR=0.761,95%CI(0.592~0.978),P=0.033]。进一步ROC曲线分析显示,25(OH)D_(3)对应的ROC曲线下面积为0.815,其预测MHD患者发生下肢肌力减退的敏感度为80.00%,特异度为80.00%。结论MHD患者血清25(OH)D_(3)水平普遍较低,下肢肌力减退者更为明显;血清维生素D水平对MHD患者是否存在下肢肌力减退具有较好的预测价值。

ObjectiveTo explore the predictive efficacy of serum vitamin D level on lower limb strength loss in patients undergoing maintenance hemodialysis(MHD).MethodsThis is a cross-sectional study with convenient sampling.In 95 MHD patients who were selected from Blood Purification Center,Strategic Support Force Medicial Center from September 2018 to October 2018,serum 25(OH)D_(3)level and a 5-repetition sit-to-stand test(5-STS)were used to represent serum vitamin D level and lower limb strength.MHD patients were divided into two groups based on the completion time of the 5-STS:normal muscle strength(n=85)and decreased muscle strength(n=10),and the demographic characteristics and laboratory indicators of the two groups were compared.The influencing factors of lower extremity muscle weakness were studied using multivariate logistic regression,and a receiver operating characteristic(ROC)curve was drawn to assess the specificity and sensitivity of the above factors in predicting lower extremity muscle weakness in MHD patients.ResultsSerum 25(OH)D_(3)levels ranged from 11.00 nmol/L to 99.50 nmol/L,with 31.23(19.90-43.30)nmol/L as the median,and the time to complete 5-STS ranged from 3.55 sec to 18.71 sec,with 9.81(7.12,12.43)sec as the median.Lower limb strength decreased in 10 cases(10.53%).Multivariate logistic regression revealed that serum 25(OH)D_(3)was a protective factor for lower limb weakness in MHD patients[OR=0.761,95%CI(0.592-0.978),P=0.033].ROC analysis revealed that the AUC of 25(OH)D_(3)was 0.815,with sensitivity and specificity of 80.00%and 80.00%,respectively.ConclusionThe level of serum 25(OH)D_(3)is low in MHD patients especially in those with reduction of strength in lower limbs.The 25(OH)D_(3)can predict the reduction of strength in lower limb of MHD patients with a satisfying sensitivity and specificity.