25-羟基维生素D与脑梗死的关系及干预治疗的临床研究

Clinical Study on Relationship of Serum 25-Hydroxyvitamin D and Cerebral Infarction and the Interventional Treatment

目的探讨血清25-羟基维生素D[25-hydroxyvitamin D,25(OH)D]水平与脑梗死患者病情严重程度的相关性及维生素D干预治疗对脑梗死预后的影响。方法分别检测217例急性脑梗死患者及163例健康体检者的血清25(OH)D水平。比较急性脑梗死组和健康对照组血清25(OH)D水平差异,以及两组维生素D缺乏、维生素D不足及维生素D充足者的比例分布;比较不同25(OH)D水平的脑梗死患者临床资料的差异并进行相关性分析;将血清25(OH)D<20 ng/ml的脑梗死患者根据其是否接受维生素D干预(阿法骨化醇0.5μg/d治疗持续1年)分为两亚组,对两组间血清25(OH)D水平、终点事件复发率及改良Rankin量表(modified Rankin Scale,m RS)评分进行1年的随访比较。结果脑梗死患者平均血清25(OH)D水平低于对照组[(13.67±1.16)ng/ml vs(20.11±2.05)ng/ml,P=0.001)]。脑梗死组血清25(OH)D水平缺乏者高于对照组(88.02%vs 63.80%,P=0.001)。血清25(OH)D水平<20 ng/ml的脑梗死患者与≥20 ng/ml的患者相比,更多合并高血压病、糖尿病、冠状动脉粥样硬化性心脏病史(P=0.010,P=0.011,P=0.037)。血清25(OH)D水平与患者入院时美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)评分呈负相关(r=-0.720,P=0.001)。血清25(OH)D水平<20 ng/ml的脑梗死患者亚组分析中,给予阿法骨化醇干预治疗组1年后短暂性脑缺血发作(transient ischemic attack,TIA)或脑梗死复发率和mR S评分均低于未干预组,但无显著差异(P=0.080,P=0.079)。结论脑梗死患者血清25(OH)D水平降低,与脑梗死病情严重程度相关;尚不能证实补充活性维生素D治疗可以降低脑梗死复发风险和改善患者预后。

Objective To evaluate the association between serum 25-hydroxyvitamin D（25 [OH] D） levels and the clinical severity in cerebral infarction patients, and to explore the infl uence in prognosis of those patients who received 25（OH） D treatment.Methods Serum concentrations of 25（OH） D were measured among 217 patients who developed acute cerebral infarction and 163 health control subjects who were free of stroke. These patients were divided into different groups based on the serum 25（OH） D concentrations for analyzing the proportion of each group in patients with cerebral infarction and compared with healthy control group. The difference about clinical data and their correlation were evaluated among the cerebral infarction patients with different 25（OH） D levels. All of the patients with the serum 25（OH） D20 ng/ml were divided into two subgroups according to whether received vitamin D therapy and compared in 1 year follow-up for indicators such as serum 25（OH） D levels, recurrence rates of the endpoint events and average modifi ed Rankin Scale scores.Results The serum 25（OH） D concentrations were signif icantly decreased in the cerebral infarction patients compared with the healthy control group, the mean value was（13.67±1.16） ng/ml and（20.11±2.05） ng/ml, respectively（P=0.001）. In the cerebral infarction group, the prevalence of 25（OH） D deficiency and sufficiency, showed obvious differences compared with the healthy control group. Compared to the serum 25（OH） D≥20 ng/ml, the serum 25（OH） D 20 ng/ml was more often in the cerebral infarction patients with hypertension, diabetes and coronary heart disease（P=0.010, P=0.011, P=0.037）. There was a negative correlation between serum 25（OH） D level and admission National Institutes of Health Stroke Scale（NIHSS） score in patients（r =-0.720, P =0.001）. Among all of the cerebral infarction patients with serum 25（OH） D levels 20 ng/ml, the subgroup which received vitamin D treatment had a recurrence rate of transient ischemic attack（TIA） or cerebral infarction and an average modif ied Rankin Scale score within one year, both were lower than that not received vitamin D treatment, but showing no statistically signif icant differences（P=0.080, P=0.079）.Conclusion The lower serum 25（OH） D levels in the patients with cerebral infarction were associated with the severity, but the evidence was still lacking that vitamin D treatment would reduce the occurrence of risk of ischemic stroke and improve patient prognosis.