脊柱外科手术患者术前维生素D含量的临床分析

A clinical analysis of vitamin D status in patients before spinal surgery

目的 :研究脊柱外科手术患者术前维生素D的浓度,分析缺乏维生素D的相关危险因素。方法 :回顾性分析503例手术患者,术前均常规测定血清25羟基维生素D[25(OH)D]的浓度,以25(OH)D≥32 ng/m L评定为患者血清维生素D的含量正常,25(OH)D≥20 ng/m L且﹤32 ng/m L为维生素D含量不足,﹤20 ng/m L为维生素D含量缺乏。结果:503例脊柱外科手术患者中,维生素D缺乏及不足的比率分别为71.4%和23.9%,女性患者维生素D缺乏的比例较男性患者高(P<0.001);BMI增大(P=0.009)和吸烟(P﹤0.001)患者维生素D缺乏的比例更高;月份分析中,维生素D缺乏比例最低为9月份(44.8%),最高为1月份(90.6%);季度分析中,患者维生素D含量冬季最低,秋季最高(P=0.001);年龄、骨密度与维生素D的含量无显著相关性。多因素分析结果表明,女性(P<0.001)、吸烟(P=0.005)、冬季(P=0.001)是维生素D缺乏的潜在危险因素。结论:脊柱外科手术患者术前存在严重的维生素D不足和缺乏,可能影响患者的手术预后,需要加强对脊柱外科患者术前维生素D含量的筛查和治疗。

Objective：To study preoperative concentrations of vitamin D in patients undergoing spinal surgery and analyze relevant risk factors associated with vitamin D deficiency. Methods：A retrospective analysis was conducted on 503 patients undergoing spinal surgery. Preoperative concentrations of serum 25-hydroxyvitamin D[25（OH）D]were measured. Normal vitamin D was defined as a serum25（OH）D level ≥ 32 ng / m L,vitamin D insufficiency as 25（OH）D ≥ 20 and 32 ng / m L,and vitamin D deficiency as 25（OH）D 20 ng / m L. Results：The rate of vitamin D deficiency and insufficiency was 71.4% and 23.9%,respectively. Rate of vitamin D deficiency in female patients was significantly higher than that in male patients（P〈0.001）. Rate of vitamin D deficiency in patients with high body mass index（P = 0.009）or patients with smoking habit（P〈0.001）was much higher compared with that in the other patients.An analysis of monthly vitamin D levels revealed that rate of vitamin D deficiency was the lowest in September（44.8%）,and the highest in January（90.6%）. The analysis of quarterly vitamin D levels showed that rate of vitamin D deficiency was the lowest in winter and the highest in fall（P = 0.001）. No correlation between vitamin D status with age or bone mineral density was identified. Multivariate analysis demonstrated that female（P〈0.001）,smoking（P = 0.005）,and winter（P = 0.001）were potential risk factors for vitamin D deficiency.Conclusion：Severe preoperative vitamin D insufficiency and deficiency existed in spinal surgery patients,and vitamin D insufficiency or deficiency may largely affect surgical outcomes of patients. Therefore,screening of preoperative vitamin D status and relevant treatment should be reinforced in spine surgery patients.