慢性阻塞性肺疾病患者血游离态25-羟基维生素D测定的临床意义

Clinical significance of the determination of serum free 25-hydroxyvitamin D in patients with chronic obstructive pulmonary disease

目的探讨游离态25-羟基维生素D[25(OH)D]测定在慢性阻塞性肺疾病(COPD)患者中的临床意义。方法对2014年11月至2015年9月在我院就诊的70例吸烟COPD患者和67例吸烟非COPD受试者分别进行COPD评估测试(CAT)问卷、肺功能测定和6 min步行试验(6MWT),检测血清总25(OH)D、维生素D结合蛋白(VDBP)及白蛋白,得出游离态25(OH)D水平。结果吸烟COPD组患者的一秒钟用力呼气量(FEV1)、FEV1/用力肺活量(FVC)、CAT评分、6MWT分别为(1.80±0.49)L、(51±12.3)%、(18.3±4.4)分、(245.3±38.4)m,而吸烟非COPD组分别为(2.75±0.32)L、(90±5.8)%、(1.2±0.3)分、(389.6±80.3)m,差异均有统计学意义(P<0.05);吸烟COPD组患者的总25(OH)D、VDBP及游离态25(OH)D水平分别为(51.3±8.9)nmol/L、(5.29±0.68)μmol/L、(12.4±2.2)pmol/L,与吸烟非COPD组[(54.7±10.8)nmol/L、(5.07±0.41)μmol/L、(14.0±2.3)pmol/L]比较,差异均有统计学意义(P<0.05);吸烟COPD组患者总25(OH)D与FEV1、FEV1/FVC、6MWT呈正相关(r=0.327,P=0.006;r=0.391,P=0.001;r=0.385,P=0.001),游离态25(OH)D水平与FEV1、FEV1/FVC、6MWT呈正相关(r=0.572,P=0.000;r=0.595,P=0.000;r=0.404,P=0.001),总25(OH)D、游离态25(OH)D水平与CAT评分呈负相关(r=-0.418,P=0.000;r=-0.432,P=0.000)。游离态25(OH)D与FEV1、FEV1/FVC、CAT评分和6MWT的相关系数均高于总25(OH)D。结论游离态25(OH)D在评估COPD患者病情过程中可能较总25(OH)D更有价值。

Objective To explore the clinical significance of free 25-hydroxyvitamin D [25（OH）D] in patients with chronic obstructive pulmonary disease（COPD）. Methods From November 2014 to September 2015, 70 smoking COPD patients in our hospital（smoking COPD group） and 67 smoking non-COPD subjects（smoking non-COPD group）were recruited in the study. COPD assessment test（CAT）, lung function and 6 minute walk test（6MWT） were performed in the two groups. The levels of serum total 25（OH）D, vitamin D binding protein（VDBP） and albumin were measured,and the free 25（OH）D levels were calculated. Results Forced expiratory volume in one second（FEV1）, forced expiratory volume in one second/forced vital capacity（FEV1/FVC）, CAT score and 6MWT were（1.80±0.49） L,（51±12.3）%,（18.3±4.4） and（245.3±38.4） m in the smoking COPD group, as compared with（2.75±0.32） L,（90±5.8）%,（1.2±0.3） and（389.6 ± 80.3） m in the smoking non-COPD group（P〈0.05）. The levels of 25（OH）D, VDBP and free 25（OH）D were（51.3±8.9） nmol/L,（5.29±0.68） μmol/L and（12.4±2.2） pmol/L in the smoking COPD group, as compared with（54.7±10.8） nmol/L,（5.07±0.41） μmol/L and（14.0±2.3） pmol/L in the smoking non-COPD group（P〈0.05）. In smoking COPD group, total 25（OH）D was positively related with FEV1, FEV1/FVC, 6MWT（r=0.327, P=0.006; r=0.391, P=0.001; r=0.385, P=0.001）, and free 25（OH）D was positively related with FEV1, FEV1/FVC, 6MWT（r=0.572, P=0.000; r=0.595,P=0.000; r=0.404, P=0.001）, while total 25（OH）D and free 25（OH）D was negatively correlated with CAT scores（r=-0.418, P=0.000; r=-0.432, P=0.000）. The correlation coefficients of free 25（OH）D with FEV1, FEV1/FVC, CAT and6 MWT were higher than those of total 25（OH）D. Conclusion The free 25（OH）D may be more valuable in the assessment of COPD patients in the course of the disease than the total 25（OH）D.