脑梗死患者25-羟维生素D水平与颈动脉粥样斑块的相关性研究

Correlation study between carotid artery atheromatous plaque and 25-hydroxy vitamin D in patients with cerebral infarction

目的分析血清25羟维生素D[25-(OH)D]与脑梗死患者颈动脉粥样硬化斑块的相关性。方法选取2013年11月至2015年9月在我院就诊的脑梗死患者194例,同期体检中心健康体检者121名作为对照组。所有受试者均行颈动脉超声检查,并检测血25-(OH)D及常规生化指标。根据脑梗死患者血清25-(OH)D水平分为缺乏组(A组)、不足组(B组)和充足组(C组),并对不同组之间临床指标及颈动脉超声结果进行比较,并对颈动脉硬化斑块的影响因素进行Logistic回归分析。结果 (1)脑梗死患者吸烟比例、超敏C反应蛋白(hsCRP)、血钙、25-(OH)D、颈动脉内膜-中层厚度(IMT)、体质量指数、收缩压、舒张压、同型半胱氨酸水平与健康人群组相比,差异具有统计学意义(P<0.05或P<0.01);(2)A组和B组颈动脉IMT、同型半胱氨酸、hs-CRP、收缩压、舒张压水平明显高于C组(均P<0.01);(3)A组和B组超声造影剂到达时间差(DAT)、超声造影剂到达各峰值的时间差(DTTP)、斑块增强强度(EI)、斑块增强密度(DE)水平,与C组之间比较差异均有统计学意义(均P<0.01);(4)Logistic回归风险显示吸烟、同型半胱氨酸、高血压、颈动脉IMT、hs-CRP以及低水平25-(OH)D是颈动脉粥样硬化斑块的独立危险因素。结论在脑梗死患者中,低水平25-(OH)D水平是颈动脉粥样硬化斑块的独立危险因素。

Objective To analyze the correlation of the serum hydroxy vitamin D[25-（OH）D] and carotid artery atheromatous plaque of patients with cerebral infarction. Methods One hundred and ninty-four cases of a- cute cerebral infarction were Included from November 2013 to September 2015 in our hospital. One hundred and twenty-one healthy people from physical examination center were selected as control group. Participants received carotid artery ultrasonography. Blood vitamin D and routine biochemical indexes were also detected. According to the serum hydroxy vitamin D levels, cerebral infarction patients were divided into deficiency group, insufficient group and sufficient group. Different clinical indicators and carotid artery ultrasound images were compared be- tween different groups. The influencing factors for carotid artery arteriosclerosis were analyzed by logistic regres- sion analysis. Results ①Compared to the healthy controls, rates of smoking, hsCRP, blood calcium and hydroxy vitamin D levels, carotid artery IMT, body mass index, systolic blood pressure, diastolic blood pressure and ho- mocysteine levels were higher in cerebral infarction patients（ P 〈0.05 or 0.01） ; ②Compared to C group, carotid artery IMT, homocysteine, hsCRP, systolic pressure, diastolic blood pressure levels were higher in A and B group, and there were statistically significant difference（all P 〈0.01） ; ③Compared to C group, there were statis- tically significant difference in the DAT, DTTP, EI（dB）, DE levels of A and B group （all P d0.01） ; ④ Logistic regression analysis revealed that hyperlipidemia, smoking, homocysteine, hypertension, carotid artery IMT, hsCRP and low level of serum 25-（OH）D are the independent risk factors for the development of carotid artery atheromatous plaque of cerebral infarction. Conclusion Low level of serum 25-（OH）D may he an independent risk factor for carotid artery plaque formation in cerebral infarction.