血清维生素D水平与老年慢性阻塞性肺疾病患者生活质量及炎症因子的相关性研究

Correlation of Vitamin D with Quality of life and Inflammatory Factors in the Elderly with COPD

目的观察和分析血清维生素D水平与老年慢性阻塞性肺疾病(COPD)患者生活质量及有关炎症因子的相关性。方法选取老年慢性阻塞性肺疾病急性发作期(AECOPD)患者173例,COPD稳定期患者64例,同期住院健康体检患者240例作为对照组。对3组血清25-羟基维生素D[25-(OH)D]水平、降钙素原(procalcitonin,PCT)、超敏C-反应蛋白(high sensitive C-reactivelprotein,hsCRP)、CRP水平及血常规、动脉血气、电解质水平进行检测和比较;对AECOPD组和COPD稳定期组患者的COPD评估测试(COPD assessment test,CAT)问卷评分情况进行评价和比较。结果对照组的血清25-(OH)D水平高于其余2组(P<0.05),维生素D缺乏患病率低于其余2组(P<0.05),COPD稳定期组的血清25-(OH)D水平高于AECOPD组,但差异无统计学意义(P>0.05)。AECOPD组患者的血清PCT、血清hsCRP、血清CRP、白细胞、中性粒细胞比例水平高于对照组及COPD稳定期患者(P<0.05),COPD稳定期组患者的上述血清炎症因子水平与对照组相比差异无统计学意义(P>0.05);AECOPD组患者的CAT评分高于COPD稳定期组(P=0.05),Pearson直线相关分析结果显示,COPD患者的血清25-(OH)D水平与CAT评分(r=-0.357)、血清PCT水平(r=-0.155)、血清CRP(r=-0.137)均呈负相关(P<0.05),多元线性回归结果显示,COPD患者的CAT评分与血清25-(OH)D水平(r=-0.132)、血清PCT水平(r=0.8)、血清CRP(r=0.084)均具有相关性(P<0.05)。结论 COPD患者表现血清维生素D水平、生活质量的下降和炎症反应的加剧,在急性加重期患者的生活质量下降和炎症反应的变化更加显著。COPD患者血清维生素D水平与其生活质量和炎症因子水平具有相关性,临床中应关注老年COPD患者血清25-(OH)D水平,从而有助于评价患者的病情。

Objective To explore the correlation of vitamin D with quality of life and inflammatory factors in the elderly with chronic obstructive pulmonary disease（COPD）. Methods 173 patients with acute exacerbation of chronic obstructive pulmonary disease（AECOPD） were selected as AECOPD group, 64 patients in stable phase of COPD were selected as stable COPD group and 240 healthy people of physical examination were 4 selected as control group; the levels of serum 25 hydroxy vitamin D [（25-（OH）D）] level, procalcitonin（PCT）, hsCRP, serum C-reactive protein（CRP）, blood routine, arterial blood gas, electrolyte of the cases in the 3 groups were detected and the results were compared; the COPD assessment test（CAT） questionnaire scores of the cases in AECOPD group and in stable COPD group were evaluated and compared. Results The serum 25-（OH）D level of the cases in control group was significantly higher and the prevalence of vitamin D deficiency was significantly lower than those in the other 2 groups（P0.05）; the serum 25-（OH）D level of the cases in stable COPD group was higher than that in AECOPD group but with no statistical difference（P0.05）; the serum levels of PCT and CRP in AECOPD group were significantly higher than those in stable COPD group and in control group（P0.05）; the CAT scores of the cases in AECOPD group were significantly higher than those in stable COPD group（P0.05）; pearson correlation analysis indicated that the serum 25-（OH）D level of the cases with COPD was in negative correlation with the CAT scores（r =-0.357）,the serum PCT level（r=-0. 155） and the serum CRP level（r =-0.137） while multiple linear regression analysis indicated that the CAT score of the cases with COPD was correlated with the serum 25-（OH）D level（r =-0.132）, the serum PCT level（r=0.8） and the serum CRP level（r = 0.084）（P0.05）. Conclusions The lower level of serum Vitamin D, the decreased quality of life and the intensified inflammatory reaction in patients with COPD,especially in the elderly with AECOPD, reveal a certain correlation among them, which should be paid attention in clinical and is of help in disease evaluation.