深圳市涂阳肺结核患者维生素D营养状况及其影响因素分析

Vitamin D nutritional status and its influencing factors in patients with smear-positive pulmonary tuberculosis in Shenzhen

目的 掌握深圳市肺结核患者的维生素D营养水平,识别维生素D缺乏重点特征人群及其影响因素,为深圳市结核病与营养相关健康促进提供科学依据.方法 以2016年诊断登记的涂阳肺结核患者作为研究对象,收集患者信息及血样,并按研究对象纳入标准,建立样本池.采用简单随机抽样,抽取受检对象120例,其中,男性84例（70.0%）,女性36例（30.0%）.25羟维生素D[25（OH）D]浓度测定采用化学发光技术.统计分析患者维生素D状况,比较不同特征患者维生素D水平,采用多因素线性回归分析,识别影响患者维生素D水平的重要影响因素.结果 120例受检患者,血25（OH）D浓度为（40.2±16.0）nmol/L.维生素D充足2例（1.7%）、不足28例（23.3%）和缺乏90例（75.0%）,其中,严重缺乏者23例（19.2%）.工作生活室内为主、室外为主和室内外难区分患者的血25（OH）D浓度分别为35.3 nmol/L、49.5 nmol/L和40.6 nmol/L,差异有统计学意义（F=8.274,P〈0.001）;日照时间（最近1个月）≥30 min/d者较〈30 min/d者,血25（OH）D浓度高,46.4 nmol/L比36.7 nmol/L,t=3.342,P=0.001.多因素线性回归分析结果显示,汉族较少数民族（β=-11.576,t=-1.991,P=0.049）,家政或居家者较其他职业人员（β=-6.136,t=-1.998,P=0.048）,日照时间〈30 min/d者较≥30 min/d者（β=-9.644,t=-2.829,P=0.006）,体质指数高（β=-2.056,t=-3.439,P=0.001）,工作生活室内程度高者（β=-4.419,t=-2.155,P=0.033）,25（OH）D浓度低.结论 深圳市肺结核患者维生素D营养水平严重不足,是维生素D缺乏重点人群,应加强维生素D相关知识的健康教育,尤其缺乏阳光照射或高体质指数等维生素D缺乏高风险重点人群.

Objective To determine the levels of vitamin D in patients with pulmonary tuberculosis in Shenzhen and identify the influencing factors of vitamin D levels and key groups of vitamin D deficiency, so as to provide a scientific basis for tuberculosis- and nutrition-related health education and promotion in Shenzhen. Methods Patients with smear-positive pulmonary tuberculosis who were diagnosed in 2016 were selected as the research subjects. Their relevant information and blood samples were collected, and the sample pool was established according to the inclusion criteria. One hundred and twenty patients were selected based on simple random sampling, including 84 men （70.0%） and 36 women （30.0%）. Blood 25-hydroxyvitamin D [25（OH）D] concentrations were measured using chemiluminescence technology. Vitamin D statuses in patients were statistically described, and vitamin D levels in patients with different characteristics were compared. Multivariate linear regression analysis was performed to identify important factors influencing vitamin D levels in patients. Results Mean serum concentration of 25（OH）D in 120 patients was （40.2±16.0） nmol/L. There were 2 cases of vitamin D sufficiency （1.7%）, 28 cases of vitamin D insufficiency （23.3%）, and 90 cases of vitamin D deficiency （75.0%）, of which 23 cases （19.2%） were of severe deficiency. 25（OH）D concentrations in patients with different lifestyles （indoors; indistinguishable indoors or outdoors; outdoors） were significantly different （35.3 nmol/L vs. 40.6 nmol/L vs. 49.5 nmol/L, F= 8.274, P〈0.001）. Mean concentration of 25（OH）D in patients with sun exposure time of 〉30 min/d was higher compared to that in those with sun exposure time 〈30 min/d in the last month （46.4 nmol/L vs. 36.7 nmol/L, t=3.342, P=0.001）. Multivariate linear regression analysis showed that the risk factors for 25（OH）D with statistical significance were Han ethnicity or not （β =-11.576, t=-1.991, P=0.049）, housekeeping （including unemployment and retirement） or not （13=-6.136, t=-1.998, P=0.048）, san exposure time〈30 rain/ d or none （β=- 9.644, t=- 2.829, P=0.006）, body mass index （ β =- 2.056, t=- 3.439, P=0.001 ）, and indoor degree of lifestyles （β =-4.419, t=-2.155, P=0.033）. Conclusion Level of vitamin D is generally insufficient in patients with pulmonary tuberculosis in Shenzhen. It is necessary to strengthen health education related to vitamin D in patients with tuberculosis, especially in the high-risk population of vitamin D deficiency, such as in those with a lack of exposure to sunlight or high BMI.