维生素D与急性缺血性脑卒中发生风险和严重程度的相关性分析

The correlation of vitamin D with risk and severity of acute ischemic stroke

目的探讨急性缺血性脑卒中患者血清维生素D水平变化,分析其与缺血性脑卒中危险因素和严重程度的关系。方法选取2018年7月至2018年9月就诊于哈尔滨医科大学附属第二医院院神经内科明确诊断为急性缺血性脑卒中患者200例。收集患者病史及入院检查结果;利用全自动罗氏生化分析仪检测甘油三酯(triglycerides,TG),总胆固醇(total cholesterol,TC)、高密度脂蛋白(high density lipoprotein,HDL)、低密度脂蛋白(low density lipoprotein,LDL)等生化指标;利用索灵全自动化学发光分析仪检测25(OH)D水平;按照美国国立卫生研究院卒中量表(National Institute of Health stroke scale,NIHSS)对患者缺血性脑卒中严重程度进行评分。结果与25(OH)D不缺乏组相比,缺乏组患者TG、TC、LDL和apoB水平较高,差异具有统计学意义(P<0.05);25(OH)D水平与年龄、TG、TC、LDL、apoB和NIHSS评分呈负相关,差异具有统计学意义(P<0.05);根据NIHSS评分将急性缺血性脑卒中患者分为轻度和中-重度两组,对比各项指标发现,仅25(OH)D水平在两组间的差异具有统计学意义(P<0.05);校正年龄、性别等混杂因素后发现,随着25(OH)D水平降低,患者发生急性脑卒中的风险逐渐增加,血清25(OH)D<14.5 ng/mL时,急性脑卒中发生风险较25(OH)D>23.65ng/mL时增加5倍以上(OR:5.57,95%CI:1.77~17.49,P<0.05)。结论急性缺血性脑卒中患者25(OH)D水平显著降低,低水平的维生素D可增加缺血性脑卒中发生风险和严重程度。

Objective To analyze the correlation of vitamin D with risk factors and severity of ischemic stroke.Methods Between July 2018 and September 2018,200 patients who were admitted to our hospital due to the acute ischemic stroke were included as subjects.The medical history and examination results of the patients were collected.Triglycerides(TG),total cholesterol(TC),high density lipoprotein(HDL)、low density lipoprotein(LDL)and other biochemical indicators were detected by Roche automatic biochemical analyzer.25(OH)D levels were detected by Sorin automatic chemiluminescence analyzer.The severity of ischemic stroke was scored according to the National Institutes of Health Stroke Scale(NIHSS).Results The levels of TG,TC,LDL,and apoB were significantly higher in patients with 25(OH)D deficiency than that of undeficient patients(P<0.05).25(OH)D was negatively correlated with age,TG,TC,LDL,apoB,and NIHSS score(P<0.05).Acute ischemic stroke patients were divided into mild,moderate,and severe groups according to the NIHSS score.25(OH)D level was significantly different between patient groups with different disease severity(P<0.05).The risk of acute stroke increased gradually with the decrease of 25(OH)D level.Low level of serum 25(OH)D(<14.5ng/mL)increased the risk of acute stroke by more than 5 times(OR 5.57,95%CI:1.77-17.49,P<0.05)compared to that when serum 25(OH)D was higher than 23.65ng/mL.There results were obtained by taking into account of age,sex,other vascular risk factors.Conclusion Patients with acute ischemic stroke show significantly low levels of 25(OH)D.Low level of 25(OH)D can increase the risk and severity of ischemic stroke.