维生素D与缺血性脑卒中预后的相关性研究

The correlation between serum vitamin D and the prognosis of ischemic stroke

目的探讨维生素D水平与缺血性脑卒中预后的相关性。方法选取2018年6月至2019年1月就诊于该院的缺血性脑卒中患者220例为研究对象,并对其血清25-羟基维生素D[25(OH)D]水平进行检测,以25(OH)D最高四分位数22.48 ng/mL为界,将其分为维生素D<22.48 ng/mL组(A组,n=165)和25(OH)D≥22.48 ng/mL组(B组,n=55)。根据美国国立卫生研究院卒中量表(NIHSS)评估缺血性脑卒中严重程度。根据改良Rankin量表(mRS)评分分为预后良好组(mRS评分≤2分)和预后不良组(mRS评分≥3分)。比较A组和B组的临床指标,以及预后良好组和预后不良组25(OH)D的水平。分析25(OH)D对缺血性脑卒中的诊断价值。结果A组年龄、男性占比、NIHSS评分、mRS评分、总胆固醇(TC)、三酰甘油(TG)及低密度脂蛋白胆固醇(LDL-C)水平与B组比较,差异均有统计学意义(P<0.05)。维生素D水平与NIHSS评分及mRS评分呈负相关(P<0.05)。受试者工作特征曲线(ROC曲线)分析结果显示,维生素D对缺血性脑卒中预后不良具有较好的诊断价值,25(OH)D诊断缺血性脑卒中预后的曲线下面积(AUC)为0.769,95%CI:0.691~0.846。预后不良组25(OH)D水平低于预后良好组(P<0.05)。进一步通过Logistic回归分析得出,随着25(OH)D水平降低,缺血性脑卒中预后不良发生风险增加,当25(OH)D<12.30 ng/mL时,缺血性脑卒中预后不良的发生风险是25(OH)D≥22.48 ng/mL患者的13倍(P<0.05)。结论维生素D水平降低是缺血性脑卒中患者预后不良的危险因素,且分析其水平对预后情况具有一定的诊断价值。

Objective This study aimed to evaluate the correlation between the level of vitamin D and prognosis of ischemic stroke.Methods From June 2018 to January 2019,220 consecutive patients with ischemic stroke who visited the Second Affiliated Hospital of Harbin Medical University were enrolled in this study.Serum level of vitamin D was measured and the patients were categorized into the following two groups based on the highest quartile levels of vitamin D:vitamin D<22.48 ng/mL(group A,n=165),vitamin D≥22.48 ng/mL(group B,n=55).Stroke severity was assessed at admission using the National Institutes of Health Stroke Scale score(NIHSS).The modified Rankin Scale(mRS)was used to categorize the patients into good prognosis group(mRS≤2)and poor prognosis group(mRS≥3).Clinical indicators between group A and group B were compared.And 25(OH)D level between good prognosis group and poor prognosis group were also compared.The diagnostic value of 25(OH)D for ischemic stroke was analyzed.Results In group A,age,male proportion,the NIHSS score,mRS score,total cholesterol(TC),triacylglycerol(TG)and low density lipoprotein cholesterol(LDL-C)had statistical significance with group B(P<0.05).Receiver operating characteristic curves analysis indicated vitamin D had a better diagnostic significance for prognosis of ischemic stroke patients,and the area under the curve of 25(OH)D for prognosis of ischemic stroke patients was 0.769,95%CI:0.691-0.846.The level of 25(OH)D of poor prognosis group was significantly lower than that of patients with good prognosis group(P<0.05).Logistic regression analysis demonstrated the decreased level of 25(OH)D was associated with increased risk of unfavorable functional outcome with ischemic stroke patients.When 25(OH)D<12.30 ng/mL,the risk of unfavorable functional outcome with ischemic stroke patients was 13 times higher than 25(OH)D≥22.48 ng/mL(P<0.05).Conclusion The decreased level of vitamin D may be the risk factor of poor prognosis of ischemic stroke,which has a diagnostic value to the prognosis of ischemic stroke.