慢性阻塞性肺疾病患者血清1,25-二羟维生素D^(3)与病情程度的关系研究

The correlation between serum 1,25 hydroxyvitamin D_(3) and disease severity in patients with chronic obstructive pulmonary disease

目的对慢性阻塞性肺疾病(COPD)患者血清1,25-二羟维生素D_(3)[1,25(OH)_(2)D_(3)]进行检测,同时分析其运动耐力与肺功能的关系,以探讨COPD患者检测血清1,25(OH)_(2)D_(3)的临床意义。方法选取90例COPD患者作为COPD组,根据维生素D标准将COPD组分为1,25(OH)_(2)D_(3)正常组(9例)和1,25(OH)_(2)D_(3)缺乏组(81例)。随机选取同期进行体检的60例健康者作为对照组。检测所有研究对象的血清1,25(OH)_(2)D_(3)水平及肺功能指标。比较COPD患者1,25(OH)_(2)D_(3)正常组与1,25(OH)_(2)D_(3)缺乏组、1,25(OH)_(2)D_(3)缺乏组与对照组的1,25(OH)_(2)D_(3)水平、第1秒用力呼气容积(FEV1)、FEV1占预计值百分比(FEV1%)、FEV1占用力肺活量的百分比(FEV1/FVC),以及不同COPD全球策略修订版(GLOD)分级患者1,25(OH)_(2)D_(3)的水平。结果1,25(OH)_(2)D_(3)正常组患者的1,25(OH)_(2)D_(3)水平(29.4±10.5)ng/ml、FEV1/FVC(75.33±5.67)%均高于1,25(OH)_(2)D_(3)缺乏组的(17.4±4.3)ng/ml、(66.44±9.81)%,差异均具有统计学意义(P<0.05)。两组FEV1、FEV1%水平比较,差异均无统计学意义(P>0.05)。1,25(OH)_(2)D_(3)缺乏组1,25(OH)_(2)D_(3)水平(17.4±4.3)ng/ml、FEV1(2.13±0.46)L、FEV1%(64.33±6.58)%、FEV1/FVC(66.44±9.81)%低于对照组的(31.2±2.3)ng/ml、(2.94±0.58)L、(81.69±12.47)%、(96.18±3.69)%,差异均具有统计学意义(P<0.05)。Ⅰ、Ⅱ、Ⅲ、Ⅳ级GOLD分级患者的1,25(OH)_(2)D_(3)水平分别为(29.4±10.5)、(22.8±7.6)、(13.5±3.5)、(12.1±4.3)ng/ml,Ⅰ级患者1,25(OH)_(2)D_(3)水平高于Ⅱ、Ⅲ、Ⅳ级患者,Ⅱ级患者高于Ⅲ、Ⅳ级患者,差异均具有统计学意义(P<0.05)。Ⅲ级与Ⅳ级患者1,25(OH)_(2)D_(3)水平比较,差异无统计学意义(P>0.05)。结论COPD患者的血清1,25(OH)_(2)D_(3)水平显著低于健康人群,且1,25(OH)_(2)D_(3)缺乏的患病率更高;1,25(OH)_(2)D_(3)缺乏COPD患者的肺功能较1,25(OH)_(2)D_(3)正常COPD患者更低,并且随着COPD严重程度的增加,1,25(OH)_(2)D_(3)缺乏的程度加重。

Objective To investigate the clinical significance of serum 1,25-dihydroxyvitamin D_(3)[1,25(OH)_(2)D_(3)]in patients with chronic obstructive pulmonary disease(COPD),and to analyze the correlation between exercise tolerance and pulmonary function.Methods 90 COPD patients were taken as the COPD group,and they were divided into 1,25(OH)_(2)D_(3)normal group(9 cases)and 1,25(OH)_(2)D_(3)deficiency group(81 cases)according to the vitamin D standard.Another 60 healthy subjects were taken as the control group.The serum 1,25(OH)_(2)D_(3)level and lung function indexes of allsubject were detected.Comparison was made on 1,25(OH)_(2)D_(3)level,forced expiratory volume in the first second(FEV1),percentage of FEV1 to predicted value(FEV1%),FEV1/forced vital capacity(FEV1/FVC)between 1,25(OH)_(2)D_(3)normal group and 1,25(OH)_(2)D_(3)deficiency group,1,25(OH)_(2)D_(3)deficiency group and control group,and 1,25(OH)_(2)D_(3)in patients with different COPD global initiative for chronic obstructive lung disease(GLOD)classification.Results The 1,25(OH)_(2)D_(3)(29.4±10.5)ng/ml and FEV1/FVC(75.33±5.67)%of 1,25(OH)_(2)D_(3)normal group were all higher than(17.4±4.3)ng/ml and(66.44±9.81)%of 1,25(OH)_(2)D_(3)deficiency group,and the difference was statistically significant(P<0.05).There was no statistically significant difference in FEV1 and FEV1%between the two groups(P>0.05).The 1,25(OH)_(2)D_(3)(17.4±4.3)ng/ml,FEV1(2.13±0.46)L,FEV1%(64.33±6.58)%and FEV1/FVC(66.44±9.81)%of 1,25(OH)_(2)D_(3)deficiency group were all lower than(31.2±2.3)ng/ml,(2.94±0.58)L,(81.69±12.47)%and(96.18±3.69)%of the control group,and the difference was statistically significant(P<0.05).The 1,25(OH)_(2)D_(3)of patients with GOLD gradeⅠ,Ⅱ,Ⅲ,andⅣwere(29.4±10.5),(22.8±7.6),(13.5±3.5),(12.1±4.3)ng/ml,respectively.The 1,25(OH)_(2)D_(3)levels of gradeⅠpatients were higher than those of gradeⅡ,ⅢandⅣpatients,and gradeⅢwas higher than gradeⅢandⅣpatients,and the difference was statistically significant(P<0.05).There was no statistically significant difference in 1,25(OH)_(2)D_(3)between gradeⅢandⅣpatients(P>0.05).Conclusion The serum 1,25(OH)_(2)D_(3)level of COPD patients is significantly lower than that of healthy people,and the prevalence of 1,25(OH)_(2)D_(3)deficiency is higher;the lung function of COPD patients with 1,25(OH)_(2)D_(3)deficiency is lower than that of COPD patients with normal 1,25(OH)_(2)D_(3),and the degree of 1,25(OH)_(2)D_(3)deficiency increased with the severity of COPD.