良性阵发性位置性眩晕患者血清VDBP、25(OH)D水平变化及意义

Changes in levels of serum VDBP and 25(OH)D in patients with benign paroxysmal positional vertigo and the significance

目的 探讨良性阵发性位置性眩晕(BPPV)患者血清维生素D结合蛋白(VDBP)、25羟维生素D[25(OH) D]水平变化及意义。方法 选取241例BPPV患者为BPPV组,根据眩晕障碍量表(DHI)分为轻微障碍组(n=109)、中等障碍组(n=76)、重度障碍组(n=56),另选取74例健康体检者为对照组。采用ELISA法检测血清VDBP、25(OH) D水平,Pearson/Spearman相关系数分析BPPV患者VDBP、25(OH) D水平和DHI评分的相关性,多元Logistic回归分析BPPV患者复发影响因素,采用受试者工作特征(ROC)曲线分析血清VDBP、25(OH) D水平对BPPV患者复发的预测价值。结果 与对照组比较,BPPV组VDBP、25(OH) D水平降低(P <0.05)。轻微、中等、重度障碍组血清VDBP、25(OH) D水平依次降低(P均<0.05)。BPPV患者VDBP与25(OH) D水平呈正相关(r=0.728,P <0.001),二者与DHI评分呈负相关(rs分别为-0.811、-0.806,P均<0.001)。高血压(OR=2. 810)、糖尿病(OR=1. 044)、DHI评分(OR=3. 093)为BPPV患者复发独立危险因素,VDBP(OR=0.989 3)、25(OH) D(OR=0.832)为独立保护因素(P均<0.05)。VDBP、25(OH) D、VDBP+25(OH) D预测BPPV患者复发的曲线下面积为0.789、0.779、0.886,灵敏度为81. 03%、82. 76%、77. 59%,特异度为64. 48%、64. 48%、81. 42%。VDBP+25(OH) D预测BPPV患者复发的曲线下面积大于VDBP、25(OH) D单独预测(P均<0.05)。结论 BPPV患者血清VDBP、25(OH) D水平降低,与头晕或平衡障碍严重程度密切相关,为BPPV复发独立保护因素;检测血清VDBP、25(OH) D水平有助于BPPV复发预测。

Objective To investigate the changes in levels of serum vitamin D binding protein(VDBP)and 25 hydroxyvitamin D[25(OH)D]and their clinical significance in patients with benign paroxysmal positional vertigo(BPPV).MethodsTotally 241 patients with BPPV admitted to our hospital from January 2019 to May 2020 were selected as the BPPV group and were divided into the mildly impaired group(n=109),moderately impaired group(n=76)and severely impaired group(n=56)according to the Dizziness Handicap Inventory(DHI),and another 74 healthy physical examiners were selected as the control group.The levels of serum VDBP and 25(OH)D were detected by ELISA;the correlation between VDBP,25(OH)D levels and DHI scores in BPPV patients was analyzed using Pearson/Spearman correlation coefficients;multiple Logistic regression was used to analyze the factors influencing relapse of patients with BPPV,and thereceiver operation characteristic(ROC)curve was used to analyze the predictive value of serum VDBPand 25(OH)D levels for relapse in BPPV patients.ResultsVDBP and 25(OH)D levels were lower in the BPPV group than in the control group(both P<0.05).Serum VDBP,and 25(OH)D levels decreased sequentially in the mildly,moderately and severely impaired groups(all P<0.05).VDBP was positively correlated with 25(OH)D levels in BPPV patients(r=0.728,P<0.001)and both were negatively correlated with DHI scores(r s=0.728,-0.811 and-0.806;both P<0.001).Hypertension(OR=2.810),diabetes(OR=1.044),and DHI score(OR=3.093)were independent risk factors for recurrence in BPPV patients,and VDBP(OR=0.989)and 25(OH)D(OR=0.832)were independent protective factors(all P<0.05).The area under the curve of VDBP,25(OH)D,and VDBP+25(OH)D in predicting the recurrence in BPPV patients was 0.789,0.779,and 0.886,with sensitivities of 81.03%,82.76%,and 77.59%,and specificities of 64.48%,64.48%,and 81.42%,respectively.The area under the curve of VDBP+25(OH)D in predicting recurrence in BPPV patients was greater than that of VDBP and 25(OH)D alone(both P<0.05).Conclusion sThe serum VDBP and 25(OH)D levels decrease in BPPV patients which are closely related to the severity of dizziness or balance disorders,and are independent protective factors against BPPV recurrence.Detectionof serum VDBP and 25(OH)D levels is helpful to the prediction of BPPV recurrence.