维生素D不足相关甲状旁腺激素增高与慢性阻塞性肺疾病病情恶化的关系

The relationship correlation between the increase of parathyroid hormone-associatedrelated with vitamin D defi-ciency and the exacerbation worsening of COPD.

目的分析维生素D不足相关甲状旁腺激素(parathyroid hormone,PTH)增高与慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)患者病情恶化的关系。方法前瞻性选取COPD患者264例,进行为期12个月的随访,采用有序logistic回归确定维生素D不足相关PTH增高是否为COPD急性加重的危险因素,用受试者工作特征(ROC)曲线确定其预测COPD中重度急性加重的最佳临界值。结果入选患者中存在维生素D不足者有242例(91.67%);logistic回归控制其他变量后,全段PTH水平增高是COPD急性加重的独立影响因素(P<0.05)。全段PTH水平用于预测COPD中度急性加重的临界值为49.50 pg/mL,敏感度为79.00%,特异度为70.10%;用于预测COPD重度急性加重的临界值为58.50 pg/mL,敏感度为71.40%,特异度为94.90%。结论维生素D不足在COPD患者中较为常见,而且维生素D不足相关PTH增高者病情恶化的风险更高。

Objective To analyze the correlation between the increase of parathyroid hormone-related vitamin D deficiency and the exacerbation of chronic obstructive pulmonary disease(COPD).Methods Prospective study was conducted on 264 COPD patients with a 12-month follow-up.Ordered logistics regression was used to determine wheth-er the increase in vitamin D deficiency-related parathyroid hormone was a risk factor for acute COPD exacerbation.ROC curve was used to determine the critical value for predicting moderate to severe acute exacerbations.Results Among the selected patients,there were 242 patients with vitamin D deficiency(91.67%).After logistics regression to control other variables,the increase in PTH levels throughout the entire period was an independent factor for the acute exacerbation of COPD(all P<0.05).The cut-off value of the whole PTH level for predicting moderate acute exacerbations was 49.50 pg/mL,with the sensitivity of 79.00%and the specificity of 70.10%.The cut-off value for predicting severe acute ex-acerbations was 58.50 pg/mL,with the sensitivity of 71.40%and the specificity of 94.90%.Conclusion Vitamin D insufficiency is more common in COPD patients,and those with increased parathyroid hormone-related vitamin D insuffi-ciency are at higher risk of deterioration.