血清维生素D水平对肺结核病患者预后的影响:一项倾向评分匹配研究

Effect of serum vitamin D level on the prognosis of patients with pulmonary tuberculosis: a propensity score matching study

目的 探究血清维生素D水平对肺结核病患者预后的影响。方法 选取在2019年1月—2021年1月河南省胸科医院结核二科接受治疗的肺结核病患者357例并收集其临床资料,根据患者血清维生素D水平将其分为充足组(64例)及不足组(293例),根据治疗结束后6个月的痰菌转阴情况评估预后。以倾向评分匹配法平衡组间差异,对数据进行1∶1匹配,两组数据各为64例。收集患者资料,进行单因素分析,将具有差异的变量纳入二元logistic回归分析模型,分析影响肺结核病患者预后的因素。比较两组患者治疗结束后的痰菌转阴率。结果 倾向性评分匹配后,不足组患者痰菌转阴率为70.31%(45/64),充足组痰菌转阴率为87.50%(56/64),组间比较差异有统计学意义(χ~2=5.680,P=0.017)。根据痰菌转阴情况将患者分为预后良好组(痰菌转阴者101例)和预后不良组(痰菌未转阴者27例)。不同预后患者FEV1%、FEV1/FVC、CD4~+、CD8~+计数及维生素D水平比较差异有统计学意义(P<0.05或0.001)。多因素回归分析结果显示CD8~+计数、FEV1%、FEV1/FVC及血清维生素D水平较低为影响肺结核预后的独立危险因素(P<0.05)。结论 低水平血清维生素D为影响肺结核病患者预后的独立危险因素,与患者的痰菌转阴率较低有关。

Objective To investigate the effect of serum vitamin D level on the prognosis of patients with pulmonary tuberculosis. Methods 357 patients with pulmonary tuberculosis treated in the Second Department of Tuberculosis, Henan Provincial Chest Hospital from January 2019 to January 2021 were selected, and their clinical data were collected. According to serum vitamin D levels, the patients selected were divided into sufficient group(64 cases) and insufficient group(293 cases), and their prognosis evaluations were conducted based on the status of sputum negative conversion 6 months after the end of treatment. The propensity score matching method was used to balance the differences between groups, and the data were matched by 1∶1, with 64 cases in each group. The data of 128 patients after matching were collected for univariate analysis, and the variables with differences were included in the binary logistic regression analysis model to analyze the factors affecting the prognosis of patients with pulmonary tuberculosis. The rates of sputum negative conversions in the two post-matching groups after the end of treatment were compared. Results After propensity score matching, the rate of sputum negative conversion in the group with deficiency of serum vitamin D was 70.31%(45/64) while the rate of the group with sufficiency was 87.50%(56/64);and the difference between the groups was statistically significant(χ~2=5.680, P=0.017). According to the sputum negative conversion, the patients were divided into good prognosis group(101 cases with sputum negative conversion) and poor prognosis group(27 cases without sputum negative conversion). There were statistically significant differences in FEV1%, FEV1/FVC, CD4, CD8counts and the vitamin D levels among patients with different prognosis(P<0.05 or 0.001). Multi-factor regression analysis showed that CD8count, FEV1%, FEV1/FVC and lower level of serum vitamin D were independent risk factors affecting the prognosis of pulmonary tuberculosis(P<0.05). Conclusion Low level of serum vitamin D is an independent risk factor affecting the prognosis of patients with pulmonary tuberculosis, which is related to the lower rate of sputum negative conversion in patients.