血清25-羟维生素D_(3)水平与帕金森病患者脑小血管病的相关性

Correlation between serum 25-hydroxyvitamin D_(3) level and cerebral small-vessel disease in patients with Parkinson′s disease

目的探讨血清25-羟维生素D_(3)[25-(OH)D_(3)]水平与帕金森病(PD)患者脑小血管病(CSVD)的相关性。方法选择2017年6月至2021年12月于郑州大学附属郑州中心医院神经内科就诊的203例PD患者为PD组,另选择50例同期在本院进行健康体检的健康人群为对照组。比较PD组与对照组受试者血清25-(OH)D_(3)水平。根据头颅磁共振显像结果,将PD患者分为PD伴CSVD组(n=117)和PD不伴CSVD组(n=86)。比较PD伴CSVD组与PD不伴CSVD组患者的性别、年龄、体质量指数(BMI)、糖尿病病史比例、高血压病史比例、高脂血症比例、吸烟者比例、白细胞计数(WBC)、红细胞计数(RBC)、血小板(PLT)计数及总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、三酰甘油(TG)、糖化血红蛋白(HbA1C)、同型半胱氨酸(Hcy)、胱抑素C(Cys-C)、25-(OH)D_(3)、尿酸(UA)、C反应蛋白(CRP)水平,采用logistic回归分析影响PD伴CSVD的相关因素,采用受试者操作特征(ROC)曲线评估血清25-(OH)D_(3)水平对PD伴CSVD的预测价值。结果PD组患者的血清25-(OH)D_(3)水平显著低于对照组(Z=-9.965,P<0.05)。PD不伴CSVD组和PD伴CSVD组患者的年龄、糖尿病病史比例、BMI、WBC、RBC及PLT、TC、HbA1C、UA、TG、Hcy、CRP水平比较差异均无统计学意义(P>0.05);PD伴CSVD组患者的性别、高血压病史比例、高脂血症史比例、吸烟者比例及血清LDL-C、Cys-C水平显著高于PD不伴CSVD组(P<0.05),血清HDL-C、25-(OH)D_(3)水平显著低于PD不伴CSVD组(P<0.05)。单因素logistic回归分析结果显示,男性、高血压病史、高脂血症、吸烟、LDL-C、HDL-C、Cys-C、25-(OH)D_(3)与PD伴发CSVD相关(OR=2.184、2.920、1.928、2.049、1.895、0.346、9.229、0.854,P<0.05)。多因素logistic回归分析结果显示,男性、高血压病史、吸烟、LDL-C为PD患者伴发CSVD的危险因素(OR=2.290、2.556、2.003、1.667,P<0.05),25-(OH)D_(3)为PD患者伴发CSVD的保护因素(OR=0.862,P<0.05)。血清25-(OH)D_(3)预测PD伴发CSVD的ROC曲线下面积为0.721(95%置信区间:0.651~0.791,P<0.05),灵敏度和特异度分别为59.8%和77.9%。结论低水平血清25-(OH)D_(3)是PD患者伴发CSVD的独立危险因素,血清25-(OH)D_(3)水平对PD患者伴CSVD具有一定的预测价值。

Objective To explore the correlation between serum 25-hydroxyvitamin D_(3)[25-(OH)D_(3)]level and cerebral small-vessel disease(CSVD)in patients with Parkinson′s disease(PD).Methods A total of 203 patients with PD admitted to the Department of Neurology,Zhengzhou Central Hospital Affiliated to Zhengzhou University from June 2017 to December 2021 were selected as PD group,and 50 health people in our hospital in the same period were selected as control group.The serum 25-(OH)D_(3) level of the subjects between the PD group and the control group was compared.According to the results of brain magnetic resonance imaging,the PD patients were divided into PD with CSVD group(n=117)and PD without CSVD group(n=86).The sex,age,body mass index(BMI),proportion of diabetes history,proportion of hypertension history,proportion of hyperlipidemia,proportion of smoker,white blood cell count(WBC),red blood cell count(RBC),platelet(PLT)count and the total cholesterol(TC),low-density lipoprotein cholesterol(LDL-C),high-density lipoprotein cholesterol(HDL-C),triacylglycerol(TG),glycosylated hemoglobin(HbA1C),homocysteine(Hcy),cystatin C(Cys-C),25-(OH)D_(3),uric acid(UA)and C-reactive protein(CRP)levels of patients were compared between PD with CSVD group and PD without CSVD group;the correlation factors of PD with CSVD were analyzed by logistic regression,the predictive value of serum 25-(OH)D_(3) level for PD combined with CSVD was evaluated by receiver operating characteristic(ROC)curve.Results The level of serum 25-(OH)D_(3) of patients in the PD group was significantly lower than that in the control group(Z=-9.965,P<0.05).There was no significant difference in age,proportion of diabetes history,BMI,WBC,RBC,PLT,TC,HbA1C,UA,TG,Hcy,CRP of patients between the PD without CSVD group and PD with CSVD group(P>0.05);the sex,proportion of hypertension history,proportion of hyperlipidemia history,proportion of smoker and the levels of serum LDL-C and Cys-C of patients in the PD with CSVD group were significantly higher than those in the PD without CSVD group(P<0.05);and the levels of serum HDL-C and 25-(OH)D_(3) were significantly lower than those in the PD without CSVD group(P<0.05).Univariate logistic regression analysis showed that male,hypertension history,hyperlipidemia,smoking,LDL-C,HDL-C,Cys-C,25-(OH)D_(3) were correlated with PD combined with CSVD(OR=2.184,2.920,1.928,2.049,1.895,0.346,9.229,0.854;P<0.05).Multivariate logistic regression analysis showed that male,hypertension history,smoking and LDL-C were the risk factors for PD patients combined with CSVD(OR=2.290,2.556,2.003,1.667;P<0.05);and 25-(OH)D_(3) was the protective factor for PD combined with CSVD(OR=0.862,P<0.05).The area under the curve of ROC of serum 25-(OH)D_(3) in predicting PD combined with CSVD was 0.721(95%confidence interval:0.651-0.791,P<0.05),the sensitivity and specificity were 59.8%and 77.9%,respectively.Conclusion Lower serum 25-(OH)D_(3) level is an independent risk factor for PD combined with CSVD,and serum 25-(OH)D_(3) level has certain predictive value for PD combined with CSVD.