血清25羟基-维生素D对急性缺血性脑卒中急诊患者结局的预测价值  

Prediction of Serum 25-Hydroxyvitamin D for Outcome of Acute Ischemic Stroke in Emergency

作　　者：刘慧珍[1,2] 郭树彬[4] 商娜 李芳 刘芦姗[1,2] 李培兰[1,2] 陈敬绵[1,2] 王丰容[1,2] 李俊玉[1,2] LIU Hui-zhen;GUO Shu-bin;SHANG Na;LI Fang;LIU Lu-shan;LI Pei-lan;CHEN Jing-mian;WANG Feng-rong;LI Jun-yu(.Capital Medical University School of Rehabilitation Medicine,Beijing 100068,China;Department of Emergency Medicine,Beijing Bo'ai Hospital,China Rehabilitation Research Center,Beijing 100068,China;Department of Neurology,Beijing Bo'ai Hospital,China Rehabilitation Research Center,Beijing 100068,China;Emergency Medicine Clinical Research Center,Beijing Chaoyang Hospital,Capital Medical University,Beijing Key Laboratory of Cardiopulmonary Cerebral Resuscitation,Beijing 100020,China)

机构地区：[1]首都医科大学康复医学院,北京市100068 [2]中国康复研究中心北京博爱医院急诊科,北京市100068 [3]中国康复研究中心北京博爱医院神经内科,北京市100068 [4]首都医科大学北京朝阳医院急诊医学临床研究中心,心肺脑复苏北京市重点实验室,北京市100020

出　　处：《中国康复理论与实践》2020年第7期830-835,共6页Chinese Journal of Rehabilitation Theory and Practice

摘　　要：目的观察急诊科急性缺血性脑卒中(AIS)患者血清25-羟基维生素D〔25(OH)D〕水平变化及其对结局的预测价值。方法 2017年10月至2019年9月,急诊科AIS患者224例(病例组)和体检中心健康体检者240例(对照组),分别于入组后24 h内检测血清25(OH)D水平;病例组入院时采用美国国立卫生研究院卒中量表(NIHSS)和营养风险筛查2002 (NRS2002)进行评定,24 h内采集静脉血行生化分析;发病后180 d随访,根据改良Rankin量表(mRS)评分分为预后良好组(mRS≤2, n=106)和预后不良组(mRS> 2, n=118)。多因素Logistic回归分析结局的影响因素;受试者工作特征(ROC)曲线评价血清25(OH)D对AIS结局的预测能力。结果病例组血清25(OH)D显著低于对照组(Z=4.296, P <0.001);预后不良组血清25(OH)D显著低于预后良好组(Z=5.876, P <0.001);校正年龄、性别、营养风险、梗死体积和NIHSS评分等因素后,25(OH)D仍是AIS结局的独立保护因素(OR=0.925, P <0.05)。ROC曲线下面积为0.795 (P <0.001),预测切点13.17 ng/ml,约登指数0.548,敏感性0.746,特异性0.802。结论血清25(OH)D水平能在较好预测AIS 180 d的结局,可能有助于AIS急诊患者的危险分层。Objective To explore the change of serum 25-hydroxyvitamin D[25(OH)D]and prediction for outcome of acute ischemic stroke in emergency.Methods From October,2017 to September,2019,224 patients with acute ischemic stroke in emergency and 240 healthy controls were detected serum 25(OH)D within 24 hours after enrollment.The patients were assessed with National Institute of Health Stroke Scale(NIHSS)and Nutritional Risk Screening 2002(NRS2002),and measured biochemics within 24 hours after admission.They were assessed with modified Rankin Scale(mRS)180 days after stroke,and divided into favourable group(mRS≤2,n=106)and unfavourable group(mRS>2,n=118).The factors related with the outcome were analyzed with Logistic regression,and the prediction of 25(OH)D for the outcome were analyzed with receiver operator characteristic(ROC)curve.Results Serum 25(OH)D was less in the patients than in the controls(Z=4.296,P<0.001),and less in the unfavourable group than in the favourable group (Z = 5.876, P < 0.001). Serum 25(OH)D (OR = 0.925, P < 0.05) was relatedwith the outcome even controlling the impacts of age, sex, nutritional risk, infarct volume, scores of NIHSS, etc.The area under curve for serum 25(OH)D predicting outcome was 0.795 (P < 0.001). The cut-off point of predictionwas 13.17 ng/ml, with the Yoden index of 0.548, which yielded a sensitivity of 0.746 and a specificity of0.802.Conclusion Serum 25-hydroxyvitamin D may predict the outcome 180 days after acute ischemic stroke, which may helpfor risk stratification in emergency.

关 键 词：急性缺血性脑卒中 25-羟基维生素D 预后 

分 类 号：R743.3[医药卫生—神经病学与精神病学]