血清25-羟维生素D与前循环急性缺血性脑卒中脑梗死体积的相关性  

Relationship between 25-hydroxyvitamin D and infarction volume in patients with acute ischemic stroke in anterior circulation

作　　者：刘慧珍[1] 商娜 李芳[2] 李俊玉 陈敬绵[1] 郭树彬[3] Liu Huizhen;Shang Na;Li Fang;Li Junyu;Chen Jingmian;Guo Shubin(Department of Emergency Medicine,Capital Medical University School of Rehabilitation Medicine,Beijing Boai Hospital,China Rehabilitation Research Center,Beijing 100068,China;Department of Neurology,Capital Medical University School of Rehabilitation Medicine,Beijing Boai Hospital,China Rehabilitation Research Center,Beijing 100068,China;Emergency Medicine Clinical Research Center,Beijing Chao-Yang 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,中国康复研究中心北京博爱医院急诊科,北京100068 [2]首都医科大学康复医学院,中国康复研究中心北京博爱医院神经内科,北京100068 [3]首都医科大学附属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,北京100020

出　　处：《中华危重病急救医学》2021年第8期973-978,共6页Chinese Critical Care Medicine

基　　金：中国康复研究中心青年基金(2018zx-Q6)。

摘　　要：目的探讨血清25-羟维生素D〔25(OH)D〕水平与梗死灶责任血管为颈内动脉系统(前循环)的急性缺血性脑卒中(AIS)患者脑梗死体积之间的关系。方法采用前瞻性队列研究方法,连续入选2017年10月至2019年9月北京博爱医院急诊科收治的AIS患者。于患者入院24 h内进行营养风险筛查2002(NRS 2002)评分以判定营养风险;采集空腹静脉血进行生化分析,包括白蛋白(ALB)、同型半胱氨酸(HCY)、尿酸(UA)、超敏C-反应蛋白(hs-CRP)等;采用电化学发光免疫分析法检测血清25(OH)D水平;行头颅磁共振成像(MRI)检查,计算脑梗死体积。根据脑梗死体积将患者分为小体积(≤1 cm^(3))组、中体积(1 cm^(3)<梗死体积<20 cm^(3))组、大体积(≥20 cm^(3))组,比较各组血清25(OH)D等指标的差异;用Logistic回归分析梗死体积的影响因素;采用Hosmer-Lemeshow(HL)检验回归模型的拟合优度。结果入选224例AIS患者,小体积组92例,中体积组90例,大体积组42例;小、中、大体积组之间血清25(OH)D水平差异无统计学意义〔μg/L:13.21(7.47,19.33)、11.20(7.00,15.07)、9.19(6.30,17.10),H=4.994,P=0.082〕。前循环的AIS患者共124例,小、中、大体积组分别有45、56、23例;随着脑梗死体积的增大,小、中、大体积组血清25(OH)D水平逐渐下降,差异有统计学意义〔μg/L:13.22(9.00,19.65)、10.41(6.72,14.92)、8.30(4.70,11.30),H=11.068,P=0.004〕;此外,脑梗死体积越大,前循环的AIS患者年龄越大〔岁:63.0(54.0,75.5)、76.0(63.0,84.0)、82.0(67.5,85.0),H=14.981,P=0.001〕,营养风险比例越高(35.6%、53.6%、73.9%,χ^(2)=9.271,P=0.010),血清hs-CRP水平越高〔mg/L:1.91(0.92,3.40)、4.10(1.73,22.42)、19.74(4.02,68.81),H=21.477,P<0.001〕,ALB水平越低(g/L:42.39±4.12、38.11±5.06、35.14±5.49,F=19.347,P<0.001)。有序多分类Logistic回归分析显示,校正年龄、性别、心房颤动、营养风险、hs-CRP等混杂因素后,25(OH)D仍是前循环AIS患者脑梗死体积的独立保护因�Objective To investigate the correlation between the level of serum 25-hydroxyvitamin D[25(OH)D]and infarction volume in patients with acute ischemic stroke(AIS)with internal carotid artery system(anterior circulation).Methods A prospective cohort study was conducted.Patients with AIS admitted to the department of emergency of Beijing Boai Hospital from October 2017 to September 2019 were enrolled.Nutritional risk screening 2002(NRS 2002)were assessed in all cases within 24 hours after enrollment.Fasting venous blood was collected for biochemical analysis,including albumin(ALB),homocysteine(HCY),uric acid(UA),hypersensitive C-reactive protein(hs-CRP),etc.Serum 25(OH)D level was detected by electrochemiluminescence immunoassay.Magnetic resonance imaging(MRI)was performed to calculate the volume of cerebral infarction.According to the volume of cerebral infarction,the patients were divided into small volume(≤1 cm^(3))group,medium volume(1 cm^(3)<infarct volume<20 cm^(3))group and large volume(≥20 cm^(3))group.The differences of serum 25(OH)D and other indicators in each group were compared;the influencing factors of infarct volume were analyzed by Logistic regression;and the goodness of fit of regression model was tested by Hosmer-Lemeshow(HL).Results A total of 224 patients with AIS were enrolled,92 in small volume group,90 in medium volume group and 42 in large volume group,and there was no significant difference in serum 25(OH)D level among small,medium and large volume groups[μg/L:13.21(7.47,19.33),11.20(7.00,15.07),9.19(6.30,17.10),H=4.994,P=0.082].There were 124 patients with AIS in anterior circulation,45,56 and 23 patients in the small,medium and large volume groups,respectively,with the increase of the cerebral infarction volume,the serum 25(OH)D level in small,medium and large volume groups decreased gradually,and the difference was statistically significant[μg/L:13.22(9.00,19.65),10.41(6.72,14.92),8.30(4.70,11.30),H=11.068,P=0.004].In addition,with the increase of the cerebral infarction volume,the

关 键 词：急性缺血性脑卒中 脑梗死体积 前循环 25-羟维生素D 

分 类 号：R743.3[医药卫生—神经病学与精神病学]