维生素D水平与接受静脉溶栓治疗的缺血性卒中患者预后的关系  

Association of vitamin D levels with prognosis in ischemic stroke patients receiving intravenous thrombolytic therapy

作　　者：俞刘珍雄 张康睿 杨若蕊 刘学春[2] 王龙[2] 吴竹青[2] 吴君仓 Yu-Liu Zhenxiong;Zhang Kangrui;Yang Ruorui;Liu Xuechun;Wang Long;Wu Zhuqing;Wu Juncang(Department of Neurology,Hefei Hospital Afiliated to Anhui Medical University,the Second People's Hospital of Hefei City,Hefei 2300l,China;the Fifth Clinical School of Medicine,Anhui Medical University,Hefei 230022,China)

机构地区：[1]安徽医科大学附属合肥医院,合肥市第二人民医院神经内科,合肥230011 [2]安徽医科大学第五临床医学院,合肥230022

出　　处：《中华脑血管病杂志（电子版）》2023年第2期94-101,共8页Chinese Journal of Cerebrovascular Diseases(Electronic Edition)

基　　金：合肥市自主创新政策“借转补”项目(J2019Y01);合肥市第二人民医院2021年度青年科研基金项目(2021yqn07)。

摘　　要：目的探讨血清25羟基维生素D[25(OH)D]水平与接受静脉溶栓(IVT)治疗的急性缺血性脑卒中(AIS)患者3个月临床转归之间的关系。方法收集2020年2月至2022年6月在合肥市第二人民医院连续接受IVT治疗的AIS患者的临床资料及实验室指标,根据溶栓后24 h内空腹血清25(OH)D水平是否<20 ng/ml,将患者分为维生素D缺乏组和非维生素D缺乏组。根据发病后3个月的改良Rankin量表(mRS)评分,将mRS评分<3分定义为转归良好,mRS评分≥3分定义为转归不良。应用多变量logistic回归分析确定3个月临床转归的独立影响因素,采用受试者工作特征(ROC)曲线分析25(OH)D水平对3个月临床转归不良的预测价值。结果共纳入177例接受IVT治疗的AIS患者,其中112例临床转归良好,65例转归不良。多变量logistic回归分析显示,接受IVT治疗的AIS患者25(OH)D水平与3个月时转归不良呈显著独立负相关(OR=0.83,95%CI:0.77~0.90,P<0.001),且维生素D缺乏组患者发生转归不良的风险显著高于非维生素D缺乏组患者(OR=18.52,95%CI:6.29~54.53,P<0.001)。ROC曲线分析显示,接受IVT治疗的患者25(OH)D水平预测3个月临床转归不良的曲线下面积(AUC)为0.737(95%CI:0.66~0.82,P<0.001),最佳截断值为19.50,敏感度和特异度分别为58.5%和86.6%。结论在接受IVT治疗的AIS患者中,溶栓后24 h内空腹血清25(OH)D水平是3个月转归不良的保护因素,且25(OH)D水平对3个月时的临床转归不良有预测价值。Objective To investigate the relationship between serum 25-hydroxyvitamin D[25(OH)D]levels and 3-month clinical outcomes in patients with acute ischemic stroke(AIS)who received intravenous thrombolysis(IVT).Methods The clinical data and laboratory indicators of AIS patients who received IVT consecutively from February 2020 to June 2022 in the Second People's Hospital of Hefei City were collected.According to whether the fasting serum 25(OH)D level was less than 20 ng/ml within 24 hours after thrombolysis,the patients were divided into the vitamin D deficiency group and the non-vitamin D deficiency group.According to the modified Rankin scale(mRS)score at 3 months after disease onset,the mRS score<3 was defined as a good outcome,and the mRS score≥3 was defined as a poor outcome.Multivariate logistic regression analysis was used to determine the independent influencing factors of 3-month clinical outcome.The receiver operating characteristic(ROC)curve was used to analyze the predictive value of 25(OH)D level on 3-month clinical outcome.Results A total of 177 AIS patients treated with IVT were enrolled,of which 112 patients had good clinical outcomes and 65 patients had poor clinical outcomes.Multivariate logistic regression analysis showed that 24 h 25(OH)D level in AIS patients treated with IVT was negatively and independently correlated with poor outcomes at 3 months(OR=0.83,95%CI=0.77-0.90,P<0.001),and the risk of poor outcomes in patients with vitamin D deficiency was significantly higher than that in patients without vitamin D deficiency(OR=18.52,95%CI=6.29-54.53,P<0.001).ROC curve analysis showed that the area under the curve(AUC)of 25(OH)D collected after IVT treatment predicted poor clinical outcome at 3 months was 0.737(95%CI=0.66-0.82,P<0.001),the optimal cut-off value was 19.50,and the sensitivity and specificity were 58.5%and 86.6%,respectively.Conclusion In AIS patients treated with IVT,25(OH)D level is a protective factor for poor clinical outcomes at 3 months,and 25(OH)D level has predictive value

关 键 词：缺血性脑卒中 静脉溶栓 25羟基维生素D 临床转归 

分 类 号：R743.3[医药卫生—神经病学与精神病学]