血清25-羟维生素D与急诊病房卒中相关性肺炎发生及预后的相关性  

Association of serum 25-hydroxy vitamin D with the occurrence and outcome of stroke-associated pneumonia in patients in emergency ward

作　　者：刘慧珍[1,2] 商娜[1,2] 李俊玉 王娜 李芳[1,3] 刘小蒙[1,2] 郭树彬[4] LIU Huizhen;SHANG Na;LI Junyu;WANG Na;LI Fang;LIU Xiaomeng;GUO Shubin(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]首都医科大学附属北京朝阳医院急诊医学临床中心,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》2023年第10期1214-1220,共7页Chinese Journal of Rehabilitation Theory and Practice

基　　金：中国康复研究中心青年基金项目(No.2018zx-Q6);心肺脑复苏北京市重点实验室开放课题(No.2020XFN-KFKT-01)。

摘　　要：目的研究血清25-羟维生素D〔25(OH)D〕与急诊病房急性缺血性脑卒中(AIS)患者卒中相关性肺炎(SAP)发生及预后的相关性。方法收集2019年1月至2021年12月北京博爱医院急诊病房256例AIS患者的临床资料。24 h内检测血常规、生化指标和血清25(OH)D水平,进行美国国立卫生研究院卒中量表(NIHSS)评分、A2DS2评分。根据住院期间是否发生肺炎分为非SAP组(n=164)和SAP组(n=92)。采用多因素Logistic回归模型分析SAP的影响因素;采用受试者操作特征曲线评价血清25(OH)D、A2DS2对SAP的预测能力。随访SAP组28 d生存情况。采用多因素Cox比例风险回归模型分析维生素D营养状况与SAP 28 d全因死亡的相关性。结果SAP组血清25(OH)D显著低于非SAP组(Z=6.896,P<0.001)。调整年龄、性别、梗死体积、A2DS2评分等因素后,低血清25(OH)D水平(OR=0.934,95%CI 0.884~0.986,P=0.014)是SAP的独立危险因素。血清25(OH)D、A2DS2评分及二者联合产生的预测值预测SAP的曲线下面积(95%CI)依次为0.774(0.718~0.824)、0.832(0.781~0.876)、0.851(0.802~0.893)(P<0.001),最佳截断值依次为25(OH)D<10.2 ng/mL、A2DS2>5.0分、联合预测值>0.207,约登指数依次为0.493、0.662、0.616;联合A2DS2评分可提高血清25(OH)D的预测效能(Z=2.106,P=0.035)。调整年龄、性别、梗死体积、NIHSS评分后,维生素D缺乏(HR=2.871,95%CI 1.004~8.208,P=0.049)是SAP发生28 d全因死亡的独立危险因素。结论血清25(OH)D与急诊病房AIS患者SAP的发生和预后独立相关,可作为SAP的独立预测因子。Objective To investigate the association between serum 25-hydroxy vitamin D[25(OH)D]and the occurrence and outcome of stroke-associated pneumonia(SAP)in patients with acute ischemic stroke(AIS)in emergency ward.Methods The clinical data of 256 patients with AIS from January,2019 to December,2021 were collected in the emer‐gency department of Beijing Bo'ai Hospital.Blood routine,biochemical indicators and serum concentration of 25(OH)D were detected within 24 hours after enrollment;meanwhile,National Institute of Health Stroke Scale(NIHSS)and A2DS2 score were evaluated.The patients were divided into non-SAP group(n=164)and SAP group(n=92)according to whether pneumonia occurred during hospitalization.Multivariable logistic regression model was used to analyze the influencing factors of SAP.The predictive ability of serum 25(OH)D and A2DS2 for SAP were evaluated by receiver operating characteristic(ROC)curves.The 28-day survival of patients with SAP was followed up.Multivariable Cox proportional hazard regression model was used to investigate the associ‐ation between vitamin D nutritional status and 28-day all-cause mortality.Results Serum 25(OH)D was significantly lower in the SAP group than that in the non-SAP group(Z=6.896,P<0.001).After adjusting age,sex,infarct volume,A2DS2 score and other factors,lower serum 25(OH)D level(OR=0.934,95%CI 0.884 to 0.986,P=0.014)was an independent risk factor for SAP.The areas under curve(95%CI)of serum 25(OH)D,A2DS2 score and their combined model for predicting SAP were 0.774(0.718 to 0.824),0.832(0.781 to 0.876)and 0.851(0.802 to 0.893)(P<0.001),respectively;and the optimum cut-off val‐ues were 25(OH)D<10.2 ng/mL,A2DS2 score>5 points,combined prediction>0.207,and the Youden index were 0.493,0.662 and 0.616,respectively.A2DS2 score could improve the prediction efficiency of serum 25(OH)D(Z=2.106,P=0.035).After adjusting age,sex,infarct volume and NIHSS score,vitamin D deficiency was an independent risk factor for all-cause mortality after 28 days of SAP(HR=2.871,95%CI 1.00

关 键 词：脑卒中 卒中相关性肺炎 25-羟维生素D 预后 

分 类 号：R743.3[医药卫生—神经病学与精神病学]