维生素D营养状况与急诊科老年患者短期预后的相关性  

Association of serum 25 hydroxy-vitamin D with short-term prognosis in elderly patients in emergency care settings

作　　者：刘慧珍[1] 商娜 李俊玉 王娜[1] 刘小蒙 郭树彬[2] 王国栋[3] Liu Huizhen;Shang Na;Li Junyu;Wang Na;Liu Xiaomeng;Guo Shubin;Wang Guodong(Department of Emergency Medicine,Beijing Bo'Ai Hospital,China Rehabilitation Research Center,Capital Medical University School of Rehabilitation Medicine,Beijing 100068,China;Emergency Medicine Clinical Center,Beijing ChaoYang Hospital,Capital Medical University,Beijing Key Laboratory of Cardiopulmonary Cerebral Resuscitation,Beijing 100020,China;Cardiovascular Department,Bejing Bo'Ai Hospital,China Rehabilitation Research Center,Capital Medical University School of Rehabilitation Medicine,Beijing 100068,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,北京10068 [2]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,北京100020 [3]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心血管内科,北京100068

出　　处：《中华急诊医学杂志》2023年第10期1371-1376,共6页Chinese Journal of Emergency Medicine

基　　金：心肺脑复苏北京市重点实验室开放课题(2020XFN-KFKT-02)。

摘　　要：目的分析维生素D(Vit D)营养状况与急诊科老年患者短期预后的相关性。方法连续收集2021年1月至2021年9月于本院急诊监护病房和急诊留观病房治疗的老年患者317例的临床资料;24 h内检测血常规、生化、血清白细胞介素-6(IL-6)、促甲状腺素(TSH)、皮质醇(COR)、25-羟维生素D[25(OH)D]水平,将患者分为维生素D(VitD)严重缺乏和非严重缺乏组;随访患者住院期间发生机械通气和28d全因死亡情况。采用多因素Logistic回归模型分析VitD营养状况与机械通气的相关性,采用受试者工作特征(ROC)曲线评价血清25(OH)D对机械通气的预测能力,计算ROC曲线下面积(95%置信区间)[AUC(95%CI)];采用Cox比例风险回归模型分析VitD营养状况与28d全因死亡的相关性。结果机械通气组血清25(OH)D水平显著低于非机械通气组(Z=5.150,P<0.001);多因素Logistic回归分析显示,VitD严重缺乏优势比(OR)=7.223,95%CI:1.546~33.742,P=0.012与机械通气独立相关;血清25(OH)D预测机械通气的AUC(95%CI)为0.825(0.770~0.871)(P<0.001),预测切点11.0μg/L,敏感度0.903,特异度0.677,约登指数0.580。Cox回归分析显示,VitD严重缺乏[风险比(HR)=2.403,95%CI:1.133~5.096,P=0.022]是急诊老年患者发生28d全因死亡的独立危险因素。结论血清25(OH)D可作为急诊老年患者短期预后的独立预测因子。Objective To explore the association of Vitamin D(Vit D)nutritional status and prognosis in elderly patients in emergency care settings.Methods The clinical data of 317 elderly patients admitted in the Emergency Care Unit and Emergency Observation Ward of Beijing Bo'Ai hospital from January 2021 to September 2021 were collected continuously.Blood routine,biochemical indicators,serum interleukin-6(IL-6),thyroid-stimulating hormone(TSH),cortisol(COR)and 25-hydroxyvitamin D[25(OH)D]levels were detected within 24 hours after enrollment.Patients were divided into severe vitamin D deficiency group and non-severe vitamin D deficiency group according to the level of serum 25(OH)D.Patients were followed up for the treatment with machinery ventilation during hospitalization and 28-day all-cause mortality.Multivariable logistic regression model was used to analyze the association between the Vit D nutritional status and machinery ventilation.In order to evaluate the predictive ability of serum 25(OH)D for the requirement of machinery ventilation,the receiver operating characteristic(ROC)curve was applied and the area under the ROC curve(95%confidence interval)[AUC(95%CI)]was calculated.Cox proportional hazards regression model was used to analyze the association between Vit D nutritional status and 28-day all-cause mortality.Results Serum 25(OH)level in the machinery ventilation group was significantly lower than that in the non-mechanical ventilation group(Z=5.150,P<0.001).Multivariable logistic regression analysis showed that severe Vit D deficiency(OR=7.223,95%CI:1.546-33.742,P=0.012)was independently associated with machinery ventilation.The AUC(95%CI)of serum 25(OH)D for predicting machinery ventilation was 0.825(0.770-0.871)(P<0.001),the predictive cut-off point was 11.0μg/L,and the Youden index was 0.580,yielding a sensitivity of 0.903 and a specificity of 0.677.Cox regression analysis showed that severe Vit D deficiency(HR=2.403,95%CI:1.133-5.096,P=0.022)was an independent predictor of 28-day all-cause mortality in

关 键 词：维生素D营养状况 急诊 老年 短期预后 相关性 

分 类 号：R459.7[医药卫生—急诊医学]