25-羟维生素D水平对肺间质纤维化患者弥散功能障碍程度的影响  

Effect of 25-hydroxyvitamin D levels on the degree of diffusion dysfunction in patients with pulmonary fibrosis

作　　者：丁劭瑞 曹佳伟 铁华 马婷婷 吴赓 景丽娟 李锋 DING Shaorui;CAO Jiawei;TIE Hua;MA Tingting;WU Geng;JING Lijuan;LI Feng(The First Clinical Medical College,General Hospital of Ningxia Medical University,Yinchuan,Ningxia 750004,China;Medical Laboratory Center,General Hospital of Ningxia Medical University,Yinchuan,Ningxia 750004,China)

机构地区：[1]宁夏医科大学总医院第一临床医学院,宁夏银川750004 [2]宁夏医科大学总医院医学实验中心,宁夏银川750004

出　　处：《检验医学与临床》2024年第8期1063-1068,共6页Laboratory Medicine and Clinic

摘　　要：目的探讨25-羟维生素D[25(OH)D]水平对肺间质纤维化(PF)患者弥散功能障碍程度的影响。方法选取2020年1月至2023年6月宁夏医科大学总医院收治的81例诊断为PF的患者作为研究对象。根据《成人肺功能诊断规范中国专家共识》将一氧化碳弥散量(DLCO%pred)≥60%的患者纳入正常+轻度弥散功能障碍组(DN组,64例),DLCO%pred<60%的患者纳入中重度弥散功能障碍组(DD组,17例)。收集并比较所有患者的临床资料,包括:住院时长、住院次数、白细胞计数(WBC)、中性粒细胞百分比(NEUT)、淋巴细胞百分比(LYM)、单核细胞百分比(M)、红细胞计数(RBC)、血红蛋白(Hb)水平、血小板计数(PLT)、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(FIB)水平、凝血酶时间(TT)、D-二聚体(D-D)水平、血氧分压(PO_(2))、二氧化碳分压(PCO_(2))、第1秒用力呼气容积(FEV_(1))、用力肺活量(FVC)、FEV_(1)/FVC、呼气流量峰值(PEF)、25(OH)D水平。采用多因素Logistic回归分析影响PF弥散功能障碍严重的危险因素。绘制受试者工作特征(ROC)曲线分析25(OH)D、FVC单独及2项指标联合对PF弥散功能障碍严重的诊断价值。根据25(OH)D与PF弥散功能障碍程度的ROC曲线中的最佳截断值将患者分为维生素D缺乏组与维生素D非缺乏组,进行Kaplan-Meier生存曲线分析。结果DN组NEUT、住院时长、WBC、D-D水平均低于DD组,PT短于DD组,FEV_(1)、FVC、PEF、M、25(OH)D水平均高于DD组,差异均有统计学意义(P<0.05)。两组LYM、RBC、PLT、APTT、TT、PO_(2)、PCO_(2)、住院次数、FEV_(1)/FVC、Hb水平、FIB水平比较,差异均无统计学意义(P>0.05)。多因素Logistic回归分析结果显示,FVC降低、25(OH)D水平降低、住院时长延长是PF患者弥散功能障碍严重的独立危险因素(P<0.05)。25(OH)D与FVC单独诊断PF弥散功能障碍严重的曲线下面积(AUC)分别为0.723、0.828,均低于2项指标联合检测的0.888(P<0.05)�Objective To investigate the effect of 25-hydroxyvitamin D[25(OH)D]levels on the degree of diffusion dysfunction in patients with pulmonary fibrosis(PF).Methods A total of 81 patients diagnosed with PF admitted to the General Hospital of Ningxia Medical University from January 2020 to June 2023 were selected as the research objects.According to the Chinese Expert Consensus on the Diagnostic Criteria of Lung Function in Adults,patients with carbon monoxide diffusion capacity(DLCO%pred)≥60%were included in the normal+mild diffusion dysfunction group(DN group,64 cases),and patients with DLCO%pred<60%were included in the moderate to severe diffusion dysfunction group(DD group,17 cases).The clinical data of all patients were collected and compared,including length of hospital stay,number of hospitalizations,white blood cell count(WBC),neutrophil percentage(NEUT),lymphocyte percentage(LYM),monocyte percentage(M),red blood cell count(RBC),hemoglobin(Hb)level,platelet count(PLT)level,prothrombin time(PT),activated partial thromboplastin time(APTT),fibrinogen(FIB)level,thrombin time(TT),D-dimer(D-D)level,partial pressure of oxygen(PO_(2)),partial pressure of carbon dioxide(PCO_(2)),forced expiratory volume in one second(FEV_(1)),forced vital capacity(FVC),FEV_(1)/FVC,peak expiratory flow(PEF),25(OH)D,DLCO.Multivariate Logistic regression was used to analyze the risk factors affecting the degree of PF diffusion dysfunction.The receiver operating characteristic(ROC)curve was drawn to analyze the diagnostic value of 25(OH)D,FVC alone and the combination of the two indexes for the severity of PF diffusion dysfunction.The patients were divided into vitamin D deficiency group and vitamin D non-deficiency group according to the optimal cut-off value of ROC curve between 25(OH)D index and the severity of diffusion dysfunction in PF patients,and Kaplan-Meier survival curve analysis was performed.Results NEUT,length of hospital stay,WBC,D-D level in DN group were lower than those in DD group,PT was shorter than that in DD group,F

关 键 词：肺间质纤维化 25-羟维生素D 肺功能 病例对照研究 影响因素 

分 类 号：R563.9[医药卫生—呼吸系统]