美国成年女性血清25-羟维生素D水平与全因死亡风险的相关性  

Correlation between serum 25-hydroxyvitamin D levels and all-cause mortality risk among adult women in the United States

作　　者：刘婧 李金平[2] 田田 马芳 Liu Jing;Li Jinping;Tian Tian;Ma Fang(Department of Daytime Ward,General Hospital of Ningxia Medical University,Yinchuan 750004,China;Department of Surgical Oncology,General Hospital of Ningxia Medical University,Yinchuan 750004,China;Department of Laboratory Medicine,Yinchuan Women and Children Health Care Hospital,Yinchuan 750001,China;Department of Nephrology and Hematology,the First People′s Hospital in Shizuishan,Shizuishan 753200,China)

机构地区：[1]宁夏医科大学总医院日间病房,银川750004 [2]宁夏医科大学总医院肿瘤外一科,银川750004 [3]银川市妇幼保健院检验科,银川750001 [4]石嘴山市第一人民医院肾脏血液科,石嘴山753200

出　　处：《中华健康管理学杂志》2024年第6期421-427,共7页Chinese Journal of Health Management

摘　　要：目的分析美国成年女性血清25-羟维生素D[25(OH)D]水平与全因死亡风险的相关性。方法本研究为回顾性队列研究,资料来源于美国国家健康与营养调查数据库2011—2016年数据,共纳入6452例资料完整的美国成年女性为研究对象,以发生全因死亡为终点事件。根据血清25(OH)D<25.0 nmol/L、25.0~49.9 nmol/L、50.0~74.9 nmol/L和≥75.0 nmol/L分为严重缺乏组(285例)、缺乏组(1695例)、不足组(2119例)和充足组(2353例)。将血清25(OH)D水平作为连续变量和分类变量分别纳入Cox比例风险模型,估计全因死亡风险。采用限制性立方样条拟合Cox回归模型观察血清25(OH)D连续变化与全因死亡风险的曲线关系,采用二分段线性回归模型分析饱和阈值效应,分析美国成年女性血清25(OH)D水平与全因死亡风险的相关性。结果6452例女性血清25(OH)D水平为(68.2±31.6)nmol/L,仅36.5%(2353/6452)的女性血清25(OH)D水平充足。随访时间(5.8±1.8)年,共有375例发生死亡,累积全因死亡率为5.8%。经多因素校正后,血清25(OH)D水平每增加10 nmol/L,全因死亡风险降低5%(HR=0.95,95%CI:0.91~0.98)(P<0.05)。血清25(OH)D充足组全因死亡风险较严重缺乏组低54%(HR=0.46,95%CI:0.29~0.75)(P<0.05,P趋势<0.001)。血清25(OH)D与全因死亡风险之间存在“L”形非线性关联(P=0.007),且存在拐点,当25(OH)D<128.5 nmol/L时,25(OH)D每增加10 nmol/L,全因死亡风险降低8%(HR=0.92,95%CI:0.88~0.96)(P<0.001)。结论美国成年女性高血清25(OH)D水平与低全因死亡风险呈非线性相关,维持足够的维生素D水平可能降低女性死亡风险。Objective To examine the correlation between serum 25-hydroxyvitaminD[25(OH)D]levels and all-cause mortality risk among adult women in the United States.Methods Data for this retrospective cohort study were obtained from the National Health and Nutrition Examination Survey 2011—2016.A total of 6452 women with complete data were enrolled and the end point event was all-cause mortality.The subjects were categorized into four groups based on serum 25(OH)D levels:severe deficiency group[25(OH)D<25.0 nmol/L,n=285],deficiency group[25(OH)D 25.0-49.9 nmol/L,n=1695],insufficient group[25(OH)D 50.0-74.9 nmol/L,n=2119],and sufficient group[25(OH)D≥75.0 nmol/L,n=2353].The serum 25(OH)D level was included in cox proportional hazards model as a continuous variables and a categorical variables,respectively,to estimate the risk of all-cause mortality.Cox regression model based on restricted cubic splines was used to observe the curve relationship between the continuous change of serum 25(OH)D and the risk of all-cause mortality.A two-piecewise linear regression model was used to analyze the saturation threshold effect and examine the correlation between serum 25(OH)D levels and all-cause mortality risk among adult women in the United States.Results A total of 6452 women were enrolled.The mean level of serum 25(OH)D was(68.2±31.6)nmol/L,and only 36.5%(2353/6452)of the women had sufficient vitamin D.During the follow-up time of(5.8±1.8)years,375 women died,and the all-cause mortality rate of 5.8%.After multivariate adjustment,for every 10 nmol/L increase in serum 25(OH)D level,the risk of all-cause mortality was reduced by 5%(HR=0.95,95%CI:0.91-0.98)(P<0.05).Compared with serum 25(OH)D severe deficiency group,the risk of all-cause mortality in 25(OH)D sufficient group was 54%lower(HR=0.46,95%CI:0.29-0.75)(P<0.05,Ptrend<0.001).The association between serum 25(OH)D levels and all-cause mortality risk exhibited an L-shaped curve(P=0.007)and the inflection point was 128.5 nmol/L;when the serum level of 25(OH)D was less than 128

关 键 词：女(雌)性 成年人 25-羟维生素D 死亡率 相关性 

分 类 号：R151.43[医药卫生—营养与食品卫生学]