肌萎缩侧索硬化患者血清25-羟基维生素D 3水平与预后分析  

Analysis of serum 25-hydroxyvitamin D 3 levels and prognosis in patients with amyotrophic lateral sclerosis

作　　者：王红芬[1] 王浩然 林彦琛 白炯明 李懋[1] 黄旭升[1] Wang Hongfen;Wang Haoran;Lin Yanchen;Bai Jiongming;Li Mao;Huang Xusheng(Department of Neurology,First Medical Center,Chinese PLA General Hospital,Beijing 100853,China;Department of Neurology,Henan Provincial Chest Hospital,Zhengzhou 450003,China;Department of Rehabilitation Medicine,Characteristic Medical Center of People's Armed Police Force,Tianjin 300162,China)

机构地区：[1]解放军总医院第一医学中心神经内科医学部,北京100853 [2]河南省胸科医院神经内科,郑州450003 [3]武警特色医学中心康复医学科,天津300162

出　　处：《中华内科杂志》2025年第4期325-332,共8页Chinese Journal of Internal Medicine

基　　金：天津市卫生健康委员会中医中西医结合科研课题(2023124)。

摘　　要：目的:探索血清25-羟基维生素D 3[25(OH)D 3]作为肌萎缩侧索硬化(ALS)疾病严重程度生物标志物的潜在价值,并分析影响ALS预后的危险因素。方法:纳入2018年10月至2021年10月在解放军总医院第一医学中心神经内科住院符合修订El Escorial诊断标准的217例ALS患者。观察不同25(OH)D 3水平患者间修订的ALS功能评分量表(ALSFRS-R)等临床指标的差异,并探索25(OH)D 3水平与ALSFRS-R评分中每个项目的相关性。进行前瞻性队列研究,筛选影响ALS患者生存时间的独立危险因素。结果:3组不同血清25(OH)D 3水平患者中,男性占比存在差异(χ^(2)=10.51,P<0.05)。血清25(OH)D 3水平与ALSFRS-R评分中下肢功能评分呈显著正相关(r=0.05,P<0.05);血清25(OH)D 3水平不是影响生存时间的危险因素(HR=0.98,95%CI 0.93~1.04,P>0.05),而诊断延迟时间(HR=0.94,95%CI 0.89~0.99,P<0.05)和用力肺活量(HR=0.94,95%CI 0.97~0.99,P<0.05)是独立危险因素。结论:血清中不同水平25(OH)D 3组间的性别构成存在差异。血清高25(OH)D 3水平可能与下肢功能保护有关,但对延长生存时间作用不明确。Objective:To evaluate serum 25-hydroxyvitamin D 3[25(OH)D 3]as a potential biomarker for amyotrophic lateral sclerosis(ALS)severity and to identify risk factors influencing ALS prognosis.Methods:This study included 217 ALS patients hospitalized at the Department of Neurology,First Medical Center,Chinese PLA General Hospital,between October 2018 and October 2021,who met the revised El Escorial diagnostic criteria.A cross-sectional analysis assessed differences in clinical indicators-including the ALS Functional Rating Scale-Revised(ALSFRS-R)and forced vital capacity percentage(FVC%)-across different serum 25(OH)D 3 levels.The correlation between 25(OH)D 3 levels and individual ALSFRS-R components was also examined.Conduct a prospective cohort study to identify independent risk factors affecting the survival time of ALS patients.Results:Among three groups categorized by serum 25(OH)D 3 levels,there were significant differences in the proportion of males(χ^(2)=10.51,P<0.05).Serum 25(OH)D 3 levels correlated positively with lower limb function scores in the ALSFRS-R(r=0.05,P<0.05),but they were not identified as an independent risk factor for survival(HR=0.98,95%CI 0.93-1.04,P>0.05).In contrast,delayed diagnosis(HR=0.94,95%CI 0.89-0.99,P<0.05)and reduced FVC%(HR=0.94,95%CI 0.97-0.99,P<0.05)were independent predictors of shorter survival.Conclusion:Serum 25(OH)D 3 levels differ by gender distribution and may be linked to better lower limb function in ALS patients.However,their role in prolonging survival remains uncertain.

关 键 词：肌萎缩侧索硬化 维生素D 预后 

分 类 号：R746.3[医药卫生—神经病学与精神病学]