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OACSTPCD
Effect of 25-hydroxyvitamin D levels on the degree of diffusion dysfunction in patients with pulmonary fibrosis
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(PO2)、二氧化碳分压(PCO2)、第1秒用力呼气容积(FEV1)、用力肺活量(FVC)、FEV1/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,FEV1、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、PO2、PCO2、住院次数、FEV1/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).根据25(OH)D与PF患者弥散功能障碍程度的ROC曲线中最佳截断值进行分组,将血清25(OH)D<12.20 nmol/L的PF患者纳入维生素D缺乏组(24例),血清25(OH)D≥12.20 nmol/L的PF患者纳入维生素D非缺乏组(57例).Kaplan-Meier生存曲线分析结果显示,维生素D缺乏组住院时长为10.77 d,维生素D非缺乏组住院时长为9.03 d,两组住院时长比较,差异有统计学意义(P<0.05).结论 25(OH)D可以判断PF患者弥散功能障碍程度,可以成为一种新型治疗PF的药物并为临床医生治疗PF提供更多的药物选择.
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 percent-age(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(PO2),partial pressure of carbon dioxide(PCO2),forced expiratory volume in one second(FEV1),forced vital capacity(FVC),FEV1/FVC,peak expiratory flow(PEF),25(OH)D,DLCO.Multivariate Logistic regression was used to analyze the risk factors affecting the degree of PF dif-fusion 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 dys-function.The patients were divided into vitamin D deficiency group and vitamin D non-deficiency group ac-cording to the optimal cut-off value of ROC curve between 25(OH)D index and the severity of diffusion dys-function 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,FEV1,FVC,PEF,M,25(OH)D level in DN group were higher than those in DD group,the differ-ences were statistically significant(P<0.05).There was no significant difference in LYM,RBC,PLT,APTT,TT,PO2,PCO2,number of hospitalizations,FEV1/FVC,Hb level,and FIB between the two groups(P>0.05).Multivariate Logistic regression analysis showed that decreased FVC,decreased 25(OH)D level,and prolonged length of hospital stay were independent risk factors for severe diffusion dysfunction in PF pa-tients(P<0.05).The area under the curve(AUC)of 25(OH)D and FVC alone in the diagnosis of severe PF diffusion dysfunction were 0.723 and 0.828 respectively,which were lower than the 0.888 of the combined detection of the two indicators(P<0.05).According to the optimal cut-off value in ROC curve between ser-um 25(OH)D level and the degree of diffusion dysfunction in PF patients,PF patients with serum 25(OH)D<12.20 nmol/L were included in the vitamin D deficiency group(24 cases).PF patients with serum 25(OH)D≥12.20 nmol/L were included in the vitamin D non-deficiency group(57 cases).Kaplan-Meier sur-vival curve analysis showed that the length of hospital stay was 10.77 days in the vitamin D deficiency group and 9.03 days in the non-vitamin d deficiency group,with a statistically significant difference between the two groups(P<0.05).Conclusion 25(OH)D can be used to determine the degree of diffusion dysfunction in PF patients,and it can be used as a new drug for the treatment of PF and provide clinicians with more drug op-tions.
丁劭瑞;曹佳伟;铁华;马婷婷;吴赓;景丽娟;李锋
宁夏医科大学总医院:第一临床医学院,宁夏银川 750004宁夏医科大学总医院:医学实验中心,宁夏银川 750004
临床医学
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
pulmonary interstitial fibrosis25-hydroxyvitamin Dpulmonary functioncase-control studyinfluencing factor
《检验医学与临床》 2024 (008)
1063-1068 / 6
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