Department of Neurology and Dijon Stroke Registry, EA4184, University Hospital and Medical School of Dijon, University of Burgundy, Dijon, France.
Eur J Neurol. 2013 Jan;20(1):57-61. doi: 10.1111/j.1468-1331.2012.03758.x. Epub 2012 May 26.
We aimed to evaluate the association between 25-hydroxyvitamin D (25(OH)D) levels and both clinical severity at admission and outcome at discharge in stroke patients.
From February 2010 to December 2010, consecutive stroke patients admitted to the Department of Neurology of Dijon, France, were identified. Clinical information was collected. Serum concentration of 25(OH)D was measured at baseline. Stroke severity was assessed at admission using the NIHSS score. Functional impairment was evaluated at discharge using the modified Rankin scale (m-Rankin). Multivariate analyses were performed using logistic regression models.
Of the 386 recorded patients, serum 25(OH)D levels were obtained in 382 (median value = 35.1 nM; IQR = 21-57.8). At admission, 208 patients had a NIHSS ≤5, with a higher mean 25(OH)D level than that observed in patients with moderate-to-high severity (45.9 vs. 38.6 nM, P < 0.001). In multivariate analyses, a 25(OH)D level in the lowest tertile (<25.7 nM) was a predictor of a NIHSS ≥6 (OR = 1.67; 95% CI = 1.05-2.68; P = 0.03). The mean 25(OH)D level was lower in patients with moderate-to-severe handicap at discharge (m-Rankin 3-6) than in patients with no or mild handicap (35.0 vs. 47.5 nM, P < 0.001). In multivariate analyses, the lowest tertile of 25(OH)D level (<25.7 nM) was associated with a higher risk of moderate-to-severe handicap (OR = 2.06; 95% CI = 1.06-3.94; P = 0.03).
A low serum 25(OH)D level is a predictor of both severity at admission and poor early functional outcome in stroke patients. The underlying mechanisms of these associations remain to be investigated.
我们旨在评估 25-羟维生素 D（25（OH）D）水平与卒中患者入院时的临床严重程度和出院时的结局之间的关系。
2010 年 2 月至 2010 年 12 月，连续入组法国第戎神经内科的卒中患者。收集临床信息，在基线时测量血清 25（OH）D 浓度。入院时采用 NIHSS 评分评估卒中严重程度，采用改良 Rankin 量表（m-Rankin）评估出院时的功能障碍。采用 logistic 回归模型进行多变量分析。
在记录的 386 例患者中，有 382 例（中位数 35.1nM；IQR 21-57.8）获得了血清 25（OH）D 水平。入院时，208 例患者 NIHSS≤5，其平均 25（OH）D 水平高于中重度患者（45.9 比 38.6 nM，P＜0.001）。多变量分析显示，25（OH）D 水平处于最低三分位数（＜25.7 nM）是 NIHSS≥6 的预测因素（OR 1.67；95%CI 1.05-2.68；P=0.03）。出院时中重度残疾患者（m-Rankin 3-6）的平均 25（OH）D 水平低于无或轻度残疾患者（35.0 比 47.5 nM，P＜0.001）。多变量分析显示，25（OH）D 水平最低三分位数（＜25.7 nM）与中重度残疾风险增加相关（OR 2.06；95%CI 1.06-3.94；P=0.03）。
血清 25（OH）D 水平较低是卒中患者入院时严重程度和早期功能结局不良的预测因素。这些关联的潜在机制仍有待研究。
