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血清 25-羟维生素 D 缺乏症可预测无高血糖的缺血性脑卒中患者的长期预后不良。

Serum 25-hydroxyvitamin D deficiency predicts long-term poor prognosis among ischemic stroke patients without hyperglycaemia.

机构信息

Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, Jiangsu, China; Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, United States; Department of Neurology, Affiliated Hospital of Nantong University, Nantong, Jiangsu, China.

Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, Jiangsu, China; Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, United States.

出版信息

Clin Chim Acta. 2017 Aug;471:81-85. doi: 10.1016/j.cca.2017.05.020. Epub 2017 May 16.

Abstract

BACKGROUND

It is unclear whether 25-hydroxyvitamin D [25(OH)D] has a protective effect on long-term prognosis of ischemic stroke and whether it is affected by blood glucose levels. We aim to examine the effect of serum vitamin D especially its deficiency on 1-year poor outcome of ischemic stroke patients in total patients and by blood glucose subgroups.

METHODS

A total of 3041 ischemic patients from China Antihypertensive Trial in Acute Ischemic Stroke were included. The serum concentrations of 25(OH)D were measured at baseline. All subjects were followed up for death and vascular events at 1year after acute ischemic stroke.

RESULTS

Among total ischemic stroke patients and those with hyperglycemia, 25(OH)D deficiency was not associated with the risk of vascular events and death. In the normoglycemic subgroup, 25(OH)D deficiency subjects had a significantly higher risk of poor prognosis compared with those with 25(OH)D≥20ng/ml. The hazard ratio (95% confidence interval) was 1.58(1.04-2.41) in the multivariable adjusted model (P for linear trend=0.02).

CONCLUSION

Serum 25(OH)D deficiency may be merely an independent risk factor of 1-year poor prognosis in ischemic stroke patients without hyperglycemia. Future studies about improving long-term prognosis of ischemic stroke by vitamin D supplementation could be first applied to these patients.

摘要

背景

目前尚不清楚 25-羟维生素 D [25(OH)D] 是否对缺血性脑卒中的长期预后具有保护作用,以及其是否受血糖水平的影响。我们旨在研究血清维生素 D 水平(尤其是其缺乏)对所有缺血性脑卒中患者及血糖亚组患者 1 年预后不良的影响。

方法

共纳入中国急性缺血性脑卒中降压试验(CATIS)中的 3041 例缺血性脑卒中患者。于基线时测量血清 25(OH)D 浓度。所有患者均随访 1 年,观察其死亡及血管事件发生情况。

结果

在所有缺血性脑卒中患者及高血糖患者中,25(OH)D 缺乏与血管事件和死亡风险无关。在血糖正常亚组中,与 25(OH)D≥20ng/ml 的患者相比,25(OH)D 缺乏的患者预后不良风险显著更高。多变量调整模型的危险比(95%置信区间)为 1.58(1.04-2.41)(P 趋势=0.02)。

结论

血清 25(OH)D 缺乏可能仅是无高血糖的缺血性脑卒中患者 1 年预后不良的独立危险因素。未来关于通过补充维生素 D 改善缺血性脑卒中长期预后的研究,可以首先应用于这些患者。

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