血清 25-羟维生素 D 水平与全因和死因特异性死亡率的关系：一项基于人群的队列研究。
Serum 25-Hydroxyvitamin D Values and Risk of All-Cause and Cause-Specific Mortality: A Population-Based Cohort Study.
机构信息
Division of General Internal Medicine, Mayo Clinic, Rochester, MN.
Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN.
出版信息
Mayo Clin Proc. 2018 Jun;93(6):721-730. doi: 10.1016/j.mayocp.2018.03.006. Epub 2018 May 2.
OBJECTIVE
To determine the relationship between 25-hydroxyvitamin D (25[OH]D) values and all-cause and cause-specific mortality.
PATIENTS AND METHODS
We identified all serum 25(OH)D measurements in adults residing in Olmsted County, Minnesota, between January 1, 2005, and December 31, 2011, through the Rochester Epidemiology Project. All-cause mortality was the primary outcome. Patients were followed up until their last clinical visit as an Olmsted County resident, December 31, 2014, or death. Multivariate analyses were adjusted for age, sex, race/ethnicity, month of measurement, and Charlson comorbidity index score.
RESULTS
A total of 11,022 individuals had a 25(OH)D measurement between January 1, 2005, and December 31, 2011, with a mean ± SD value of 30.0±12.9 ng/mL. Mean age was 54.3±17.2 years, and most were female (77.1%) and white (87.6%). There were 723 deaths after a median follow-up of 4.8 years (interquartile range, 3.4-6.2 years). Unadjusted all-cause mortality hazard ratios (HRs) and 95% CIs for 25(OH)D values of less than 12, 12 to 19, and more than 50 ng/mL were 2.6 (95% CI, 2.0-3.2), 1.3 (95% CI, 1.0-1.6), and 1.0 (95% CI, 0.72-1.5), respectively, compared with the reference value of 20 to 50 ng/mL. In a multivariate model, the interaction between the effect of 25(OH)D and race/ethnicity on mortality was significant (P<.001). In white patients, adjusted HRs for 25(OH)D values of less than 12, 12 to 19, 20 to 50, and greater than 50 ng/mL were 2.5 (95% CI, 2.2-2.9), 1.4 (95% CI, 1.2-1.6), 1.0 (referent), and 1.0 (95% CI, 0.81-1.3), respectively. In patients of other race/ethnicity, adjusted HRs were 1.9 (95% CI, 1.5-2.3), 1.7 (95% CI, 1.1-2.6), 1.5 (95% CI, 1.0-2.0), and 2.1 (95% CI, 0.77-5.5).
CONCLUSION
White patients with 25(OH)D values of less than 20 ng/mL had greater all-cause mortality than those with values of 20 to 50 ng/mL, and white patients had greater mortality associated with low 25(OH)D values than patients of other race/ethnicity. Values of 25(OH)D greater than 50 ng/mL were not associated with all-cause mortality.
目的
确定 25-羟维生素 D（25[OH]D）值与全因和死因特异性死亡率之间的关系。
患者和方法
我们通过罗切斯特流行病学项目，确定了 2005 年 1 月 1 日至 2011 年 12 月 31 日期间明尼苏达州奥姆斯特德县成年人的所有血清 25（OH）D 测量值。全因死亡率是主要结局。患者随访至最后一次临床就诊，作为奥姆斯特德县居民，2014 年 12 月 31 日或死亡。多变量分析调整了年龄、性别、种族/民族、测量月份和 Charlson 合并症指数评分。
结果
共有 11022 人在 2005 年 1 月 1 日至 2011 年 12 月 31 日之间进行了 25（OH）D 测量，平均±SD 值为 30.0±12.9ng/mL。平均年龄为 54.3±17.2 岁，大多数为女性（77.1%）和白人（87.6%）。中位数随访 4.8 年后（四分位间距，3.4-6.2 年）有 723 人死亡。未经调整的全因死亡率危险比（HR）和 95%CI 为 25（OH）D 值<12、12-19 和>50ng/mL 分别为 2.6（95%CI，2.0-3.2）、1.3（95%CI，1.0-1.6）和 1.0（95%CI，0.72-1.5），与 20-50ng/mL 的参考值相比。在多变量模型中，25（OH）D 与种族/民族对死亡率的影响之间的交互作用具有统计学意义（P<.001）。在白人患者中，25（OH）D 值<12、12-19、20-50 和>50ng/mL 的调整后 HR 分别为 2.5（95%CI，2.2-2.9）、1.4（95%CI，1.2-1.6）、1.0（参考值）和 1.0（95%CI，0.81-1.3）。在其他种族/民族的患者中，调整后的 HR 分别为 1.9（95%CI，1.5-2.3）、1.7（95%CI，1.1-2.6）、1.5（95%CI，1.0-2.0）和 2.1（95%CI，0.77-5.5）。
结论
25（OH）D 值<20ng/mL 的白人患者全因死亡率高于 20-50ng/mL 值的患者，白人患者与低 25（OH）D 值相关的死亡率高于其他种族/民族的患者。25（OH）D 值>50ng/mL 与全因死亡率无关。
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