Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
J Korean Med Sci. 2019 Jul 29;34(29):e195. doi: 10.3346/jkms.2019.34.e195.
Although vitamin D deficiency is prevalent in patients with chronic obstructive pulmonary disease (COPD), the influence of vitamin D deficiency on COPD has not been fully established. Moreover, the inflammation process is associated with vitamin D deficiency in the general population. Therefore, this study aimed to determine whether clinical phenotypes, comorbidities, and exacerbation rates are affected by the level of plasma fibrinogen, well studied by an inflammatory marker in COPD patients, and 25-hydroxy (25-OH) vitamin D.
This retrospective study analyzed patients with COPD whose inflammatory marker levels, especially plasma fibrinogen and 25-OH vitamin D levels, had been examined. A correlation analysis was conducted for inflammatory markers and 25-OH vitamin D. Clinical characteristics, comorbidities and exacerbation rates were compared among four groups based on plasma fibrinogen concentrations (threshold, 350 mg/dL) and 25-OH vitamin D levels (threshold, 20 ng/mL).
Among 611 patients with COPD, 236 were included in the study. The levels of inflammatory markers had no statistical correlation with the serum 25-OH vitamin D levels. The four groups showed no statistically significant differences in age, sex, smoking history, inhaler use, and severity of comorbidities. Patients with high plasma fibrinogen concentrations and low 25-OH vitamin D levels had lower lung function, higher severity index, and higher annual rate of severe exacerbations 12 months before (0.23/year) and after (0.41/year) the measurement of 25-OH vitamin D levels than did the other patients.
Our findings suggested an interaction between vitamin D deficiency and COPD. The measurement of plasma fibrinogen concentrations could help identify a severe phenotypic group among patients with vitamin D deficiency.
虽然维生素 D 缺乏在慢性阻塞性肺疾病（COPD）患者中很常见，但维生素 D 缺乏对 COPD 的影响尚未完全确定。此外，炎症过程与一般人群中的维生素 D 缺乏有关。因此，本研究旨在确定血浆纤维蛋白原水平是否会影响 COPD 患者的临床表型、合并症和加重率，而血浆纤维蛋白原是 COPD 患者中一种研究得很好的炎症标志物。
本回顾性研究分析了炎症标志物水平（特别是血浆纤维蛋白原和 25-羟维生素 D 水平）检查过的 COPD 患者。对炎症标志物和 25-羟维生素 D 进行了相关性分析。根据血浆纤维蛋白原浓度（阈值为 350mg/dL）和 25-羟维生素 D 水平（阈值为 20ng/mL），将患者分为四组，比较各组间的临床特征、合并症和加重率。
在 611 例 COPD 患者中，236 例纳入研究。炎症标志物水平与血清 25-羟维生素 D 水平无统计学相关性。四组患者在年龄、性别、吸烟史、吸入器使用和合并症严重程度方面无统计学差异。高血浆纤维蛋白原浓度和低 25-羟维生素 D 水平的患者，肺功能较低，严重指数较高，且在测量 25-羟维生素 D 水平前 12 个月（0.23/年）和后 12 个月（0.41/年）严重加重的年发生率较高。
我们的研究结果表明，维生素 D 缺乏与 COPD 之间存在相互作用。测量血浆纤维蛋白原浓度有助于识别维生素 D 缺乏患者中的严重表型组。
