脊柱外科手术患者术前维生素D含量的临床分析
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国家自然科学基金资助(81271988)


A clinical analysis of vitamin D status in patients before spinal surgery
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    目的:研究脊柱外科手术患者术前维生素D的浓度,分析缺乏维生素D的相关危险因素。方法:回顾性分析503例手术患者,术前均常规测定血清25羟基维生素D[25(OH)D]的浓度,以25(OH)D≥32 ng/mL评定为患者血清维生素D的含量正常,25(OH)D≥20 ng/mL且﹤32 ng/mL为维生素D含量不足,﹤20 ng/mL为维生素D含量缺乏。结果:503例脊柱外科手术患者中,维生素D缺乏及不足的比率分别为71.4%和23.9%,女性患者维生素D缺乏的比例较男性患者高(P < 0.001);BMI增大(P=0.009)和吸烟(P﹤0.001)患者维生素D缺乏的比例更高;月份分析中,维生素D缺乏比例最低为9月份(44.8%),最高为1月份(90.6%);季度分析中,患者维生素D含量冬季最低,秋季最高(P=0.001);年龄-骨密度与维生素D的含量无显著相关性。多因素分析结果表明,女性(P < 0.001)-吸烟(P=0.005)-冬季(P=0.001)是维生素D缺乏的潜在危险因素。结论:脊柱外科手术患者术前存在严重的维生素D不足和缺乏,可能影响患者的手术预后,需要加强对脊柱外科患者术前维生素D含量的筛查和治疗。

    Abstract:

    Objective:To study preoperative concentrations of vitamin D in patients undergoing spinal surgery and analyze relevant risk factors associated with vitamin D deficiency. Methods:A retrospective analysis was conducted on 503 patients undergoing spinal surgery. Preoperative concentrations of serum 25-hydroxyvitamin D[25(OH)D]were measured. Normal vitamin D was defined as a serum 25(OH)D level ≥ 32 ng/mL,vitamin D insufficiency as 25(OH)D ≥ 20 and <32 ng/mL,and vitamin D deficiency as 25(OH)D < 20 ng/mL. Results:The rate of vitamin D deficiency and insufficiency was 71.4% and 23.9%,respectively. Rate of vitamin D deficiency in female patients was significantly higher than that in male patients (P < 0.001). Rate of vitamin D deficiency in patients with high body mass index (P = 0.009)or patients with smoking habit (P < 0.001)was much higher compared with that in the other patients. An analysis of monthly vitamin D levels revealed that rate of vitamin D deficiency was the lowest in September(44.8%),and the highest in January(90.6%). The analysis of quarterly vitamin D levels showed that rate of vitamin D deficiency was the lowest in winter and the highest in fall (P = 0.001). No correlation between vitamin D status with age or bone mineral density was identified. Multivariate analysis demonstrated that female(P < 0.001),smoking(P = 0.005),and winter(P = 0.001)were potential risk factors for vitamin D deficiency. Conclusion:Severe preoperative vitamin D insufficiency and deficiency existed in spinal surgery patients,and vitamin D insufficiency or deficiency may largely affect surgical outcomes of patients. Therefore,screening of preoperative vitamin D status and relevant treatment should be reinforced in spine surgery patients.

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翁峰标,张建伟,凡进,李青青,余利鹏,殷国勇.脊柱外科手术患者术前维生素D含量的临床分析[J].南京医科大学学报(自然科学版),2015,(12):1727-1730

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  • 收稿日期:2015-05-17
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  • 在线发布日期: 2016-01-04
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