血清总25-(OH)D对急性心肌梗死患者近期预后的影响

目的探讨血清总25羟基维生素D[25-(OH) D]对急性心肌梗死患者近期预后的影响。方法选取急性心肌梗死且行急诊经皮冠状动脉介入治疗(PCI)的患者共1 324例,收集其临床资料并检测血清总25-(OH) D水平,随访1年记录主要不良事件。根据是否发生主要不良事件分为事件组及对照组,回顾性分析两组患者临床特点。根据血清总25-(OH) D水平将患者分为维生素D缺乏组、不足组及正常组,分析三组患者的临床特点及预后差异。结果发生不良事件组217人,对照组1 107人。事件组25-(OH) D水平低于对照组(P=0. 007)。维生素D缺乏组与不足组患者非致死性心肌梗死、非计划血运重建发生率及高血压、糖尿病患病率均高于维生素D正常组。单因素COX分析结果提示维生素D缺乏及不足与PCI术后1年内发生不良事件相关(维生素D缺乏OR=2. 621,95%CI 1. 048～6. 553,P=0. 039;维生素D不足OR=2. 750,95%CI 1. 076～7. 031,P=0. 035)。ROC曲线分析25-(OH) D预测1年内未发生不良反应的灵敏度和特异性分别为56. 5%、59. 0%。结论低水平血清25-(OH)D是急性心肌梗死患者PCI术后发生主要不良事件的危险因素。

Effect of serum total 25-hydroxyvitamin D on short-term prognosis of acute myocardial infarction

Aim To investigate the effect of serum total 25-hydroxyvitamin D on short-term prognosis of acute myocardial infarction. Methods 1324 patients with acute myocardial infarction who underwent emergency percutaneous coronary intervention (PCI) were selected. The clinical data were collected, the total 25-hydroxyvitamin D were tested. Major adverse events were recorded during 1 year follow-up. According to the occurrence of major adverse events, the patients were divided into event group and control group. The clinical characteristics of the two groups were analyzed retrospectively. The patients were divided into three groups according to the serum total 25-hydroxyvitamin D level:vitamin D deficiency, insufficient and normal group. The clinical characteristics and prognosis of the three groups were analyzed. Results There were 217 patients in the adverse event group and 1107 in the control group. The total 25-hydroxyvitamin D level in the event group was lower than that in the control group(P=0.007). The incidence of non-fatal myocardial infarction, unplanned revascularization and the proportion of hypertension and diabetes in vitamin D deficiency group and insufficient group were higher than that in vitamin D normal group. Univariate COX analysis showed that vitamin D deficiency and insufficient were associated with adverse events within 1 year after PCI (vitamin D deficiency OR=2.1,5%CI 1.048-6.553, P=0.039; vitamin D insufficient OR=2.0,5%CI 1.076-7.031, P=0.035). The sensitivity and specificity of ROC curve analysis of 25-hydroxyvitamin D for predicting non-adverse reactions within one year were 56.5% and 59.0% respectively. Conclusion Low level of serum total 25-hydroxyvitamin D was a risk factor for major adverse events after PCI in patients with acute myocardial infarction.