慢性阻塞性肺疾病患者血游离态25-羟基维生素D测定的临床意义

目的 探讨游离态25-羟基维生素D25(OH)D]测定在慢性阻塞性肺疾病(COPD)患者中的临床意义.方法 对2014年11月至2015年9月在我院就诊的70例吸烟COPD患者和67例吸烟非COPD受试者分别进行COPD评估测试(CAT)问卷、肺功能测定和6 min步行试验(6MWT),检测血清总25(OH)D、维生素D结合蛋白(VDBP)及白蛋白,得出游离态25(OH)D水平.结果 吸烟COPD组患者的一秒钟用力呼气量(FEV1)、FEV1/用力肺活量(FVC)、CAT评分、6MWT分别为(1.80±0.49)L、(51±12.3)%、(18.3±4.4)分、(245.3±38.4)m,而吸烟非COPD组分别为(2.75±0.32)L、(90±5.8)%、(1.2±0.3)分、(389.6±80.3)m,差异均有统计学意义(P<0.05);吸烟COPD组患者的总25(OH)D、VDBP及游离态25(OH)D水平分别为(51.3±8.9)nmol/L、(5.29±0.68)μmol/L、(12.4±2.2)pmol/L,与吸烟非COPD组(54.7±10.8)nmol/L、(5.07±0.41)μmol/L、(14.0±2.3)pmol/L]比较,差异均有统计学意义(P<0.05);吸烟COPD组患者总25(OH)D与FEV1、FEV1/FVC、6MWT呈正相关(r=0.327,P=0.006;r=0.391,P=0.001;r=0.385,P=0.001),游离态25(OH)D水平与FEV1、FEV1/FVC、6MWT呈正相关(r=0.572,P=0.000;r=0.595,P=0.000;r=0.404,P=0.001),总25(OH)D、游离态25(OH)D水平与CAT评分呈负相关(r=-0.418,P=0.000;r=-0.432,P=0.000).游离态25(OH)D与FEV1、FEV1/FVC、CAT评分和6MWT的相关系数均高于总25(OH)D.结论 游离态25(OH)D在评估COPD患者病情过程中可能较总25(OH)D更有价值.

Clinical significance of the determination of serum free 25-hydroxyvitamin D in patients with chronic obstructive pulmonary disease

Objective To explore the clinical significance of free 25-hydroxyvitamin D 25(OH)D] in patients with chronic obstructive pulmonary disease (COPD). Methods From November 2014 to September 2015, 70 smoking COPD patients in our hospital (smoking COPD group) and 67 smoking non-COPD subjects (smoking non-COPD group) were recruited in the study. COPD assessment test (CAT), lung function and 6 minute walk test (6MWT) were performed in the two groups. The levels of serum total 25(OH)D, vitamin D binding protein (VDBP) and albumin were measured, and the free 25(OH)D levels were calculated. Results Forced expiratory volume in one second (FEV1), forced expira-tory volume in one second/forced vital capacity (FEV1/FVC), CAT score and 6MWT were (1.80±0.49) L, (51±12.3)%, (18.3±4.4) and (245.3±38.4) m in the smoking COPD group, as compared with (2.75±0.32) L, (90±5.8)%, (1.2±0.3) and (389.6 ± 80.3) m in the smoking non-COPD group (P<0.05). The levels of 25(OH)D, VDBP and free 25(OH)D were (51.3 ± 8.9) nmol/L, (5.29 ± 0.68)μmol/L and (12.4 ± 2.2) pmol/L in the smoking COPD group, as compared with (54.7 ± 10.8) nmol/L, (5.07±0.41)μmol/L and (14.0±2.3) pmol/L in the smoking non-COPD group (P<0.05). In smoking COPD group, total 25(OH)D was positively related with FEV1, FEV1/FVC, 6MWT (r=0.327, P=0.006;r=0.391, P=0.001;r=0.385, P=0.001), and free 25(OH)D was positively related with FEV1, FEV1/FVC, 6MWT (r=0.572, P=0.000;r=0.595, P=0.000; r=0.404, P=0.001), while total 25(OH)D and free 25(OH)D was negatively correlated with CAT scores (r=-0.418, P=0.000; r=-0.432, P=0.000). The correlation coefficients of free 25(OH)D with FEV1, FEV1/FVC, CAT and 6MWT were higher than those of total 25(OH)D. Conclusion The free 25(OH)D may be more valuable in the as-sessment of COPD patients in the course of the disease than the total 25(OH)D.