血清维生素D水平对维持性血液透析患者下肢肌力减退的预测作用

目的探讨维持性血液透析(MHD)患者血清维生素D水平对下肢肌力减退的预测作用。 方法横断面研究设计,选择2018年9月至10月于战略支援部队特色医学中心血液净化中心的95例MHD患者,检测其血清25-羟维生素D₃[25(OH)D₃]水平,采用5次站立-坐下实验(5-STS)评价其下肢肌力。根据5-STS完成时间将MHD患者分为下肢肌力正常组(n＝85)与减退组(n＝10),比较两组患者人口学特征、实验室指标。采用多因素Logistic回归分析下肢肌力减退的影响因素,绘制受试者工作特征(ROC)曲线分析上述因素预测MHD患者发生下肢肌力减退的特异度和敏感度。 结果95例MHD患者血清25(OH)D₃水平为11.00~99.50 nmol/L,中位数31.23(19.90~43.30)nmol/L;5-STS完成时间为3.55 s~18.71 s,中位数9.81(7.12,12.43)s,下肢肌力减退者10例(10.53%)。多因素Logistic回归分析显示,血清25(OH)D₃是MHD患者下肢肌力减退的保护性因素[OR＝0.761,95%CI(0.592~0.978),P＝0.033]。进一步ROC曲线分析显示,25(OH)D₃对应的ROC曲线下面积为0.815,其预测MHD患者发生下肢肌力减退的敏感度为80.00%,特异度为80.00%。 结论MHD患者血清25(OH)D₃水平普遍较低,下肢肌力减退者更为明显;血清维生素D水平对MHD患者是否存在下肢肌力减退具有较好的预测价值。

The prediction of serum vitamin D level on lower limb strength reduction in maintenance hemodialysis patients

ObjectiveTo explore the predictive efficacy of serum vitamin D level on lower limb strength loss in patients undergoing maintenance hemodialysis (MHD). MethodsThis is a cross-sectional study with convenient sampling. In 95 MHD patients who were selected from Blood Purification Center, Strategic Support Force Medicial Center from September 2018 to October 2018, serum 25(OH)D₃ level and a 5-repetition sit-to-stand test (5-STS) were used to represent serum vitamin D level and lower limb strength. MHD patients were divided into two groups based on the completion time of the 5-STS: normal muscle strength (n=85) and decreased muscle strength (n=10), and the demographic characteristics and laboratory indicators of the two groups were compared. The influencing factors of lower extremity muscle weakness were studied using multivariate logistic regression, and a receiver operating characteristic (ROC) curve was drawn to assess the specificity and sensitivity of the above factors in predicting lower extremity muscle weakness in MHD patients. ResultsSerum 25(OH)D₃ levels ranged from 11.00 nmol/L to 99.50 nmol/L, with 31.23(19.90-43.30)nmol/L as the median, and the time to complete 5-STS ranged from 3.55 sec to 18.71 sec, with 9.81(7.12, 12.43) sec as the median. Lower limb strength decreased in 10 cases (10.53%). Multivariate logistic regression revealed that serum 25(OH)D₃ was a protective factor for lower limb weakness in MHD patients[OR=0.761, 95%CI(0.592-0.978), P=0.033]. ROC analysis revealed that the AUC of 25(OH)D₃ was 0.815, with sensitivity and specificity of 80.00% and 80.00%, respectively. ConclusionThe level of serum 25(OH)D₃ is low in MHD patients especially in those with reduction of strength in lower limbs. The 25(OH)D₃ can predict the reduction of strength in lower limb of MHD patients with a satisfying sensitivity and specificity.