维生素D 缺乏与脊柱结核易感性的关系研究

摘要： 目的 研究维生素 D 缺乏对脊柱结核易感性及病理发展的影响。方法 选取 2013 年 6 月—2016 年 5 月于我院行手术治疗的初治脊柱结核患者 163 例 （病例组）， 同期于我院行健康查体人员 170 例为对照组。应用酶联免疫吸附法检测 2 组样本血清 25-羟基维生素 D ［25 （OH） D］ 水平， 分为严重缺乏 （＜25 nmol/L） 和其他情况 （包括缺乏、 不足及充足）。比较 2 组整体和不同季节的 25 （OH） D 水平变化； 病例组根据病理分型分为增生型和干酪样坏死型， 比较 25 （OH） D 的非严重缺乏 （≥25 nmol/L）、 严重缺乏 （＜25 nmol/L） 组中病理分型的分布情况。结果 病例组 25 （OH） D 表达水平 ［23.99 （20.55， 29.54） nmol/L］ 低于对照组 ［42.94 （35.68， 51.04）nmol/L］， 差异有统计学意义 （P＜ 0.01）， 且不同季节病例组 25 （OH） D 表达水平均低于对照组 （P＜0.05）， 而 2 组夏季 25 （OH） D 表达水平均高于春冬季 （P＜0.008 3）； 病例组春冬季 25 （OH） D 严重缺乏者比例较高， 夏季较低， 严重缺乏者在各季节的分布差异有统计学意义 （P＜0.01）， 对照组一年四季 25 （OH） D 缺乏者比例均较高， 但季节的分布差异无统计学意义 （P＞0.05）。病例组干酪样坏死型有 107 例， 增生型有 56 例， 严重缺乏组干酪样坏死型比例 （79.17%， 76/96） 高于非严重缺乏组（46.27%， 31/67）， 差异有统计学意义 （P＜0.01）。结论 排除季节影响， 维生素 D 缺乏与脊柱结核发病风险增加有关， 并与脊柱结核病理分型有关。

The relation between vitamin D deficiency and susceptibility to spinal tuberculosis

Abstract：Objective To explore the relation between vitamin D deficiency and susceptibility to spinal tuberculosis. Methods A total of 163 hospitalized patients with untreated spinal tuberculosis in Tianjin Haihe hospital were enrolled in this study from June 2013 to May 2016. A total of 170 individuals participated in health examination program at the same period were enrolled as the control group. The serum level of 25-hydroxyvitamin D 25(OH)D] was measured by enzyme linked immunosorbent assay. The 25(OH)D grading included serious deficiency group (<25 nmol/L), deficiency group (≥25 nmol/L and <50 nmol/L), insufficiency group (≥50 nmol/L and <75 nmol/L) and sufficiency group (≥75 nmol/L). Histopathological classification was confirmed by intraoperative findings. Results The serum level of 25(OH)D was significantly lower in patient group 23.99(20.55,29.54)nmol/L] than that of control group 42.94(35.68,51.04) nmol/L] (P< 0.01), and which was also significantly lower in four seasons than that of controls (P<0.05). The serum levels of 25(OH)D were significantly higher in summer group than those of winter group in both patient and control groups (P＜0.008 3). The proportion of patients with serious deficiency of 25(OH)D was significantly higher in spring and winter groups in patient group, which was significantly lower in summer group (P＜0.01). There was no significant difference in patients with serious deficiency of 25(OH)D between four seasons (P＜0.01). For control group, there was a higher proportion of cases with deficiency of 25(OH)D in four seasons, and there was no significant difference in the distribution of seasons (P＞0.05). In patient group, there were 107 cases of caseous necrosis type, 56 cases of hyperplasia type, and the proportion of caseous necrosis type was significantly higher in the severe deficiency group (79.17%, 76/96) than that of deficiency group (46.27%， 31/67, P＜0.01). Conclusion Excluding the effect of season, vitamin D deficiency is associated with susceptibility to spinal tuberculosis and histopathologic classification.