标题：血清25羟维生素D水平与急性缺血性脑卒中患者脑梗死体积及颈内动脉狭窄的关系

      作者：陈梅鹃 1，王滔 2，刘乐梅 1，文雯 1，王利 1    乐山市人民医院老年病科 1、放射影像科 2，四川 乐山 614000

      卷次： 2021年32卷4期

      【摘要】 目的 探讨血清25羟维生素D [25(OH)D]水平与急性缺血性脑卒中患者脑梗死体积及颈内动脉狭窄的关系。方法 选取2018年10月至2019年10月乐山市人民医院诊治的200例急性缺血性脑卒中患者为研究对象，根据患者的颈部血管彩超结果分为颈内动脉正常组69例和颈内动脉狭窄组131例。根据梗死病灶体积大小将患者分为小体积组(梗死病灶体积≤1 cm3) 108例、中体积组(1 cm3<梗死病灶体积<20 cm3) 48例和大体积组(梗死病灶体积≥20 cm3) 44例。应用多因素Logistic回归方法分析脑梗死体积以及颈内动脉狭窄的影响因素，采用Pearson相关性分析血清25(OH)D水平与颈内动脉狭窄率和脑梗死体积的相关性。结果 颈内动脉狭窄组患者的收缩压、舒张压、总胆固醇和低密度脂蛋白水平明显高于颈内动脉正常组，而25(OH)D水平明显低于颈内动脉正常组，差异均有统计学意义(P<0.05)；多因素Logistic回归分析结果显示，收缩压、舒张压、总胆固醇和低密度脂蛋白是急性缺血性脑卒中患者颈内动脉狭窄的独立危险因素(P<0.05)，而25(OH)D是其保护因素(P<0.05)；大体积组患者的总胆固醇和低密度脂蛋白水平明显高于中体积组和小体积组，而25(OH)D水平明显低于中体积组和小体积组，中体积组总胆固醇和低密度脂蛋白水平明显高于小体积组，而25(OH)D水平明显低于小体积组，差异均有统计学意义(P<0.05)；多因素Logistic回归分析结果显示，总胆固醇和低密度脂蛋白是急性缺血性脑卒中患者脑梗死体积的独立危险因素(P<0.05)，而25(OH)D是其保护因素(P<0.05)；Pearson相关性分析显示，血清25(OH)D水平与颈内动脉狭窄率和脑梗死体积均呈负相关性(r=-0.593、-0.562，P<0.05)。结论 颈内动脉狭窄以及脑梗死体积较大的急性缺血性脑卒中患者血清25(OH)D水平下降，且25(OH)D是急性缺血性脑卒中患者脑梗死体积与颈内动脉狭窄的保护因素，在临床诊断和治疗中具有一定的价值。
      【关键词】 急性缺血性脑卒中；25羟维生素D；脑梗死体积；颈内动脉狭窄；相关性
      【中图分类号】 R743.3 【文献标识码】 A 【文章编号】 1003—6350（2021）04—0425—05

Relationship between serum 25 hydroxyvitamin D level and cerebral infarction volume and internal carotidartery stenosis in patients with acute ischemic stroke.
CHEN Mei-juan 1, WANG Tao 2, LIU Le-mei 1, WEN Wen 1,WANG Li 1. Department of Geriatrics 1, Department of Radiology and Imaging 2, Leshan People's Hospital, Leshan 614000,Sichuan, CHINA
【Abstract】 Objective To investigate the relationship between serum 25 hydroxyvitamin D (25(OH)D) leveland cerebral infarction volume and internal carotid artery stenosis in patients with acute ischemic stroke. Methods A to-tal of 200 patients with acute ischemic stroke who were diagnosed and treated in Leshan People's Hospital from October2018 to October 2019 were selected, the patients were divided into the normal internal carotid artery group (n=69) and in-ternal carotid artery stenosis group (n=131) according to the results of color Doppler ultrasound of the neck vessels. Thepatients were divided into small volume group (n=108, infarct volume≤ 1 cm3), middle volume group (n=48, 1 cm3< in-farct volume <20 cm3), large volume group (n=44, infarct volume≥20 cm3) according to the size of infarct. Multivariatelogistic regression analysis was used to analyze the influencing factors of cerebral infarction volume and internal carotidartery stenosis. Pearson correlation analysis was used to analyze the correlation between serum 25(OH)D level and inter-nal carotid artery stenosis rate and cerebral infarction volume. Results Systolic blood pressure, diastolic blood pres-sure, total cholesterol, and low-density lipoprotein in the internal carotid artery stenosis group were significantly higherthan those in the normal internal carotid artery group, while the level of 25(OH)D was significantly lower than that of thenormal internal carotid artery group (all P<0.05). Multivariate Logistic regression analysis showed that systolic bloodpressure, diastolic blood pressure, total cholesterol and low-density lipoprotein were independent risk factors for internalcarotid artery stenosis in patients with acute ischemic stroke (all P<0.05), while 25(OH)D was the protective factor (P<0.05). The levels of total cholesterol and low-density lipoprotein in the large volume group patients were significantlyhigher than those in the middle volume group and the small volume group, while the level of 25(OH)D was significantlylower than that of the middle volume group and the small volume group, the levels of total cholesterol and low-density li-poprotein in the middle volume group were significantly higher than those in the small volume group, while level of the