摘要
目的探讨卒中后疲劳(PSF)患者的血清25-羟基维生素D[25(OH)D]水平变化及维生素D3(VD3)干预对神经功能康复的影响。方法选取2018年1月-12月赤峰学院附属医院收治的初发急性缺血性脑卒中患者100例。其中,50例伴PSF为研究组,50例无PSF为病例对照组,另选取同期50例健康体检者为正常对照组。比较3组的一般资料,行单因素和多因素分析,明确PSF发生的危险因素。研究组进一步随机分为PSF-A组与PSF-B组,A组采取VD3干预6个月,随访比较两组的血清25(OH)D水平,疲劳严重程度量表(FSS)、美国国立卫生研究院卒中量表(NIHSS)及Fugl-Meyer量表(FMA)评分变化。结果研究组的NIHSS评分、FSS评分高于病例对照组(P<0.05),FMA评分和血清25(OH)D水平低于病例对照组(P<0.05),研究组和病例对照组的血清25(OH)D水平低于正常对照组(P<0.05)。多因素逐步Logistic回归分析显示,病程[OlR=1.369(95%CI:1.024,2.561)]、NIHSS评分[OlR=3.319(95%CI:1.031,3.456)]、FSS评分[OlR=2.661(95%CI:1.053,2.915)]是影响PSF的独立危险因素,而FMA评分[OlR=2.982(95%CI:1.147,3.668)]、血清25(OH)D水平[OlR=2.114(95%CI:1.121,3.865)]是保护因素(P<0.05)。随着PSF严重程度的增加,FSS评分和NIHSS评分逐步升高(P<0.05),而FMA评分和血清25(OH)D水平降低(P<0.05)。血清25(OH)D与FSS评分、NIHSS评分呈负相关(r=-0.525和-3.179,均P<0.05),与FMA评分呈正相关(r=0.619,P<0.05)。随访3和6个月,PSF-A组的FSS评分、NIHSS评分低于PSF-B组(P<0.05),FMA评分和血清25(OH)D水平高于PSF-B组(P<0.05)。结论血清25(OH)D降低可能与缺血性脑卒中后PSF的发生及程度有关,VD3干预可能有利于促进神经功能及肢体功能的康复。
Objective To investigate the changes of serum levels of 25-hydroxyvitamin D[25(OH)D]in ischemic stroke patients with post-stroke fatigue(PSF)and the intervention of vitamin D3(VD3)on the rehabilitation of neurological function.Methods From January 2018 to December 2018 wereenrolled,100 acute ischemic stroke patients who admitted to Affiliated Hospital of Chifeng University.Among them,50 patients with PSF were divided as research group and 50 patients without PSF as the illness control group.50 cases of healthy subjects were enrolled as normal controls(NC group).The general data of the three groups were statistically compared.The single factor and multivariate analysis were used to determine the risk factors of PSF.The research group was further divided into PSF-A group and PSF-B group,with 25 cases in each group,and group A was treated with VD3 for 6 months.The serum 25(OH)D level,FSS score,NIHSS score and FMA score were compared between the two groups.Results The NIHSS score and FSS score in the research group were higher than those in the illness control group,the FMA score and serum 25(OH)D were lower than those in the illness control group,the serum 25(OH)D levels in the research group and the illness control group were lower than those in the NC group,and the differences were statistically significant(P<0.05).Logistic multivariate regression analysis showed that the course of disease[O^R=1.369(95%CI:1.024,2.561)],NIHSS score[O^R=3.319(95%CI:1.031,3.456)]and FSS score[O^R=2.661(95%CI:1.053,2.915)]were independent risk factors for PSF,while the FMA score[O^R=2.982(95%CI:1.147,3.668)]and serum 25(OH)D level[O^R=2.114(95%CI:1.121,3.865)]were protective factors(P<0.05).As the severity of PSF increased,FSS and NIHSS scores increased(P<0.05),while FMA scores and serum 25(OH)D levels decreased(P<0.05).The serum 25(OH)D was negatively correlated with FSS score and NIHSS score(r=-0.525 and-3.179,P<0.05),and positively correlated with FMA score(r=0.619,P<0.05).After 3 and 6 months of follow-up,the FSS and NIHSS scores of PSF-A group were lower than those of PSF-B group,while the FMA score and serum 25(OH)D level were higher than those of PSF-B group,and the differences were statistically significant(P<0.05).Conclusion The decline of serum 25(OH)D may be related to the occurrence and extent of PSF after ischemic stroke.VD3 intervention may be beneficial to promote the recovery of nerve function and limb function.
作者
安学雷
闵连秋
Xue-lei An;Lian-qiu Min(Department of Neurology,The First Affiliated Hospital of Jinzhou Medical University,Jinzhou,Liaoning 121001,China)
出处
《中国现代医学杂志》
CAS
2020年第11期32-38,共7页
China Journal of Modern Medicine
基金
辽宁省自然科学基金指导计划项目(No:20170540379)。
