广西南宁格雷夫斯病患者维生素D缺乏和不足危险因素分析

Risk factors for vitamin D deficiency and insufficiency in patients with Graves disease in Nanning，Guangxi Province，China

摘要:

目的：探讨不同维生素D营养状况格雷夫斯病（Graves disease，GD）患者临床特征及GD患者发生维生素D缺乏和不足的危险因素。方法：收集328名GD患者病例资料，依据患者维生素D水平分为维生素D缺乏和不足组[25（OH）D3<75 nmol/L]和维生素D正常组[25（OH）D3≥75 nmol/L]，比较2组年龄、性别构成、促甲状腺激素（thyroid stimulating hormone，TSH）、游离三碘甲状腺原氨酸（free triiodothyronine，FT3）、游离甲状腺素（free thyroxine，FT4）、促甲状腺素受体抗体（thyrotropin receptor an－tibody，TRAb）、甲状腺过氧化物酶抗体（thyroid peroxide antibody，TPOAb）及甲状腺球蛋白抗体（thyroglobulin antibody，TGAb）等水平以探讨2组临床特征；单因素及多因素logistic回归分析GD患者发生维生素D缺乏不足的危险因素。结果：GD患者维生素D缺乏和不足的检出率为64.02%。维生素D缺乏和不足GD患者年龄小于维生素D正常GD患者，差异具有统计学意义[（34.89±12.25） vs. （39.11±11.97），P<0.05]。2组性别及季节构成存在显著差异（P<0.05）。多因素logistic回归分析，结果显示GD患者发生维生素D缺乏和不足的危险因素为性别及季节，与甲状腺抗体、甲状腺功能及肝功能无相关关系（P>0.05）。女性GD患者发生维生素D缺乏和不足风险为男性GD患者的3.052倍（OR=3.052，95%CI=1.641~5.676，P<0.05），而冬季发生维生素D缺乏和不足的风险为夏季的2.173倍（OR=2.173，95%CI=1.303~3.623，P<0.05）。结论：女性GD患者冬季时较男性患者及夏季时更容易出现维生素D缺乏和不足，应注意预防。同时，在研究GD患者维生素D水平时应注意校正以上危险因素。

Abstract:

Objective：To investigate the clinical characteristics of different vitamin D status in patients with Graves disease（GD） and the risk factors for vitamin D deficiency and insufficiency in GD patients. Methods：The medical data of 328 patients with GD were collected. These patients were divided into two groups according to their vitamin D levels：vitamin D deficiency and insufficiency group [25（OH）D3 <75mmol/L] and vitamin D sufficiency group[25（OH）D3≥75mmol/L]. Age，sex，the levels of thyroid stimulating hor－mone，free triiodothyronine，free thyroxine，thyrotropin receptor antibody（TRAb），thyroid peroxide antibody（TPOAb），and thyroglobu－lin antibody（TGAb） were compared to investigate the clinical characteristics of these two groups. Univariate and multivariate logistic regression analyses were used to identify the risk factors for vitamin D deficiency and insufficiency in patients with GD. Results：The prevalence of vitamin D deficiency and insufficiency in GD patients was 64.02%. The age of the vitamin D deficiency and insuffi－ciency group was significantly younger than that of the vitamin D sufficiency group （34.89±12.25 vs. 39.11±11.97，P<0.05）. There were significant differences in sex and seasonal compositions between the two groups（both P<0.05）. The multivariate logistic regression analysis showed that the risk factors for vitamin D deficiency and insufficiency in GD patients were sex and season；no association with thyroid antibody，thyroid function，or liver function was found（P >0.05）. The risk of vitamin D deficiency and insufficiency in fe－male GD patients was 3.052 times higher than that in male GD patients（odds ratio[OR]=3.052，95% confidence interval（CI）：1.641 to 5.676，P<0.05）. Moreover，the risk of vitamin D deficiency and insufficiency in winter was 2.173 times higher than that in summer（OR=2.173，95% CI=1.303 to 3.623，P<0.05）. Conclusion：The risk of vitamin D deficiency and insufficiency is higher in female GD patients than in male GD patients and in winter than in summer，which prevention measures should be taken for. In the mean－time，the above risk factors should be adjusted when studying the vitamin D level in GD patients.