维生素D结合蛋白在良性阵发性位置性眩晕患者血清中的表达及与复发的关系

The relationship between the serum vitamin D binding protein and disease recurrence in patients with benign paroxysmal positional vertigo

摘要:

目的 探究良性阵发性位置性眩晕（BPPV）患者血清维生素D结合蛋白（DBP）水平与复发的关系，及其对复发的评估价值。方法 选取2016年2月—2018年2月四川绵阳四〇四医院神经内科收治的BPPV患者318例作为观察组，所有患者经手法复位治疗，1周后复查确认治疗成功，并随访1年。根据是否复发将观察组患者分为复发组（62例）和未复发组（256例）。另取同期该院300例健康体检者作为对照组。应用汉化版眩晕障碍量表（DHI）和Berg平衡量表（BBS）评估受试者眩晕程度。采用酶联免疫吸附试验检测患者血清DBP水平，全自动电化学发光免疫法检测血清25-羟维生素D［25（OH）D］水平，Pearson法分析血清DBP与25（OH）D的相关性，受试者工作特征曲线（ROC）分析血清DBP对BPPV患者复发的诊断效能。结果 观察组DHI评分（功能评分、躯体评分、情感评分、总分）、BBS评分>45分的比例、DBP及25（OH）D水平均低于对照组（P <0.05）。复发组患者血清DBP及25（OH）D水平低于未复发组（P <0.05）。Pearson法结果显示，BPPV患者血清DBP水平与25（OH）D水平呈正相关（r =0.549，P <0.05）。单因素Logistic回归分析结果显示，DHI评分（功能评分、躯体评分、情感评分、总分）、BBS评分<45分、DBP、25（OH）D是BPPV患者复发的影响因素（P <0.05）。多因素Logistic回归分析结果显示，DBP ［R=2.035（95% CI：1.608，2.575）］、25（OH）D ［R=1.679（95% CI：1.271，2.218）］是BPPV患者复发的独立危险因素（P <0.05）。ROC曲线结果显示，截断值为665.320 μg/ml时，血清DBP预测BPPV患者复发的曲线下面积为0.905；敏感性为95.2%，特异性为74.1%。结论 BPPV患者血清DBP、25（OH）D水平降低，两者呈正相关，均是BPPV患者复发的独立危险因素，DBP对BPPV患者复发具有一定预测效能。

Abstract:

Objective To detect the relationship between serum vitamin D binding protein (DBP) level and disease recurrence in patients with benign paroxysmal positional vertigo (BPPV), and to explore the value of DBP in predicting the recurrence of BPPV.Methods A total of 318 patients with BPPV admitted to the Department of Neurology of our hospital from February 2016 to February 2018 were selected as the research subjects (observation group). All patients were treated with manual reduction, reevaluated one week later to confirm the curative effect of the treatment, and followed up for one year. Patients were divided into BPPV recurrence group (62 cases) and BPPV non-recurrence group (256 cases). Another 300 healthy people undergoing physical examination in our hospital at the same period were selected as the control group. The vertigo degree was assessed by Chinese version of Dizziness Handicap Inventory (DHI) and Berg Balance Scale (BBS). The level of DBP was detected by enzyme-linked immunosorbent assay (ELISA) and serum 25-hydroxyvitamin D [25(OH)D] level was detected by automatic electrochemiluminescence immunoassay. Pearson correlation coefficient was used to measure the relationship between DBP and 25(OH)D. Receiver operating characteristic (ROC) curve was used to analyze the diagnostic efficacy of serum DBP level for the recurrence of BPPV.Results Compared with the control group, the DHI scores (including scores of functional, physical, and emotional impacts as well as the total score), the proportion of BBS score > 45, and serum levels of DBP and 25(OH)D in the observation group were significantly lower (P < 0.05). Compared with the non-recurrence group, the serum DBP and 25(OH)D in the recurrence group were significantly lower (P < 0.05). Pearson correlation analysis showed that DBP level positively correlated with 25(OH)D level (r = 0.549, P < 0.05). Univariate Logistic regression analysis showed that DHI scores (including scores of functional, physical, and emotional impacts as well as the total score), BBS score <45, DBP and 25(OH)D were the influencing factors for BPPV recurrence (P < 0.05). Multivariate Logistic regression analysis showed that the levels of DBP [R = 2.035 (95% CI: 1.608, 2.575)] and 25(OH)D [R = 1.679 (95% CI: 1.271, 2.218)] were risk factors for BPPV recurrence (P <0.05). ROC curve showed that when the cutoff value was set at 665.320 μg/ml, the area under the ROC curve of serum DBP for predicting BPPV recurrence was 0.905, with a sensitivity of 95.2% and a specificity of 74.1%.Conclusions The serum levels of DBP and 25(OH)D are decreased in patients with BPPV, and they are positively correlated. Both of DBP and 25(OH)D are independent risk factors for recurrence of BPPV, while DBP is to some extent of value for predicting the recurrence of BPPV.