目的 探讨绝经女性良性阵发性位置性眩晕(benign paroxysmal positional vertigo,BPPV)患者血清 25-羟维生素D3[25-hydroxyvitamin D3,25(OH)D3]、血钙水平与骨代谢指标的变化及临床意义.方法 选取 2020 年 8 月至 2021 年 8月杭州市第九人民医院 103 例绝经BPPV患者纳入BPPV组,根据 1 年复发情况,再将其分为复发组(n=18)与无复发组(n=85);另选取同期 50 名健康体检的绝经女性纳入对照组.收集其临床资料及血清 25(OH)D3、血钙、骨代谢指标[I型前胶原氨基端前肽(procollagen type Ⅰ N-terminal propeptide,PINP)、骨钙素N端中分子片段(N-terminal midfragment of osteocalcin,N-MID)、Ⅰ型胶原羟基端肽β降解产物(β-isomerised C-terminal telopeptide of collagen typeⅠ,β-CTX)和骨性碱性磷酸酶(bone alkaline phosphatase,BALP)],构建Logistic回归模型分析绝经女性发生BPPV的危险因素,并采用受试者操作特征曲线分析相关指标对BPPV复发的预测价值.结果 BPPV组患者的血清 25(OH)D3水平显著低于对照组(P<0.05),长期饮食不规律占比、PINP、N-MID、BALP 水平均显著高于对照组(P<0.05);多因素 Logistic 回归分析结果显示,低 25(OH)D3、高PINP、高N-MID、高BALP均是绝经女性发生BPPV的危险因素(P<0.05);复发组患者的25(OH)D3水平显著低于无复发组(P<0.05),PINP、N-MID、BALP水平均显著高于无复发组(P<0.05);25(OH)D3、PINP、N-MID、BALP及四项联合预测BPPV复发的曲线下面积(area under the curve,AUC)分别为 0.833、0.654、0.697、0.782、0.910,四项联合预测的AUC最大,敏感度和特异性分别为 98.97%、70.62%.结论 绝经女性BPPV患者血钙水平无明显改变,血清 25(OH)D3水平降低,PINP、N-MID与BALP水平升高均是发生BPPV的危险因素,且可用于BPPV复发的预测.
Changes and significance of serum 25(OH)D3,blood calcium and bone metabolism in menopausal women with BPPV
Objective To investigate the changes and clinical significance of serum 25-hydroxyvitamin D3[25(OH)D3],blood calcium and bone metabolism indexes in menopausal women with benign paroxysmal positional vertigo(BPPV).Methods A total of 103 menopausal BPPV patients from Hangzhou Ninth People's Hospital from August 2020 to August 2021 were enrolled into BPPV group.According to the one-year recurrence situation,they were divided into recurrence group(n=18)and non-recurrence group(n=85).A total of 50 healthy menopausal women during the same period were enrolled as control group.The clinical data,serum 25(OH)D3,calcium and bone metabolism indexes[procollagen typeⅠN-terminal propeptide(PINP),N-terminal midfragment of osteocalcin(N-MID),β-isomerised C-terminal telopeptide of collagen typeⅠ(β-CTX),bone alkaline phosphatase(BALP)]were collected.Logistic regression model was constructed to analyze the risk factors of BPPV in menopausal women.The predictive value of related indexes for BPPV recurrence was analyzed by receiver operating characteristic curves.Results The serum 25(OH)D3 level in BPPV group was significantly lower than that in control group(P<0.05),and the proportion of long-term irregular diet,PINP,N-MID and BALP levels were significantly higher than those in control group(P<0.05).Multivariate Logistic regression analysis showed that low 25(OH)D3,high PINP,high N-MID and high BALP were all risk factors for BPPV in menopausal women(P<0.05).The 25(OH)D3 level in recurrence group was significantly lower than that in non-recurrence group(P<0.05),and the PINP,N-MID and BALP levels were significantly higher than those in non-recurrence group(P<0.05).The area under the curve(AUC)of 25(OH)D3,PINP,N-MID,BALP and the four combined predictions for BPPV recurrence were 0.833,0.654,0.697,0.782 and 0.910,respectively,and the AUC of the four combined predictions was the largest.The sensitivity and specificity were 98.97%and 70.62%,respectively.Conclusion There is no significant change in level of serum calcium in menopausal women with BPPV.Decreased serum 25(OH)D3 and increased PINP,N-MID and BALP are risk factors of BPPV,which can be applied to predict BPPV recurrence.
万方数据
