急性康复病房患者血清25羟维生素D水平与非特异性肌肉骨骼疼痛之间的相关性

　　在急性康复病房（ARU）患者中，非特异性肌肉骨骼疼痛的治疗较难。

　　为了调查维生素D是否作为ARU患者非特异性肌肉骨骼疼痛发生的潜在可逆性风险因素，加利福尼亚（州）米申维耶霍（市）圣约瑟夫医疗（集团）米申（使命）医院、麻省总医院（马萨诸塞州综合医院）、哈佛大学医学院、哈佛大学公共卫生学院开展了一项横断面研究。

　　该研究共入组414例2011年7月～2012年6月加利福尼亚（州）米申维耶霍（市）ARU的住院患者。一旦入住ARU内，就需检测其血清25-羟维生素D（25(OH)D）水平，并评估其非特异性肌肉骨骼疼痛。在控制临床相关协变量的情况下，采用多变量逻辑回归分析血清25(OH)D水平与非特异性肌肉骨骼疼痛之间的相关性。

　　结果发现：在414例患者中，25(OH)D平均水平（±标准差）为29（±12）ng/mL，其中30%伴有非特异性肌肉骨骼疼痛。在对年龄、性别、种族、体重指数、功能独立性评分、迪约-卡尔森共病指数、骨折、类固醇应用、骨质疏松症/骨质软化病史以及患者类型（骨科、心外科、神经科、脊柱损伤或创伤性脑损伤）等基线资料校正后，血清25(OH)D水平与非特异性肌肉骨骼疼痛呈负相关（每10ng/mL比值比：0.67，95%置信区间：0.48～0.82）。以血清25(OH)D水平分为两组：与血清25(OH)D水平＞20ng/mL的患者相比，当血清25(OH)D水平＜20ng/mL时发生非特异性肌肉骨骼疼痛的比例更高（比值比：2.33，95%置信区间：1.23～4.17）。

　　因此，成人患者入住ARU病房时血清25(OH)D水平与非特异性肌肉骨骼疼痛发生呈负相关。以上数据仍需随机对照研究验证补充维生素D在ARU患者非特异性肌肉骨骼疼痛中的作用。

JPEN J Parenter Enteral Nutr. 2016;40(3):367-73.

Association Between Serum 25(OH)D Level and Nonspecific Musculoskeletal Pain in Acute Rehabilitation Unit Patients.

Matossian-Motley DL, Drake DA, Samimi JS, Camargo CA Jr, Quraishi SA.

Mission Hospital, St Joseph Health, Mission Viejo, California; Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Harvard School of Public Health, Boston, Massachusetts.

OBJECTIVE: Nonspecific musculoskeletal pain can be difficult to manage in acute rehabilitation unit (ARU) patients. We investigated whether vitamin D status is a potential modifiable risk factor for nonspecific musculoskeletal pain in ARU patients.

MATERIALS AND METHODS: This cross-sectional study focused on 414 adults from an inpatient ARU in Mission Viejo, California, between July 2011 and June 2012. On ARU admission, all patients had serum 25-hydroxyvitamin D (25(OH)D) levels measured and were assessed for nonspecific musculoskeletal pain. We performed multivariable logistic regression to test the association of serum 25(OH)D level with nonspecific musculoskeletal pain while adjusting for clinically relevant covariates.

RESULTS: Among these 414 patients, mean (SD) 25(OH)D level was 29 (12) ng/mL, and 30% had nonspecific musculoskeletal pain. After adjustment for age, sex, race, body mass index, Functional Independence Measure score, Deyo-Charlson Comorbidity Index, fractures, steroid use, history of osteoporosis/osteomalacia, and patient type (orthopedic, cardiac, neurological, spinal cord injury, or traumatic brain injury), serum 25(OH)D level was inversely associated with nonspecific musculoskeletal pain (odds ratio [OR] per 10 ng/mL, 0.67; 95% confidence interval [CI], 0.48-0.82). When 25(OH)D level was dichotomized, patients with levels <20 ng/mL had higher odds of nonspecific musculoskeletal pain (OR, 2.33; 95% CI, 1.23-4.17) compared with patients with levels ≥20 ng/mL.

CONCLUSIONS: In adult patients, serum 25(OH)D level on admission to ARU was inversely associated with nonspecific musculoskeletal pain. These data support the need for randomized, controlled trials to test the role of vitamin D supplementation to improve nonspecific musculoskeletal pain in ARU patients.

KEYWORDS: acute rehabilitation; musculoskeletal; pain; vitamin D

PMID: 25316682

PMCID: PMC4409573

DOI: 10.1177/0148607114555909