术前维生素D水平与非心脏手术患者术后心脏、肾脏及感染性疾病发病率的关系
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Preoperative Vitamin D Concentration and Cardiac, Renal, and Infectious Morbidity after Noncardiac Surgery
背景与目的
低水平维生素D与心血管疾病、肾脏疾病和感染风险有关。术后病人容易发生类似的并发症，但维生素D缺乏是否会导致术后并发症仍不清楚。本研究旨在探讨术前低水平维生素D是否与非心脏手术后30天内的心血管事件有关。
方 法
我们分析了VISION研究生物库中的患者，这些患者至少45岁，至少住院一晚。术前采集血液，并测量维生素D浓度水平。主要结果：术后30天内心血管事件（死亡、心肌损伤、非致命性心脏骤停、中风、充血性心力衰竭）。次要结果：肾损伤和感染性并发症。
结 果
本研究共纳入3851名参与者。术前维生素D浓度为70±30nmol/l，62%患者存在维生素D缺乏。262例（0.7%）患者死亡，41例（1.1%）发生充血性心力衰竭或非致命性心脏骤停，540例（14%）出现心肌损伤，15例（0.4%）发生中风。术前维生素D浓度与主要结果无关（术前维生素D每增加10 nmol/l，平均相对疗效比值比[95%CI]：0.93[0.85，1.01]，P = 0.095)。然而，它与术后感染（术前维生素D每增加10 nmol/l，平均相对疗效比值比[95%CI]：0.94[0.90,0.98]，P=0.005）和肾功能（术前维生素D每增加10 nmol/l，术后估计肾小球滤过率的平均变化[95%CI]：0.29[0.11,0.48]ml·min-1·73/ m-2，P值=0.004）有关。
结 论
术前维生素D水平与患者术后30天心血管事件预后无相关性。然而，维生素D缺乏与感染性并发症和肾功能下降之间存在显著的相关性。虽然对肾脏的影响没有临床意义，但补充维生素D对感染性并发症的影响需要进一步研究。
原始文献摘要
Turan A, Artis AS, Hanline C, et al.Preoperative Vitamin D Concentration and Cardiac, Renal, and Infectious Morbidity after Noncardiac Surgery.[J]. Anesthesiology 2019,132(1):121-130DOI：10.1097/ALN.0000000000003000.
Background: Low 25-hydroxyvitamin D is associated with cardiovascular, renal, and infectious risks. Postsurgical patients are susceptible to similar complications, but whether vitamin D deficiency contributes to postoperative complications remains unclear. We tested whether low preoperative vitamin D is associated with cardiovascular events within 30 days after noncardiac surgery.
Methods: We evaluated a subset of patients enrolled in the biobank substudy of the Vascular events In noncardiac Surgery patIents cOhort evaluatioN (VISION) study, who were at least 45 yr with at least an overnight hospitalization. Blood was collected preoperatively, and 25-hydroxyvitamin D was measured in stored samples. The primary outcome was the composite of cardiovascular events (death, myocardial injury, nonfatal cardiac arrest, stroke, congestive heart failure) within 30 postoperative days. Secondary outcomes were kidney injury and infectious complications.
Results: A total of 3,851 participants were eligible for analysis. Preoperative 25-hydroxyvitamin D concentration was 70 ± 30 nmol/l, and 62% of patients were vitamin D deficient. Overall, 26 (0.7%) patients died, 41 (1.1%) had congestive heart failure or nonfatal cardiac arrest, 540 (14%) had myocardial injury, and 15 (0.4%) had strokes. Preoperative vitamin D concentration was not associated with the primary outcome (average relative effect odds ratio [95% CI]: 0.93 [0.85, 1.01] per 10 nmol/l increase in preoperative vitamin D, P = 0.095). However, it was associated with postoperative infection (average relative effect odds ratio [95% CI]: 0.94 [0.90, 0.98] per 10 nmol/l increase in preoperative vitamin D, P adjusted value = 0.005) and kidney function (estimated mean change in postoperative estimated glomerular filtration rate [95% CI]: 0.29 [0.11, 0.48] ml · min-1 · 1.73 m-2 per 10 nmol/l increase in preoperative vitamin D, P adjusted value = 0.004).
Conclusions: Preoperative vitamin D was not associated with a composite of postoperative 30-day cardiac outcomes. However, there was a significant association between vitamin D deficiency and a composite of infectious complications and decreased kidney function. While renal effects were not clinically meaningful, the effect of vitamin D supplementation on infectious complications requires further study.
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贵州医科大学高鸿教授课题组
翻译：牛振瑛 编辑：冯玉蓉 审校：王贵龙