血清钙和25-羟基维生素D对老年良性阵发性位置性眩晕复发的预测模型：一项单中心随访队列研究

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中文摘要

目的： 探讨血清钙和25-羟基维生素D（25-OH-VD）对老年良性阵发性位置性眩晕（BPPV）患者行耳石复位法（CRP）后复发的预测价值，并建立定量预测模型。
方法： 开展了一项单中心随访队列研究，纳入2020年1月至2025年6月接受CRP治疗的286例老年BPPV患者（年龄≥60岁）。患者随访1年，根据复发情况分为未复发组（n=213）和复发组（n=73）。此外，60名健康老年人作为对照，用于比较基线生化水平。测定空腹血清25-OH-VD和钙水平。采用Pearson相关分析评估变量之间的关系。采用受试者工作特征（ROC）曲线评估预测性能，并采用多因素logistic回归识别独立危险因素以建立预测模型。
结果： 复发组的血清钙（1.94±0.47 mmol/L）和25-OH-VD（15.34±3.45 ng/mL）水平显著低于未复发组（2.35±0.56 mmol/L，18.44±3.74 ng/mL）和对照组（2.68±0.48 mmol/L，23.61±3.92 ng/mL；均p<0.05）。两者水平呈正相关（r=0.637，p<0.05）。多因素logistic回归显示，血清钙降低（OR=0.301，95%CI：0.152-0.593）、25-OH-VD降低（OR=0.808，95%CI：0.728-0.898）、多次复位操作（OR=4.945）、高血压（OR=2.237）、睡眠障碍（OR=2.113）、颈椎病（OR=2.167）和焦虑（OR=2.726）是复发的独立危险因素。联合预测模型的AUC为0.762（95%CI：0.697-0.827），优于单一指标（钙AUC=0.707；25-OH-VD AUC=0.717）。最佳截断值为0.339（灵敏度56.2%，特异度81.2%）。
结论： 血清钙和25-OH-VD降低是老年BPPV患者CRP后复发的独立预测因素，二者联合可提高预测效能。该预测模型为早期识别高危患者提供了定量依据。然而，由于其灵敏度相对较低，该模型在临床实践中应作为辅助工具而非独立检测。这些发现需要在多中心研究中进一步外部验证，钙和维生素D补充的干预效果应通过随机对照试验加以确认。

英文摘要

OBJECTIVES: To investigate the predictive value of serum calcium and 25-hydroxyvitamin D (25-OH-VD) on recurrence after canalith repositioning procedure (CRP) in elderly patients with benign paroxysmal positional vertigo (BPPV), and to establish a quantitative prediction model.
METHODS: A single-center follow-up cohort study was conducted involving 286 elderly BPPV patients (age≥60 years) treated with CRP from January 2020 to June 2025. Patients were followed for 1 year and divided into a non-recurrence group (n = 213) and a recurrence group (n = 73) based on recurrence status. Additionally, 60 healthy elderly individuals served as controls for comparing baseline biochemical levels. Fasting serum 25-OH-VD and calcium levels were measured. Pearson correlation analysis evaluated the relationship between variables. Receiver operating characteristic (ROC) curves assessed predictive performance, and multivariate logistic regression identified independent risk factors to establish a predictive model.
RESULTS: Serum calcium (1.94 ± 0.47 mmol/L) and 25-OH-VD (15.34 ± 3.45 ng/mL) levels were significantly lower in the recurrence group compared to the non-recurrence group (2.35 ± 0.56 mmol/L, 18.44 ± 3.74 ng/mL) and controls (2.68 ± 0.48 mmol/L, 23.61 ± 3.92 ng/mL; all p < 0.05). Levels were positively correlated (r = 0.637, p < 0.05). Multivariate logistic regression revealed that reduced serum calcium (OR = 0.301, 95%CI: 0.152-0.593), reduced 25-OH-VD (OR = 0.808, 95%CI: 0.728-0.898), multiple repositioning maneuvers (OR = 4.945), hypertension (OR = 2.237), sleep disorders (OR = 2.113), cervical spondylosis (OR = 2.167), and anxiety (OR = 2.726) were independent risk factors for recurrence. The combined predictive model yielded an AUC of 0.762 (95%CI: 0.697-0.827), superior to single indicators (calcium AUC = 0.707; 25-OH-VD AUC = 0.717). The optimal cut-off value was 0.339 (sensitivity 56.2%, specificity 81.2%).
CONCLUSION: Serum calcium and reduced 25-OH-VD are independent predictive factors for post-CRP recurrence in elderly BPPV patients, and their combination improves predictive efficacy. The predictive model provides a quantitative basis for early identification of high-risk patients. However, due to its relatively low sensitivity, the model should be used as an adjunctive tool rather than a standalone test in clinical practice. These findings require further external validation in multi-center studies, and interventional effects of calcium and vitamin D supplementation should be confirmed by randomized controlled trials.