血清维生素D水平与后半规管良性阵发性位置性眩晕（PC-BPPV）中Epley手法首次尝试成功率之间的关系

文献信息

中文摘要

背景/目的： 维生素D缺乏与良性阵发性位置性眩晕（BPPV）的发生和复发相关，但其对耳石复位手法即刻成功率的影响仍不确定。本研究探讨了后半规管BPPV（PC-BPPV）患者血清维生素D水平与Epley手法首次尝试成功率之间的关系。方法：本前瞻性观察性研究连续纳入140例经客观确诊的单侧PC-BPPV成人患者。在治疗前于就诊时测量血清25-羟基维生素D水平。所有患者均接受标准化的Epley手法治疗。首次尝试成功定义为在一周随访时位置性眩晕完全缓解且Dix-Hallpike试验中位置性眼震消失。血清维生素D水平既作为连续变量分析，也按实验室参考范围分析：缺乏（<50 nmol/L）、不足（50-75 nmol/L）和充足（75-250 nmol/L）。结果：Epley手法在74/140例患者（52.9%）中首次尝试即成功。在预先设定的主要分析中，血清维生素D≥50 nmol/L的患者首次尝试成功率高于<50 nmol/L者（60.9% vs. 46.1%；OR 1.83，95% CI 0.93-3.59，p = 0.079），但差异未达到统计学显著性。在未调整的探索性分析中，首次尝试成功患者的血清维生素D中位数显著高于治疗失败者（52.2 [IQR，30.0-68.4] vs. 36.8 [IQR，21.3-66.1] nmol/L，p = 0.029），且成功率在三层分类中呈数值上升（46.1%、62.2%、59.3%），但无明确的剂量-反应模式，总体比较（p = 0.208）及两两亚组比较均未达到统计学显著性。在调整年龄、性别和入组月份的多变量模型中，维生素D仍与首次尝试成功独立但轻度相关（每10 nmol/L的调整OR 1.14，95% CI 1.00-1.29）。结论：关于维生素D缺乏与非缺乏患者之间Epley手法首次尝试成功率的预先设定主要比较未达到统计学显著性，尽管点估计倾向于非缺乏组成功率更高（OR 1.83，95% CI 0.93-3.59）。一项探索性、最初未调整的分析提示血清维生素D作为连续变量与首次尝试成功之间存在正向、轻度的关联；该关联在多变量调整后仍存在（调整OR 1.14，95% CI 1.00-1.29），但在分类维生素D阈值之间未呈现明确的剂量-反应模式。这些发现应被视为产生假设，而非确立维生素D的确定性预后作用，需要更大规模、把握度充分的多中心研究加以证实。

英文摘要

Background/Objectives: Vitamin D deficiency has been associated with the occurrence and recurrence of benign paroxysmal positional vertigo (BPPV), but its influence on the immediate success of canalith repositioning maneuvers remains uncertain. This study investigated the relationship between serum vitamin D levels and the first-attempt success of the Epley maneuver in patients with posterior canal BPPV (PC-BPPV). Methods: This prospective observational study included 140 consecutive adults with objectively confirmed unilateral PC-BPPV. Serum 25-hydroxyvitamin D levels were measured at presentation before treatment. All patients underwent a standardized Epley maneuver. First-attempt success was defined as complete resolution of positional vertigo and disappearance of positional nystagmus on the Dix-Hallpike test at the one-week follow-up visit. Serum vitamin D levels were analyzed both as a continuous variable and according to laboratory reference ranges: deficiency (<50 nmol/L), insufficiency (50-75 nmol/L), and sufficiency (75-250 nmol/L). Results: The Epley maneuver was successful after the first attempt in 74 of 140 patients (52.9%). In the primary, pre-specified analysis, first-attempt success was more frequent among patients with serum vitamin D ≥50 nmol/L than <50 nmol/L (60.9% vs. 46.1%; OR 1.83, 95% CI 0.93-3.59, p = 0.079), a difference that did not reach statistical significance. In unadjusted exploratory analyses, patients with first-attempt success had significantly higher median serum vitamin D levels than those with treatment failure (52.2 [IQR, 30.0-68.4] vs. 36.8 [IQR, 21.3-66.1] nmol/L, p = 0.029), and success rates numerically increased across the three-tier classification (46.1%, 62.2%, 59.3%), without a clear dose-response pattern, neither the overall comparison (p = 0.208) nor pairwise subgroup comparisons reaching statistical significance. In a multivariable model adjusting for age, sex, and month of enrolment, vitamin D remained independently, though modestly, associated with first-attempt success (adjusted OR 1.14 per 10 nmol/L, 95% CI 1.00-1.29). Conclusions: The pre-specified primary comparison of first-attempt Epley maneuver success between vitamin D-deficient and non-deficient patients did not reach statistical significance, although the point estimate favored higher success in the non-deficient group (OR 1.83, 95% CI 0.93-3.59). An exploratory, initially unadjusted analysis suggested a positive, modest association between serum vitamin D as a continuous variable and first-attempt success; this association persisted after multivariable adjustment (adjusted OR 1.14, 95% CI 1.00-1.29) but did not follow a clear dose-response pattern across categorical vitamin D thresholds. These findings should be regarded as hypothesis-generating rather than establishing a definitive prognostic role for vitamin D, and larger, adequately powered multicenter studies are needed to confirm them.