摘要
目的 了解PICU危重患儿25-羟基维生素D[25（OH）D]及维生素D结合蛋白（vitamin D binding protein,VDBP）水平变化,分析其临床意义及与预后的关系.方法 收集2015年2月至2016年7月入住广西医科大学第一附属医院PICU符合条件的危重症患儿295例为研究对象（研究组）;同期收集儿科门诊体检正常儿童44例作为对照组.研究组患儿于住院第1天和第7天（在PICU住院达7 d者）各抽2份2 ml血,分别检测血清25（OH）D和VDBP水平;对照组正常儿于入组当天抽取2份2 ml血,采用相同方法检测25（OH）D和VDBP水平.通过血清总钙、28 d病死率、器官衰竭率、住PICU时间、机械通气率、PRISMⅢ评分等判断预后.结果 （1）295例患儿中,各系统疾病患儿25（OH）D缺乏率、VDBP水平下降的发生率比较差异无统计学意义（P〉0.05）.（2）研究组的25（OH）D、VDBP水平较对照组低[（61.38±29.42）nmol/L比（97.11±30.11）nmol/L;（514.36±211.13）μmol/L比（840.82±448.96）μmol/L],差异有统计学意义（P〈0.05）.（3）25（OH）D充足（n=85）、不足（n=97）、缺乏组（n=113）间VDBP水平、第28天病死率、器官衰竭率、机械通气率比较差异无统计学意义（P〉0.05）;25（OH）D缺乏及不足患儿比充足组患儿住PICU时间更长,PRISMⅢ评分更高,差异有统计学意义（P〈0.05）.（4）入住PICU第7天较第1天25（OH）D升高[（71.14±31.78）nmol/L比（60.65±30.77）nmol/L,P〈0.05],VDBP水平升高[（532.23±148.49）μmol/L比（484.73±128.17）μmol/L,P〈0.05],PRISMⅢ评分降低[2.0（0.0-5.0）分比5.0（3.0-8.0）分,P〈0.05].（5）295例危重患儿中,第28天存活257例（87.1％）、死亡38例（12.9％）,死亡组较存活组25（OH）D水平更低[（51.17±29.65）nmol/L比（62.89±29.15）nmol/L,P〈0.05],PRISMⅢ评分更高[8.5（5.0-14.3）分比4.0（1.0-7.0）分,P〈0.05].结论 危重患儿普遍存在25（OH）D、VDBP水平不足或缺乏.维生素D水平�
Objective To investigate the 25-hydroxy-vitamin D[25（OH）D] and vitamin D binding protein （ VBDP） levels in critically ill children admitted to PICU,their clinical significance and the relation-ship with prognosis. Methods Two hundred and ninty-five children with critical illness admitted to PICU from February 2015 to July 2016 were enrolled as subjects（ study group） and 44 healthy controls were recrui-ted. Serum 25（OH）D and VDBP levels were measured on the 1st and 7th day of PICU,then clinical data were collected for statistical analysis. Results （1） Among subjects,there were no statistically significant differ-ences in the incidences of 25（OH）D deficiency and VDBP decline（P〉0. 05）. （2）The levels of 25 （OH）D and VDBP in the study group were lower than those in the control group [ （ 61. 38 ± 29. 42 ） nmol/L vs. （97. 11 ± 30. 11） nmol/L; （514. 36 ± 211. 13）μmol/L vs. （840. 82 ± 448. 96）μmol/L,respectively,P 〈0. 05]. （3） There were no significant differences in the level of VDBP ,28-day mortality,organ failure rate and mechanical ventilation rate among 25（OH）D adequate group（n=85）,inadequate group（n=97） and deficient group（ n=113 ） （ P〉0. 05 ） . The duration of PICU stay,PRISMⅢscores were significantly longer and higher （P〈0. 05） in 25（OH）D inadequate group or deficient group than those of 25（OH）D adequate group.（4） Compare to the 7th day ,the levels of 25（OH）D and VDBP were lower （P 〈0.05） and PRISM Ⅲscores was higer on the 1st day in the cases staying in PICU≥7 d[ （71. 14 ± 31. 78）nmol/L vs. （60.65 ±30.77）nmol/L;（532.23 ±148.49）μmol/L vs. （484.73 ±128.17）μmol/L;2.0（0.0 -5.0） scores vs. 5. 0（3. 0-8. 0）scores,respectively,P〈0. 05]. （5） Among the 295 cases of critically ill children ,the 28-day mortality was 12. 9%（38/295）,the death patients showed lower 25（OH）D status[ （51. 17 ± 29.65）nmol/L vs. （62.89 ±29.15）nmol/L,P 〈0.05] and higher PRISM
作者
杨志勇
陈局
黎萍
韦丹
Yang Zhiyong;Chen Ju;Li Ping;Wei Dan(Department of Pediatric Intensive Care Unit,the First Affiliated Hospital of Guangxi Medical University,Nanning 530021,China)
出处
《中国小儿急救医学》
CAS
2018年第8期602-606,共5页
Chinese Pediatric Emergency Medicine
基金
广西壮族自治区卫生和计划生育委员会自筹经费科研课题（Z2016324）
关键词
危重患儿
25-羟基维生素D
维生素D结合蛋白
临床意义
预后
Critically ill children
25-hydroxy-vitamin D
Vitamin D binding protein
Clinical significance
Clinical prognosis
