维生素D缺乏与脓毒症预后相关性研究

doi:10.7504/nk2014100501

摘要/Abstract

摘要：

目的探讨维生素D缺乏与重症监护病房(ICU)脓毒症患者预后的相关性。方法检测2012年4月至2013年8月广西医科大学第一附属医院236例入住ICU脓毒症患者的血清25(OH)D质量浓度，比较25(OH)D充足组、25(OH)D不足组、25(OH)D缺乏组的急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分、主要生化指标、ICU留住时间以及28 d病死率。多因素Cox回归分析影响预后的危险因素。结果 (1)175例(74.1%)血25(OH)D减少，其中100例(42.3%)25(OH)D不足，75例(31.8%)25(OH)D缺乏。(2)25(OH)D缺乏组与其余两组相比，ICU留住时间更长，APACHEⅡ评分、血降钙素原(PCT)、全段甲状旁腺激素(iPTH)、血培养阳性率以及28 d病死率更高(P<0.01)。随着血清25(OH)D浓度的降低，APACHE Ⅱ评分增高(r=-0.716，P<0.01)，28 d病死率上升(r=-0.376，P<0.01)。(3)25(OH)D充足组、25(OH)D不足组以及25(OH)D缺乏组中位生存时间分别为26.0 d、23.3 d和18.4 d(P<0.05)。(4)Cox分析显示，25(OH)D<20 μg/L(即维生素D缺乏)是影响预后的危险因素(OR 1.205，95%CI 1.154，1.257，P=0.006)。结论脓毒症患者维生素D缺乏发生率高，维生素D缺乏是影响其预后的独立危险因素。补充维生素D或可作为脓毒症的一种辅助治疗手段。

关键词: 维生素D缺乏, 重症监护病房, 脓毒症

Abstract:

Abstract：Objective To investigate the prevalence of vitamin D deficiency in septic patients in intensive care unit (ICU) and its association with prognosis.Methods A prospective observational study was performed to evaluate vitamin D status in 236 patients admitted to ICU of our hospital from April 2012 to August 2013.The patients were divided into three groups according to serum 25-hydroxyvitamin D(25［OH］D)：vitamin D sufficiency，vitamin D insufficiency，and vitamin D deficiency.Acute Physiology and Chronic Health Evaluation Ⅱ (APACHEⅡ) score，length of stay (LOS) in ICU，main biochemical results，and 28-day mortality were compared among patients with different serum 25(OH)D levels.The overall survival at 28 days was evaluated using Kaplan-Meier analysis.Potential risk factors for 28-day mortality were analyzed by Cox proportional hazards regression.Results Most of the 236 patients (74.1%) developed hypovitaminosis D (Insufficiency group accounted for 42.3%，100/236；Deficiency group accounted for 31.8%，75/236).LOS，APACHEⅡ score，serum procalcitonin，intact parathyroid hormone (iPTH)，positive blood culture and 28-day mortality were higher in deficiency group than those in the other two groups (P<0.01).25(OH)D levels were negatively correlated with APACHEⅡ score and 28-day mortality (r=-0.716，P<0.01；r=-0.376，P<0.01，respectively).Mean survival time was 26.0 days in sufficiency group，23.3 days in insufficiency group and 18.4 days in deficiency group，respectively，and the differences are significant (P<0.05).In a Cox regression model，25(OH)D levels below 20 μg/L was an independent risk factor of 28-day mortality (OR 1.205，95%CI 1.154，1.257，P=0.006).Conclusion This study demonstrates that vitamin D deficiency is highly prevalent in septic patients admitted to ICU.Vitamin D deficiency is an independent risk factor of 28-day mortality.Vitamin D may be an important therapeutic target of sepsis.

Key words: vitamin D deficiency, intensive care unit, sepsis

中图分类号:

R631+.4

陈朝彦，罗佐杰，胡杰妤，覃桦，梁敏，秦映芬，锁颖君. 维生素D缺乏与脓毒症预后相关性研究[J]. 中国实用内科杂志, DOI: 10.7504/nk2014100501.

CHEN Zhao-yan，LUO Zuo-jie，HU Jie-yu，QIN Hua，LIANG Min，QIN Ying-fen，SUO Ying-jun. [J]. Acta Metallurgica Sinica, DOI: 10.7504/nk2014100501.

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