血清25-OH-维生素D在儿童脓毒症发病机制中的研究

发布时间：2018-01-27 14:57

本文关键词： 脓毒症 -羟维生素D 儿童　出处：《中国全科医学》2017年S2期 　论文类型：期刊论文

【摘要】：目的探讨血清25-OH-维生素D(25-OH-Vit D)在儿童脓毒症中的发病机制。方法选取2016年1月—2017年1月在瑞安市人民医院儿科病房被确诊为脓毒症的患儿50例为试验组,对照组为同期体检正常儿童50例。检测其血清25-OH-Vit D水平和白介素(IL)-2R、IL-4、IL-6、IL-10水平。根据患儿血清25-OHVit D水平将其分为3组:充足组、不足组和缺乏组。比较3组患儿的观察指标。再根据28 d后的预后状态将患儿分为好转组和恶化组,确定影响脓毒症患儿预后的独立危险因素。结果充足组、不足组、缺乏组患儿IL-2R、IL-4、IL-6水平高于对照组,IL-10水平低于对照组(P0.05);不足组、缺乏组患儿IL-2R、IL-4、IL-6水平高于充足组,IL-10水平低于充足组(P0.05);缺乏组患儿IL-2R、IL-4、IL-6水平高于不足组,IL-10水平低于不足组(P0.05)。50例脓毒症患儿最终有9例在28 d以内恶化,其余41例患儿好转。恶化组患儿IL-2R、IL-4、IL-6水平高于好转组(P0.05),而25-OH-Vit D、IL-10水平低于好转组(P0.05)。Spearman相关分析显示,脓毒症患儿血清25-OH-Vit D水平与28 d恶化率、血清中IL-2R、IL-4、IL-6水平呈负相关(r=-0.345,P0.05;r=-0.264,P0.05;r=-0.394,P0.05;r=-0.615,P0.05),与IL-10水平呈正相关(r=0.151,P0.05)。多因素Logistic回归分析结果显示,25-OH-Vit D水平为影响脓毒症患儿预后的独立影响因素(P0.05)。结论 25-OH-Vit D为影响严重脓毒症患儿预后的独立预测因素。维生素D可以通过影响机体的免疫功能、促炎/抗炎因子平衡来导致脓毒症的发病和预后。
[Abstract]:Objective to study the serum 25-OH- vitamin D (25-OH-Vit D). Methods from January 2016 to January 2017, 50 children who were diagnosed as sepsis in pediatric ward of Ruian people's Hospital were selected as experimental group. The serum level of 25-OH-Vit D and interleukin-6 (IL-2R) IL-4T were measured in the control group (n = 50). The level of IL-10 was divided into 3 groups according to the serum level of 25-OHVit D: sufficient group. The observation indexes of the three groups were compared with those of the deficiency group. According to the prognosis of 28 days, the children were divided into two groups: the improved group and the worse group. Results the levels of IL-2RU IL-4 and IL-6 in children with sepsis were higher than those in control group (P < 0.05). The level of IL-10 was lower than that of control group (P 0.05). In the deficiency group, the level of IL-4 and IL-6 in the deficiency group was higher than that in the sufficient group and the level of IL-10 was lower than that in the sufficient group (P 0.05). The level of IL-6 in the deficiency group was higher than that in the deficient group. The level of IL-10 was lower than that of deficiency group (P 0.05). Finally, 9 cases of sepsis children deteriorated within 28 days, the other 41 cases improved. The level of IL-6 was higher than that of the improvement group (P 0.05), while the level of 25-OH-Vit Dnil 10 was lower than that of the improvement group (P 0.05). Spearman correlation analysis showed that the level of IL-10 was lower than that in the improved group. The serum level of 25-OH-Vit D in septic children was negatively correlated with the deterioration rate of 28 days, and the level of IL-6 in serum was negatively correlated with that of r-0.345 (P0.05). R-0.264 (P0.05); R-0.394P0.05; There was a positive correlation between the level of IL-10 and the level of IL-10. The results of multivariate Logistic regression analysis showed that there was a positive correlation between the level of IL-10 and the level of P0. 05% (P 0. 05). The level of 25-OH-Vit D was an independent factor influencing the prognosis of children with sepsis (P0.05). Conclusion 25-OH-Vit D is an independent predictor of prognosis in children with severe sepsis. Vitamin D may affect the immune function of children with severe sepsis. Proinflammatory / anti-inflammatory factors balance to lead to the onset and prognosis of sepsis.
【作者单位】：浙江省瑞安市人民医院温州医科大学附属第三医院;
【基金】：温州市科技计划项目(Y20160238)
【分类号】：R720.597
【正文快照】： 儿童脓毒症是感染性疾病中一种常见且病死率较高的疾(1)符合本研究采用的脓毒症诊断标准,本研究使用的儿童病。在经济发达的美国,每年有70多万人发病,20多万人死脓毒症诊断标准来自2012年版儿童严重脓毒症与脓毒性休克亡,病死率高达30%~50%[1]。脓毒症是病原体与宿主免疫治疗

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