维生素D与儿童社区获得性肺炎免疫功能的关系

发布时间：2018-02-14 06:34

本文关键词： 维生素D 免疫功能社区获得性肺炎儿童　出处：《北京协和医学院》2017年硕士论文　论文类型：学位论文

【摘要】：目的探索维生素D与儿童社区获得性肺炎(Community-acquired pneumonia,CAP)免疫功能、炎症指标及住院时间的关系。方法1.研究对象:2011.01-2012.12在首都儿科研究所附属儿童医院治疗的29日龄-16岁CAP儿童共797例,其中完善免疫学指标的为367例,于住院24至48小时内采用化学发光法测定血清25(OH)D水平,流式细胞法测定CD3、CD4、CD8、CD4/CD8、CD19、Thl、Th2及Th17水平,免疫散射比浊法测定血清IgG、IgA及IgM水平,入院当日测定感染指标白细胞(White Blood Cell,WBC)、C反应蛋白(C-reactive Protein,CRP)及降钙素(Procalcitonin,PCT)水平,并记录患儿住院时间;2.分组:根据血25(OH)D水平,将CAP患儿分为充足组、不足组、缺乏组、严重缺乏组;3.明确不同组别CAP患儿免疫指标的差异,了解25(OH)D水平与差异免疫指标的关系;4.分析不同组别炎症指标及住院时间的差异。结果1.共367例CAP儿童纳入研究,平均年龄为3.5±3.3岁,男244例,女123例;2.充足组、不足组、缺乏组及严重缺乏组血清25(OH)D水平中位数(Q25,Q75)分别为:35.0(36.6,40.3)ng/ml、24.5(24.0,25.1)ng/ml、14.8(14.2,15.2)ng/ml及 7.0(6.3,7.4)ng/ml。3.充足组、不足组、缺乏组、严重缺乏组CD19分别为25.5± 11.7%、24.2± 10.8%、22.3± 12.3%及20.5± 12.5%,组间总体差异显著,严重缺乏组CD19低于充足组,p0.05;充足组、不足组、缺乏组、严重缺乏组CD3分别为63.7±11.5%、63.5±13.0%、66.6±12.5%及66.7±15.7%,组间总体差异显著,严重缺乏组CD3高于充足组,p均0.05;充足组、不足组、缺乏组、严重缺乏组Th17分别为0.4±0.4%、0.4±0.3%、0.6±0.5%及0.7±0.81%,组间总体差异显著,严重缺乏组和缺乏组Th17高于充足组,p均0.05;其余免疫指标在各组间无显著差异;4.充足组、不足组、缺乏组及严重缺乏组血清CRP水平分别为:22.1±35.4mg/L、23.9±38.2mg/L、37.9±56.2mg/L 和 50.6±71.0mg/L,严重缺乏组 CRP 高于其他各组,p均0.05;充足组、不足组、缺乏组及严重缺乏组PCT分别为:0.6±0.9ng/d1、1.9±3.8ng/d1、1.6±3.6ng/d1、8.8±33.9ng/d1,严重缺乏组 PCT 高于其他各组,p 均0.05。5.住院时间:严重缺乏组平均住院时间12.5±7.2天,充足组平均住院时间9.4±5.6天,两组之间具有统计学差异(P0.001)。结论1.维生素D严重缺乏组CD19低于充足组,维生素D缺乏组CD3高于充足组;2.维生素D严重缺乏组和缺乏组Th17高于充足组;3.维生素D严重缺乏组CRP、PCT高于其他组;4.维生素D严重缺乏组住院时间较充足组长。
[Abstract]:Objective to explore the relationship between vitamin D and immune function, inflammatory indexes and hospital stay in children with community-acquired pneumonia. Methods: 1. A total of 797 CAP children aged between 29 days and 16 years old were treated in the Children's Hospital affiliated to the Capital Institute of Pediatrics from January to February 2011.Methods: a total of 797 children aged between 29 days and 16 years old were enrolled in the study. Among the 367 cases with perfect immunological indexes, the serum levels of 25 OHH were measured by chemiluminescence assay during 24 to 48 hours of hospitalization, the levels of CD3, CD4, CD8, CD4 / CD8, CD19, Th1, Th2 and Th17 were measured by flow cytometry, and the levels of IgA and IgM in serum were determined by immunoturbidimetry. On the day of admission, the levels of White Blood Blood Cell-C reactive protein (CRP) and calcitonin Procalcitonin (PCT) were measured, and the duration of hospitalization was recorded 2.The children with CAP were divided into sufficient group, insufficient group and lack group according to the blood 25 OHH D level. To understand the relationship between the level of 25 OHH D and the differential immunological index. 4. To analyze the difference of inflammation index and length of stay in different groups. Results 1. A total of 367 children with CAP were included in the study. The mean age was 3.5 卤3.3 years old, 244 males and 123 females. The median serum levels of 25 OHHU D in adequate, deficient, deficient and severe deficiency groups were:: 35.036.6ng / ml 24.025.1ngr / ml 14.8ng/ ml 14.2ngrml and 7.06.37.4ngg.3. sufficient group, deficient group, deficient group, The CD19 of severe deficiency group was 24.2 卤10.8 and 22.3 卤12.3% and 20.5 卤12.5, respectively. The CD19 of severe deficiency group was lower than that of sufficient group (p 0.05), and the CD3 of sufficient group, deficiency group, deficiency group and severe deficiency group was 63.7 卤11.5 卤63.5 卤13.06.6 卤12.5% and 66.7 卤15.7, respectively. The CD3 of severe deficiency group was higher than that of sufficient group (P 0.05), the Th17 of sufficient group, insufficient group, deficiency group and severe deficiency group were 0.4 卤0.4 卤0.3 卤0.3 卤0.6 卤0.5% and 0.7 卤0.81, respectively. The overall difference between the two groups was significant. The Th17 of severe deficiency group and deficiency group were higher than that of sufficient group (0.05), and the other immunological indexes had no significant difference among groups. The serum CRP levels in the deficiency group and the severe deficiency group were 23.9 卤38.2 mg / L, 37.9 卤56.2 mg / L and 50.6 卤71.0 mg / L, respectively. The CRP levels in the severe deficiency group were higher than those in the other groups (P < 0.05). The PCT of the deficiency group and the severe deficiency group were 1.9 卤3.8ng / d 1.96 卤3.6ng / d 1.88 卤33.9ng / d 1, respectively. The PCT of the severe deficiency group was higher than that of the other groups (P < 0.05). The average hospitalization time was 12.5 卤7.2 days in the severe deficiency group and 9.4 卤5.6 days in the sufficient group. There was a statistical difference between the two groups (P 0.001). Conclusion 1.The CD19 of the group with severe vitamin D deficiency is lower than that of the group with sufficient vitamin D. The CD3 of vitamin D deficiency group was higher than that of adequate group 2. The Th17 of severe vitamin D deficiency group and deficiency group was higher than that of adequate group 3. The CD3 of vitamin D severe deficiency group was higher than that of other groups.
【学位授予单位】：北京协和医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R725.6

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