危重症患儿25-羟基维生素D、维生素D结合蛋白测定及临床意义

发布时间：2018-05-20 19:40

本文选题：危重患儿 + 25(OH)D　；参考：《广西医科大学》2017年硕士论文

【摘要】：目的了解儿科重症监护病房(PICU)危重患儿25-羟基维生素D(25(OH)D)及维生素D结合蛋白(VBDP)水平,分析其临床意义及预后的关系。方法收集2015年2月-2016年7月入住广西医科大学第一附属医院儿科重症监护病房(PICU)符合条件危重症患儿295例为研究对象(研究组);同期收集广西医科大学第一附属医院儿科门诊体检正常儿童44例作为对照(对照组)。研究组患儿于住院第1d和第7d各抽2份2ml血,1份采用电化学发光法检测血清25(OH)D水平,1份采用酶联免疫法检测VDBP水平;对照组正常儿于入组当天抽取2份2ml血,采用相同方法检测25(OH)D和VDBP水平。根据25(OH)D水平,将患儿分为25(OH)D充足组、25(OH)D不足组、25(OH)D缺乏组。比较研究组和对照组25(OH)D和VDBP水平;分析研究组主要系统疾病25(OH)D和VDBP水平情况;分析研究组入院第1天25(OH)D与VDBP水平、年龄、血清总Ca、BMI、PRISM III评分、器官衰竭率、机械通气率、第28d病死率之间的关系;入住第1天和第7天的25(OH)D、VDBP水平和PRISM III评分的差异;分析住PICU危重症患儿存活与死亡组25(OH)D、VDBP水平、PRISM III评分的差异。结果(1)研究组危重患儿295例,男175例(59.3%)、女120例(40.7%),年龄中位数为1.5(岁),对照组正常儿童44例,男23例(52.3%),女21例(47.3%),年龄中位数为3.0(岁),两组比较差异无统计学意义(P0.05);(2)各系统疾病25(OH)D水平缺乏率、VDBP水平低下无统计学意义(P0.05);(3)研究组较对照组25(OH)D、VDBP水平偏低下,差异有统计学意义(P0.05);(4)研究组中25(OH)D充足、不足、缺乏组间血清总钙、VDBP、BMI、第28d病死率、器官衰竭率、机械通气率比较差异无统计学意义(P0.05),缺乏组较不足和充足组患儿年龄稍大、住PICU时间更长、PRISM III评分更高,差异有统计学意义(P0.05);(5)入住PICU第1d较第7d 25(OH)D、VDBP水平低下,PRISM III评分更高,比较差异有统计学意义(P0.05);(6)295例危重患儿中,第28d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、PRISM III评分更高,差异有统计学意义(P0.05),死亡与存活组VDBP水平差异无统计学意义(P0.05)。结论:1.本组资料提示危重患儿存在25(OH)D、VDBP水平不足及缺乏,特别是脓毒症或MODS及外科疾病患儿缺乏明显。2.25(OH)D水平不足及缺乏的危重症患儿PRISM III评分越高,住PICU时间越长及28d死亡率更高。3.危重症患儿随着病情好转,PRISM III评分下降,其25(OH)D及VDBP水平有所升高。
[Abstract]:Objective to investigate the levels of 25-hydroxyvitamin D (25-hydroxyvitamin D) and vitamin D binding protein (VBDP) in critically ill children in pediatric intensive care unit (PICU), and to analyze the relationship between clinical significance and prognosis. Methods from February 2015 to July 2016, 295 eligible critically ill children admitted to PICU of the first affiliated Hospital of Guangxi Medical University (study group) and the first affiliated department of Guangxi Medical University (Guangxi Medical University) were collected. 44 normal children in pediatric outpatient department were used as control group (control group). In the study group, two samples of 2ml blood samples were taken on the 1st and 7th day of hospitalization respectively. The serum 25(OH)D level was detected by electrochemiluminescence method and the VDBP level was detected by enzyme-linked immunosorbent assay (Elisa) in the control group, and two samples of 2ml blood were taken from the normal children in the control group on the day of admission. 25(OH)D and VDBP levels were detected by the same method. According to the level of 25(OH)D, the children were divided into 25 OHH D deficient group and 25 OHH deficiency group in 25(OH)D sufficient group. The levels of 25(OH)D and VDBP were compared between the study group and the control group, the levels of 25(OH)D and VDBP in the main systemic diseases in the study group were analyzed, and the levels of 25(OH)D and VDBP, age, serum total CaBMI-PRISM III score, organ failure rate, mechanical ventilation rate on the first day of admission were analyzed in the study group. The relationship between fatality rate on the 28th day, the difference of VDBP level and PRISM III score between the first day and the 7th day, and the difference between the survival and death group of 25 OHH DV DBP and III score were analyzed. Results 1) 295 critically ill children in the study group, 175 males and 40.7 females, the median age was 1.5 years old, and 44 normal children in the control group. There were 23 males and 21 females with a median age of 3.0 (P < 0.05). There was no significant difference between the two groups in the deficiency rate of 25(OH)D level and the low level of VDBP. There was no significant difference between the study group and the control group (25 OHDV DBP level was lower than that in the control group.) the level of VDBP in the study group was significantly lower than that in the control group (P < 0.05), and there was no significant difference between the two groups in the level of VDBP and the level of VDBP in the study group (P < 0.05). There was no significant difference in 25(OH)D between the two groups. There was no significant difference in the mortality rate, organ failure rate and mechanical ventilation rate between the two groups. There was no significant difference between the two groups (P 0.05). The age of the children in the deficiency group and sufficient group was a little older than that in the deficiency group, and the age of the children in the deficiency group was a little older than that in the insufficient group. The mortality rate, the organ failure rate and the mechanical ventilation rate were not significantly different between the two groups. The higher the III score of PICU was, the higher the difference was (P 0.05). The lower level of VDBP in the first day of PICU was higher than that in the 7th day. The difference was statistically significant in 6295 critically ill children. On the 28th day, 257 cases survived (87.1%) and 38 cases died (12.9%). The 25(OH)D level in the death group was lower than that in the surviving group, and the III score was higher (P 0.05). There was no significant difference in the VDBP level between the death group and the survival group (P 0.05). Conclusion 1. The data suggested that there were insufficient and deficient VDBP levels in critically ill children, especially in children with sepsis or MODS and surgical diseases. The higher the PRISM III score was, the longer the duration of PICU was and the higher the death rate was at 28d. With the improvement of the condition, the 25(OH)D and VDBP levels of critically ill children decreased with the decrease of PRISM III score.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R720.597

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