老年危重症患者血清维生素D水平与APACHEⅡ评分和预后的相关性分析

Correlation of Serum Vitamin D Level with APACHEⅡScore and Prognosis in Critically Ill Elderly Patients

目的：探讨老年危重症患者血清1，25羟-维生素D3[1，25（OH）2D3]水平与急性生理功能和慢性健康状态Ⅱ（ APACHEⅡ）评分及预后的相关性，为临床治疗提供参考。方法老年危重症患者196例，检测入院第1天血清1，25（OH）2D3水平及住ICU第1个24 h的APACHEⅡ评分。根据APACHEⅡ评分分为3组：A组67例（ APACHEⅡ评分≤15分），B组89例（ APACHEⅡ评分16～25分），C组40例（ APACHEⅡ评分＞25分）；根据追踪结果，分为存活组54例与死亡组142例。结果血清1，25（OH）2D3水平依次为A组＞B组＞C组（P ＜0．05）。器官衰竭数量依次为 A 组＜B 组＜C 组（P ＜0．05）。 A、B、C 组院内死亡率分别为2．99％（2／67）、30．34％（27／89）、62．50％（25／40），3组比较，差异有统计学意义（P＜0．05）。院内死亡率依次为A组＜B组＜C组（P＜0．05）。死亡组血清1，25（OH）2D3明显低于存活组（P＜0．05），APACHEⅡ评分、器官衰竭数量明显大于存活组（P＜0．05）。老年危重症患者血清1，25（OH）2D3水平与APACHEⅡ评分呈负相关关系（P＜0．05），与院内死亡率呈正相关关系（P＜0．05）。结论血清1，25（OH）2D3水平结合APACHEⅡ评分可作为评价老年危重症患者病情及预后的重要指标。

Objective To investigate the correlation of serum 1,25 hydroxy-vitamin D3[1,25（OH）2D3]level with acute physiology and chronic health evaluationⅡ（ APACHEⅡ） score and prognosis in critically ill elderly patients to provide guidance for clinical treatment .Methods One hundred and ninety-six elderly critically ill patients were tested for the serum 1,25（OH）2D3 level on the first day of admission and APACHEⅡscore in the first 24 hours in intensive medicine （ ICU） .The patients were divided into 3 groups according their APACHEⅡ scores,67 cases in group A（APACHEⅡscore≤15）,89 cases in group B（APACHEⅡ score≥16 and ≤25） and 40 cases in group C （ APACHEⅡ score 〉25 ） .The patients were divided into survival group （ 54 cases ） and death group （ 142 cases ） according to the results of the treatment.Results The serum 1,25（OH）2D3 level was higher in group A in contrast with that in group B ,which was higher in group B in contrast with that in group C （ P〈0 .05 ） .However ,the sequence of the numbers of organ failure was group A 〈group B〈group C（P〈0.05）.The hospital mortalities in groups A,B, C were 2.99%（2/67）,30.34%（27/89）and 62.50%（25/40）,respectively,there was significant difference among three groups （ P〈0 .05 ） .The hospital mortality was the highest in group C ,and was the lowest in group A （ P〈0 .05 ） . The serum 1,25（OH）2D3 level in the death group was significantly lower than that in the survival group （P〈0.05）, while the APACHEⅡscore and numbers of organ failure were larger than those in the survival group （ P〈0 .05 ） .The serum 1,25（OH）2D3 level negatively correlated with APACHEⅡ score（P 〈0.05）,but positively correlated with hospital mortality（P〈0.05） in critically ill elderly patients（P〈0.05）.Conclusion Serum 1,25（OH）2D3 level and APACHE Ⅱscore can be the important indicators for evaluating the severity and prognosis of critically ill elderly patients .