维生素D缺乏与脓毒症预后相关性研究

Association between vitamin D deficiency and prognosis of sepsis in patients

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(i PTH)、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,APACHEⅡ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<20μg/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。

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,APACHE Ⅱ score,serum procalcitonin,intact parathyroid hormone（ i PTH）,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.