血清维生素D与儿童社区获得性肺炎的相关性研究

Correlation research of serum vitamin D and community-acquired pneumonia in children

目的分析血清维生素D与儿童社区获得性肺炎（CAP）的相关性,探讨其在判断儿童CAP病情严重程度上的意义。方法选取194例儿童CAP,按照疾病程度分：重症CAP患儿20例（Ⅰ组）和普通CAP患儿174例（Ⅱ组）,另外按照1∶1匹配选取门诊体检的正常儿童194例为对照组（Ⅲ组）。测定三组儿童的血清25-（OH）D3水平、血浆C反应蛋白（CRP）、血沉（ESR）、血常规、动脉血气,记录CAP患儿的急性病生理学和长期健康评价评分Ⅱ（APACHEⅡ）评分。采用ROC曲线评价血清25-（OH）D3对儿童重症CAP的诊断价值。结果三组间血清25-（OH）D3水平、Pa O2、CRP、WBC计数、ESR、PMN%、APACHEⅡ评分比较,差异均有统计学意义（F分别=4.53、199.47、476.92、175.90、801.71、35.57、219.86,P均〈0.05）。Pearson相关分析显示：血清25-（OH）D3水平与CRP、WBC计数、ESR、PMN%、APACHEⅡ评分呈负相关（r分别=-0.46、-0.27、-0.22、-0.12、-0.21,P均〈0.05）,而与Pa O2呈正相关（r=0.38,P〈0.05）。多因素logistic回归分析显示：血清25-（OH）D3水平是儿童重症CAP的高危因素;ROC曲线分析显示：血清25-（OH）D3对预测儿童重症CAP有较好的临床价值（曲线下面积为0.86,95%CI为0.76-0.94,P〈0.05）。结论血清维生素D不足或缺乏与儿童CAP病情严重程度密切相关,并且是重症CAP的高危因素,早期检测血清25-（OH）D3水平对于评估病情具有一定的临床意义。

Objective To analyze correlation between serum vitamin D and community-acquired pneumonia（CAP） in children and discusses its clinical value in evaluating the degree of CAP. Methods A total of 194 cases of children with CAP were selected and randomly divided into severe CAP group with 20 cases, common CAP group with 174 cases; control group included 194 cases of normal children. The serum 25-（OH） D3 level, serumc-reactive protein（CRP）,blood sedimentation（ESR）, blood routine, arterial blood gas were detected, and acute physiology and chronic health evaluation score Ⅱ（APACHEⅡ） score were recorded. The diagnostic value of serum 25-（OH） D3 level for CAP was evaluated by ROC curve. Results The serum 25-（OH）D3 level, Pa O2, CRP, WBC count, ESR, PMN%, APACHEⅡ among three groups were statistically different（F=4.53,199.47, 476.92, 175.90, 801.71, 35.57, 219.86,P〈0.05）. Pearson correlation analysis showed that serum 25-（OH）D3 level was negatively correlated with CRP, WBC count, ESR, PMN%, APACHEⅡscore（r=-0.46,-0.27,-0.22,-0.12,-0.21,P〈0.05） while positively correlated with Pa O2（r=0.38,P〈0.05）. The multivariable logistic regression analysis showed that serum 25-（OH）D3 level was high risk factor of severe CAP. The ROC curve analysis showed that serum 25-（OH）D3 had good diagnostic value for severe CAP（area under the curve was 0.86,95% CI was 0.76-0.94, P〈0.05）. Conclusion Serum vitamin D is closely related to severity of CAP in children and a high risk factor for severe CAP. Early detection of serum vitamin D has clinical significances in evaluating degree of CAP to some extent.