危重患儿维生素 D 缺乏与病情严重程度和预后的关系

The prevalence of vitamin D deficiency and its relationship with the severity and prognosis in critically ill chil-dren

目的：调查危重患儿血清维生素 D 缺乏情况以及与病情严重程度、预后的关系。方法将2010年11月1日至12月9日入住首都医科大学附属北京儿童医院重症监护病房的83例危重患儿作为研究对象。采用酶联免疫吸附法（ELISA）检测血清1，25-二羟维生素 D 浓度。测量身高/身长、体质量等参数，记录原发病、儿童危重病例评分（PCIS）、儿童死亡危险评分（PRISM）、多脏器功能障碍综合征（MODS）发生率、机械通气使用率、住院时间、28 d 是否存活等临床资料进行总结分析。结果本组患儿入院时维生素 D 缺乏共32例，维生素 D 缺乏率为38.6%；不同原发疾病组的维生素 D 水平比较差异无统计学意义（P =0.815）。营养不良组维生素 D 缺乏率高于营养正常组[60.0%（12/20例）比40.0%（8/20例），χ2=5.989，P =0.014]，维生素 D 正常组的 PCIS 评分高于维生素 D 缺乏组[（80.47±6.18）分比（77.16±7.59）分，P =0.022]。PCIS 评分与维生素D 水平呈明显正相关（r =0.267，P =0.015）。维生素 D 正常组与维生素 D 缺乏组的 PRISM 评分、MODS 发生率、机械通气使用率、住院时间及28 d 存活率间比较差异均无统计学意义（P 均﹥0.05）。结论危重患儿有较高的维生素 D 缺乏率。营养不良患儿中维生素 D 缺乏发生率更高。维生素 D 水平与患儿危重程度相关，与预后关系不明显。

Objective To investigate the prevalence of vitamin D deficiency and to examine its relationship with the severity and prognosis in the critically ill children. Methods A total of 83 critically ill children admitted from November 1,2010 to December 9,2010 to Pediatric Intensive Care Unit in Beijing Children＇s Hospital,Capital Medical University were enrolled in the study. Serum 1,25 - Dihydroxyvitamin D concentration was measured by using an en-zyme - linked immunosorbent assay（ELISA）. Anthropometric parameters such as height/ length and weight of the chil-dren were measured. Data collection also included primary disease,Pediatric Critical Illness Score（PCIS）,the Pediatric Risk of Mortality Ⅲ（PRISM Ⅲ）score,multiple organ dysfunction syndrome（ MODS）rate,mechanical ventilation rate,time of hospital of stay and the 28 - day survival rate. Results There were 32 cases with vitamin D deficiency on admission,vitamin D deficiency rate on admission was 38. 6% ,and there was no statistically significant difference among different primary disease groups（P = 0. 815）. Vitamin D deficiency rate of malnutrition group was lower than that of the normal group[60. 0%（12 / 20 cases）vs 40. 0%（8 / 20 cases）,χ2 = 5. 989,P = 0. 014]. PCIS scores of those with a normal vitamin D status was higher than those of the vitamin D deficiency group,showing a significant difference [（80. 47 ± 6. 18）scores vs（77. 16 ± 7. 59）scores,P = 0. 022]. PCIS score was positively correlated with the vitamin D level（r = 0. 267,P = 0. 015）. There was no statistically significant difference among the PRISM score,MODS rate, mechanical ventilation rate,hospital stay length and the 28th day survival rate between the normal vitamin D group and the vitamin D deficiency group（all P ﹥ 0. 05）. Conclusions A high prevalence of vitamin D deficiency is found in the critically ill children. The prevalence of vitamin D deficiency in children with malnutrition is higher. Vitamin D status may be correlated to the severity of the critically ill children,but the association with the prognosis is not obvious.