重症患者疾病严重程度与维生素D水平的相关性研究

Relationship between APACHE Ⅱ scores and vitamin D levels in critical ill patients

目的观察危重患者血清25-羟维生素D水平与各种疾病严重程度的相关性。方法收集入住ICU病房时间超过48 h、年龄≥18岁的患者作为观察资料。根据入科24 h内急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分分为2组(APACHEⅡ评分<20分组、APACHEⅡ评分≥20分组),比较2组患者次日清晨血清25-羟维生素D水平、乳酸水平及住ICU时间、28 d病死率等指标的差异;并选择同期门诊体检患者60例作为健康人群组,比较健康人群与危重症患者之间25-羟维生素D水平有无差异。结果共纳入患者114例,APACHEⅡ评分<20分患者74例、APACHEⅡ评分≥20患者40例。2组血清维生素D_3水平分别为(7.77±4.30)ng/m L、(4.95±2.29)ng/m L(P<0.05),乳酸水平分别为(2.17±1.40)mmol/L、(3.76±2.80)mmol/L(P<0.05),白细胞计数分别为(10.73±3.56)×10~9/m L、(13.68±4.23)×10~9/m L(P<0.05),住ICU时间分别为(5.19±2.73)d、(7.20±3.03)d(P<0.05),28 d病死率分别为0%、20%,上述变量在2组间差异有统计学意义;血清25-羟维生素D_3与APACHEⅡ评分呈明显负相关性(r=-0.275,P<0.05)。健康人群组60例,其血清维生素D_3水平中位数为16.48 ng/m L,与危重症患者比较差异有统计学意义(P<0.05)。结论健康人群、危重症患者普遍存在维生素D_3不足或者缺乏,危重症患者更加明显,随着病情的危重程度加重,维生素D_3水平逐渐减低。

Objective To investigate the relationship between serum 25 - hydroxyvitamin D and different APACHE Ⅱ scores in critically ill patients. Methods The data of patients aged over 18 years who were admitted to ICU from August 2014 to April 2015 in General Hospital of Ningxia Medical University were collected for observation. （ APACHE Ⅱscore 〈 20, APACHE Ⅱ score 〉 or = 20） were divided into two groups according to the acute physiology and chronic health evaluation Ⅱ （APACHE Ⅱ ） scores within 24 hours after admission. The serum 25 - vitamin D levels, lactic acid levels and ICU stay time, 28 - day mortality and other indicators were collected, and selected outpatient with physical examination as a normal group, the 25 - hydroxy vitamin D levels was compared between healthy people and critically ill patients. Results A total of 114 patients were enrolled in the study. There were 74 patients with APACHEⅡscore 〈20 and 40 patients with APACHE Ⅱ score 〉120. The levels of serum vitamin D3 were respectively （7.77±4.30） ng/mL, （ 4.95 ± 2.29） ng/mL in two groups （ P 〈 0.05 ）. The lactic acid levels were （ 2. 17 ± 1.4） mmol/L and （ 3.76±2.8） mmol/L （P 〈0.05）. The ICU stay time was（5.19 ± 2.73）days and（7.20 ±3.03）days （P 〈0.05）, and the 28 -day mortality rates were 0% and 20%, respectively. There was a significant difference between the two groups （ r = - 0. 275,P 〈 0.05 ）, and there was a significant negative correlation between the serum 25 - hydroxyvitamin D and the APACHE I[ score. Sixty patients were randomly selected for the same period, the serum Vitamin D3 level was 16. 48 ng/mL, which was significantly different with critically ill patients. Conclusion Healthy people, critically ill patients generally insufficiency or deficiency of 25 - hydroxyvitamin D level, and critically ill patients are more obviously. With the severity of the disease increasing, the level of vitamin D3 gradually are decreasing.