血清25(OH)D对脆性髋部骨折患者肺部感染的影响

Effect of serum 25(OH)D on pulmonary infections in patients with fragile hip fracture

目的探究血清维生素25(OH)D含量水平对脆性髋部骨折患者并发肺部感染的影响。方法选取2011年5月-2016年6月于医院进行治疗的脆性髋部骨折患者为研究对象,依据患者肺部感染病理学和影像学检查结果,发生肺部感染患者78例为感染组,无感染患者中抽取78例为对照组;对两组患者的性别、年龄和身高体重等资料进行整理和比较;抽取156例患者空腹静脉血,使用放射免疫法进行维生素25(OH)D浓度检测,比较两组患者维生素25(OH)D含量水平,按照美国内分泌协会2011年颁布的临床实践指南,将维生素25(OH)D浓度分为:0~20、21~30、>30μg/L三个区间,比较两组患者在这三个区间内的例数及构成比;比较感染组患者在治疗前后维生素25(OH)D浓度变化情况。结果对照组患者维生素25(OH)D浓度为(28.4±5.1)μg/L,感染组患者维生素25(OH)D浓度为(17.5±5.9)μg/L;对照组维生素25(OH)D浓度0~20μg/L患者7例占9.0%,21~30μg/L患者66例占84.6%,>30μg/L患者5例占6.4%,感染组维生素25(OH)D浓度0~20μg/L患者63例占80.8%,21~30μg/L患者12例占15.4%,>30μg/L患者3例占3.8%,两组患者数据比较差异有统计学意义(P<0.05);治疗后感染组患者维生素25(OH)D浓度为(23.1±4.7)μg/L,维生素25(OH)D浓度0~20μg/L患者27例占34.6%,21~30μg/L患者45例占57.7%,>30μg/L患者6例占7.7%,相比治疗前(17.5±5.9)μg/L上升,治疗前后数据比较差异有统计学意义(P<0.05。结论当脆性髋部骨折患者血清中维生素25(OH)D含量在30μg/L以下时,患者有可能并发肺部感染,当血清中维生素25(OH)D含量在20μg/L以下时有极大可能并发肺部感染,脆性髋部骨折患者血清中维生素25(OH)D含量水平对患者肺部感染的诊断具有预测价值。

OBJECTIVE To explore the effect of serum vitamin 25（OH）D level on pulmonary infections in patients with fragile hip fracture.METHODS Patients with fragile hip fracture from May 2011 to Jun.2016 in the hospital for treatment were selected as the research objects.According to the pathological and imaging findings of pulmonary infections in the patients,78 cases of pulmonary infections were set as infection group,and 78 cases without infection were randomly set as control group.The data of gender,age and height and weight of the two groups of patients were collected and compared.The fasting venous blood of 156 patients in the morning were extracted,and the concentrations of vitamin 25（OH）D were detected using radioimmunoassay.The vitamin 25（OH）D concentration levels between the two groups were compared.According to the clinical practice guidelines issued by the American Endocrine Society in 2011,vitamin 25（OH）D concentration was divided into three intervals： 0～20,21～30 and 〉30μg/L.The case number and constituent ratio in the three intervals between the two groups were compared,and the vitamin 25（OH）D concentration in infection group before and after treatment was compared.RESULTS The concentration of vitamin 25（OH）D in control group was（28.4 ± 5.1）ug/L,and the concentration of vitamin 25（OH）D in infection group was（17.5±5.9）ug/L.In control group,there were 7 patients（9.0%）with the concentration of vitamin 25（OH）D of 0～20μg/L,66 patients（84.6%）with the concentration of vitamin 25（OH）D of 21～30 μg/L,and 5 patients（6.4%）with the concentration of vitamin 25（OH）D above 30 μg/L.In infection group,there were 63 patients（80.8%）with the concentration of vitamin 25（OH）D of 0～20 μg/L,12 patients（15.4%）with the concentration of vitamin 25（OH）D of 21～30 μg/L,and 3 patients（3.8%）with the concentration of vitamin 25（OH）D above 30μg/L.The differences between the two groups were significant（P〈0.05）.After treatment,the concentration of vitamin 25（OH）D in infection group was（23.1±4.7）μg/L,which was higher than（17.5±5.9）μg/L before treatment,and there were 27 patients（34.6%）with the concentration of vitamin 25（OH）D of 0～20 μg/L,45 patients（57.7%）with the concentration of vitamin 25（OH）D of 21～30 μg/L,and 6 patients（7.7%）with the concentration of vitamin 25（OH）D above 30 μg/L,the differences before and after treatment were significant（P〈0.05）.CONCLUSION When the vitamin 25（OH）D content in patients with fragile hip fracture is below 30 μg/L,patients may have pulmonary infections,and when the serum vitamin 25（OH）D was below 20 μg/L,they are most likely to pulmonary infections.The serum level of vitamin 25（OH）D has predictive value of pulmonary infections in patients with fragile hip fractures.