血清25-OH-维生素D在儿童脓毒症发病机制中的研究

Effect of Serum 25-OH-VitD in the Pathogenesis of Sepsis in Children

目的探讨血清25-OH-维生素D(25-OH-Vit D)在儿童脓毒症中的发病机制。方法选取2016年1月—2017年1月在瑞安市人民医院儿科病房被确诊为脓毒症的患儿50例为试验组,对照组为同期体检正常儿童50例。检测其血清25-OH-Vit D水平和白介素(IL)-2R、IL-4、IL-6、IL-10水平。根据患儿血清25-OHVit D水平将其分为3组:充足组、不足组和缺乏组。比较3组患儿的观察指标。再根据28 d后的预后状态将患儿分为好转组和恶化组,确定影响脓毒症患儿预后的独立危险因素。结果充足组、不足组、缺乏组患儿IL-2R、IL-4、IL-6水平高于对照组,IL-10水平低于对照组(P<0.05);不足组、缺乏组患儿IL-2R、IL-4、IL-6水平高于充足组,IL-10水平低于充足组(P<0.05);缺乏组患儿IL-2R、IL-4、IL-6水平高于不足组,IL-10水平低于不足组(P<0.05)。50例脓毒症患儿最终有9例在28 d以内恶化,其余41例患儿好转。恶化组患儿IL-2R、IL-4、IL-6水平高于好转组(P<0.05),而25-OH-Vit D、IL-10水平低于好转组(P<0.05)。Spearman相关分析显示,脓毒症患儿血清25-OH-Vit D水平与28 d恶化率、血清中IL-2R、IL-4、IL-6水平呈负相关(r=-0.345,P<0.05;r=-0.264,P<0.05;r=-0.394,P<0.05;r=-0.615,P<0.05),与IL-10水平呈正相关(r=0.151,P<0.05)。多因素Logistic回归分析结果显示,25-OH-Vit D水平为影响脓毒症患儿预后的独立影响因素(P<0.05)。结论 25-OH-Vit D为影响严重脓毒症患儿预后的独立预测因素。维生素D可以通过影响机体的免疫功能、促炎/抗炎因子平衡来导致脓毒症的发病和预后。

Objective To explore the effect of serum 25-OH-VitD in the pathogenesis of sepsis in children.Methods Fifty patients who were diagnosed as sepsis in the Pediatric Ward of Ruian People’ s Hospital from January 2016 to January 2017 were selected as the experimental group,during the same period 50 normal children as the control group. Serum 25-OH-VitD,IL-2R,IL-4,IL-6 and IL-10 levels were detected. The children were divided into 3 groups according to their serum 25-OH-VitD levels： adequate group,insufficient group and lack group. The observation indexes of the 3 groups were compared. Then according to the prognosis of patients after 28 d,the children were divided into the improved group and the worsening group,to determine the independent risk factors affecting the prognosis of sepsis in children. Results The levels of IL-2R,IL-4 and IL-6 in the children in the adequate group,insufficient group and lack group were higher than that in the control group,and the level of IL-10 was lower than that in the control group（ P 〈 0. 05）. The levels of IL-2R,IL-4 and IL-6 in the children in the insufficient group and the lack group were higher than that in the adequate group,and the level of IL-10 was lower than that in the adequate group（ P 〈 0. 05）. The levels of IL-2R,IL-4 and IL-6 in the children in the lack group were higher than those in the insufficient group,and the level of IL-10 was lower than that in the insufficient group（ P 〈0. 05）. In 50 children with sepsis,9 cases deteriorated within 28 d,and the other 41 cases improved. The levels of IL-2R,IL-4 and IL-6 in the worsening group were higher than those in the improved group（ P 〈 0. 05）,while the levels of 25-OH-VitD and IL-10 were lower than those in the improved group（ P 〈 0. 05）. Spearman correlation analysis showed that the levels of serum 25-OH-VitD in children with sepsis were negatively correlated with the rate of 28 d deterioration,serum IL-2R,IL-4 and IL-6 levels（ r =-0. 345,P 〈 0. 05; r =-0. 264,P 〈 0. 05; r =-0. 394,P 〈 0. 05; r =-0. 615,P 〈 0. 05）,positive correlation with IL-10 levels（ r = 0. 151,P 〈 0. 05）. Multivariate Logistic regression analysis showed that 25-OH-VitD levels were independent prognostic factors in children with sepsis（ P 〈 0. 05）. Conclusion 25-OH-VitD were independent predictors of prognosis in patients with severe sepsis. Vitamin D can affect the immune function of the body and the balance of pro-inflammatory/anti-inflammatory factors to lead to the pathogenesis and prognosis of sepsis.