外周血维生素D水平在评价危重症患者机械通气撤机结局的临床价值

Clinical value of peripheral blood vitamin D level in predicting the outcome of weaning from mechanical ventilation in critically ill patients

目的探讨外周血维生素D水平在评价危重症患者机械通气撤机结局的临床价值。方法选择2014年6月至2017年6月我院收治的危重症机械通气时间>48 h患者130例为研究对象。收集入院时和自主呼吸测试(SBT)前的血清25-羟基维生素D3[25(OH)D3]水平,同时记录患者一般临床资料和实验室检查指标。按照撤机结局将患者分为撤机成功组和撤机失败组。采用Logistic回归方程分析维生素D水平与撤机失败的关系,并利用受试者工作特征(ROC)曲线评估其对撤机失败的预测价值。结果纳入的130例患者中,撤机失败46例(35.38%);与撤机成功组比较,撤机失败组急性生理学和慢性健康状况评分系统Ⅱ评分偏高,住重症监护病房时间较长,SBT前呼吸频率、呼吸浅快指数、C反应蛋白、N-末端脑钠肽前体、血肌酐均偏高,白蛋白偏低,两组比较差异有统计学意义(均P<0.05)。撤机失败组入院时、SBT前25(OH)D3水平分级均差于撤机成功组(均P<0.05);撤机失败组入院时、SBT前血清25(OH)D3水平均低于撤机成功组[入院时:(18.16±4.33)ng/ml比(21.60±5.25)ng/ml,P<0.05;SBT前:(13.50±3.52)ng/ml比(18.61±4.30)ng/ml,P<0.05]。多元Logistic回归分析显示入院时、SBT前25(OH)D3缺乏是撤机失败的独立危险因素(OR值分别为2.257、2.613,均P<0.05)。ROC曲线分析显示入院时、SBT前25(OH)D3水平预测的ROC曲线下面积分别为0.772和0.836,敏感性分别为80.3%和85.2%,特异性分别为69.0%和71.0%。结论危重症患者25(OH)D3不足或缺乏较为常见,其水平越低则撤机失败风险越高,可能是撤机失败的独立预测因素。

Objective To investigate the clinical value of peripheral blood vitamin D level in predicting the outcome of weaning from mechanical ventilation in critically ill patients. Methods A total of 130 critically ill patients who undergoing mechanical ventilation for more than 48 hours in our hospital were recruited from June 2014 to June2017. Serum 25（OH）D3 was detected on admission and before spontaneous breathing test（SBT） meanwhile general clinical data and laboratory examination indexes were recorded. The cases were divided into a successful weaning group and a failure weaning group according to the outcome of weaning from mechanical ventilation. Logistic regression equation was used to analyze the relationship between vitamin D level and failure weaning, and a receiver operating characteristic（ROC） curve was used to analyze the predictive value for failure weaning. Results There were 46 patients with failure weaning among 130 patients（35.38%）. Compared with the successful weaning group, the failure weaning group had significantly higher Acute Physiology and Chronic Health EvaluationⅡ score, longer duration in intensive care unit, higher respiratory rate, higher rapid shallow breathing index, higher C-reactive protein, higher N-terminal prohormone of brain natriuretic peptide, higher serum creatinine, and significantly lower albumin（all P〈0.05）. 25（OH）D3 level classifications on admission and before SBT in the failure weaning group were worse than those in the successful weaning group（P〈0.05）. 25（OH）D3 levels of the failure weaning group were lower than those of the successful weaning group [on admission：（18.16±4.33） ng/ml vs.（21.60±5.25） ng/ml, P〈0.05; before SBT：（13.50±3.52） ng/ml vs.（18.61±4.30） ng/ml, P〈0.05]. Multivariate logistic regression analysis showed that 25（OH）D3 levels on admission and before SBT were independent risk factors for failure weaning（OR values were 2.257 and 2.613, respectively, both P〈0.05）. ROC curve analysis showed that areas under ROC curve were 0.772 and 0.836, respectively, with sensitivities of 80.3% and 85.2%,specificities of 69.0% and 71.0%, respectively. Conclusions 25（OH）D3 deficiency or insufficiency is common in critically ill patients. The lower the level of vitamin D, the higher the risk of failure weaning. So it may be an independent predictor of failure weaning.