血清25-(OH)D_3水平与儿童社区获得性肺炎严重程度及免疫功能相关性研究

Study on the correlation among serum 25-(OH)D_3 level,the severity and immune function of community-acquired pneumonia in children

目的分析不同严重程度肺炎的患儿25-羟维生素D_3[25-(OH)D_3]、体液免疫及细胞免疫水平,研究血清25-(OH)D_3水平与儿童社区获得性肺炎(CAP)严重程度及免疫功能的相关性。方法收集2016年3月-2017年3月在首都儿科研究所附属儿童医院收治的175例CAP患儿作为病例组,根据病情严重程度分为重症肺炎组(n=87),轻症肺炎组(n=88)。同期采用随机数字法收集在本院保健科进行健康体检的100例健康儿童作为对照组。测定3组儿童的血清25-(OH)D_3水平,同时检测所有肺炎组患儿白细胞计数、中性粒细胞及淋巴细胞比例、血浆C反应蛋白(CRP)、降钙素原(PCT)、体液免疫(IgA、IgG、IgM),细胞免疫(CD4、CD8、CD19、CD16/56)水平,并分析血清25-(OH)D_3水平与炎性细胞及免疫功能之间的相关性。结果重症肺炎组、轻症肺炎组和对照组血清25-(OH)D_3水平差异有统计学意义(F=76.95,P<0.05),轻、重症肺炎组间白细胞计数、CRP、PCT、IgG比较差异有统计学意义(P均<0.05)。Pearson相关分析结果显示血清25-(OH)D_3水平与白细胞总数呈负相关(r=-0.307,P<0.05)。多因素Logistic回归分析显示,25-(OH)D_3和IgG水平是儿童重症社区获得性肺炎的高危因素。结论血清25-(OH)D_3与IgG水平与儿童社区获得性肺炎病情严重程度关系密切,重症肺炎患儿血清25-(OH)D_3与IgG水平明显低于轻症肺炎组,检测患儿的血清25-(OH)D_3和IgG水平对于疾病的早期评估有重要的意义。

Objective To investigate the serum levels of 25-（OH）D3,humoral immunity and cellular immunity in children with severe and mild pneumonia,and to explore the correlation among serum 25-（OH）D3 level,the severity and immune function of community-acquired pneumonia（CAP）in children. Methods A total of 175 CAP patients were enrolled in Children′s Hospital Affiliated to Capital Institute of Pediatrics from March 2016 to March 2017,and were divided into severe pneumonia group（n=87）and mild pneumonia group（n=88）.Also,100 healthy children who performed health examination in this hospital were selected as control group by random number method.The levels of serum 25-（OH）D3,white blood cell count,neutrophil and lymphocyte ratio,C-reactive protein（CRP）,procalcitonin（PCT）,humoral immunity（IgA,IgG,IgM）,and cellular immunity（CD4,CD8,CD19,CD16/56）were measured.And the correlations among serum25-（OH）D3 level,inflammatory cells and immune function were analyzed. Results The levels of serum 25-（OH）D3 were significantly different among severe pneumonia group,mild pneumonia group and control group（F=76.95,P〈0.05）.There were significant differences on the white blood cell count,CRP,PCT and IgG levels between severe pneumonia group and mild pneumonia group（all P〈0.05）.Pearson analysis indicated that serum 25-（OH）D3 level was negatively correlated with total white blood cell count（r=-0.307,P〈0.05）.Multifactor analysis showed that 25-（OH）D3 and IgG levels were the risk factors of severe community-acquired pneumonia in children. Conclusions Serum 25-（OH）D3 and IgG levels are associated with CAP in children.The levels of serum 25-（OH）D3 and IgG in children with severe pneumonia are significantly lower than those in mild pneumonia group.So it is of great significance to test serum levels of 25-（OH）D3 and IgG for early assessment of pneumonia.