维生素D与脓毒症致器官功能障碍及预后的关系

Relationship between vitamin D with organ dysfunction induced by sepsis and prognosis

目的探讨经肠内营养途径补充外源性维生素D对脓毒症患者器官功能及预后的影响。方法采用前瞻性随机单盲安慰剂对照研究,共收集入住ICU预计生存期超过7 d的脓毒症患者88例,按照25羟维生素D(25OHD)水平分为维生素D缺乏(<30 nmol·L^-1)和维生素D不足(30~49.9 nmol·L^-1)组。再随机分为治疗组(阿法骨化醇软胶囊0.5μg·d^-1)和安慰剂组(淀粉胶囊0.5μg·d^-1),口服或经胃管、肠内营养管给药,疗程均为7 d。观察干预前后患者血25OHD、钙、磷水平,急性生理功能和慢性健康状况评估Ⅱ(APACHEⅡ)评分、序贯性脏器衰竭评估(SOFA)评分,28 d预后等。结果共80例患者完成试验,维生素D缺乏和不足患者各40例,其中治疗组和安慰剂组各20例。干预后治疗组25OHD水平均有所上升,安慰剂组则下降,但组间比较无显著差异(P>0.05)。干预后治疗组血钙和血磷水平显著高于安慰剂组(P<0.05)。干预后患者APACHEⅡ评分和SOFA评分均下降,治疗组和安慰剂组间无显著差异(P>0.05)。患者28 d病死率治疗组和安慰剂组组间比较亦无显著差异(P>0.05)。试验中未出现过敏、高钙或高磷血症等相关不良反应。结论ICU脓毒症患者维生素D水平不足或缺乏现象严重,给予补充外源性维生素D可提高患者体内钙、磷水平,但对器官功能及28 d预后无改善作用。

AIM To investigate the effect of enteral supplementation of exogenous vitamin D on organ function in patients with sepsis and the effect on calcium,phosphorus and 28-day prognosis.METHODS A prospective randomized,single-blind placebo-controlled study was conducted in 88 patients with sepsis who were admitted to ICU for more than 7 days.According to the level of 25-hydroxyvitamin D(25 OHD),the patients were divided into two groups:vitamin D deficiency(25 OHD<30 nmol·L^-1)and vitamin D insufficient(25 OHD 30-49.9 nmol·L^-1).And then they were randomly divided into two groups:treatment group(alfacalcidol soft capsule 0.5μg·d^-1)and placebo group(starch capsule 0.5μg·d-1),given orally or via gastric tube and enteral nutrition tube for 7 days.The serum levels of 25 OHD,blood routine,liver and kidney function,calcium,phosphorus,acute physiological function and chronic health evaluationⅡ(APACHEⅡ)score,sequential organ failure assessment(SOFA)score and 28-day prognosis were observed.RESULTS A total of 80 patients completed the trial,40 patients with vitamin D deficiency and 40 patients with insufficient vitamin D.There were 20 cases in the treatment group and 20 cases in the placebo group.After intervention,the level of 25 OHD increased in the treatment group and decreased in the placebo group,but there was no significant difference between the two groups(P>0.05).Serum calcium and phosphorus levels in the treatment group were significantly higher than those in the placebo group(P<0.05).APACHEⅡand SOFA scores decreased after intervention,but there was no significant difference between the treatment group and the placebo group(P>0.05).There was no significant difference in 28-day mortality between the treatment group and the placebo group(P>0.05).There were no adverse reactions such as hypersensitivity,hypercalcemia or hyperphosphatemia in the course of the experiment.CONCLUSION The insufficient or deficiency of vitamin D level in ICU patients with sepsis is serious.Administration of exogenous vitamin D can increase the levels of calcium and phosphorus in the body,but has no improvement on organ function and prognosis on 28 days.