维生素D营养状态与新生儿脓毒症相关性初探

Correlation between Vitamin D Deficiency and Neonatal Sepsis

目的:探讨脐血25-羟基维生素D [25(OH) D]水平对新生儿脓毒症发生发展的相关性及预后评估的意义。方法:选取2015年3月至2017年5月武汉儿童医院和同济医院NICU收治的确诊为新生儿脓毒症的足月儿136例为病例组,同期出生的健康足月儿(临床表现及实验室检查均无异常) 141例为对照组,检测两组新生儿脐血25(OH) D水平。将病例组患儿按维生素D(VD)营养状态分为VD缺乏亚组108例、VD不足亚组16例和VD正常亚组12例,比较三组患儿新生儿急性生理学评分围产期补充Ⅱ(SNAPPE-Ⅱ)、实验室指标、NICU留住时间及28 d病死率。结果:病例组患儿脐血25(OH) D水平低于对照组,VD缺乏比例高于对照组(P均<0. 05)。VD缺乏亚组患儿的SNAPPE-Ⅱ、NICU留住时间、28 d病死率高于VD不足亚组和VD正常亚组(P均<0. 05)。病例组患儿的SNAPPE-Ⅱ评分(r=-0. 84)、28 d病死率(r=-0. 21)均与脐血25(OH) D水平呈负相关(P均<0. 05)。VD缺乏亚组和VD不足亚组的中位生存时间分别为12 d和8 d,差异无统计学意义(P>0. 05)。结论:维生素D营养状态与新生儿脓毒症的发生发展及预后具有相关性;VD缺乏状态下,患儿的病情更严重,病死率更高。

Objective:To probe into the significance of detection of 25-hydroxyl vitamin D( 25( OH) D) level in umbilical cord blood for the occurrence,development and prognosis of neonatal sepsis. Methods:A total of 136 infants with neonatal sepsis admitted to NICU of Wuhan Children’s Hospital and Tongji Hospital from Mar. 2015 to May 2017 were selected as the case group,and 141 healthy infants( without any abnormal clinical manifestations and laboratory examinations) were selected as the control group. The neonatal umbilical cord blood 25( OH) D level was determined in both groups. According to the nutritional status of vitamin D( VD),the patients in the case group were divided into 108 cases in the VD deficiency subgroup,16 cases in the VD insufficiency subgroup and 12 cases in the normal subgroup. Score for Neonatal Acute Physiology,Perinatal Extension,VersionⅡ( SNAPPE-Ⅱ),laboratory indexes,length of stay in NICU and 28-day mortality rate of three groups were compared. Results:The umbilical cord blood 25( OH) D level in the case group was lower than that in the control group,and the VD deficiency rate was higher than that in the control group( P < 0. 05). The SNAPPE-Ⅱ,laboratory indexes,length of stay in NICU and 28-day mortality rate of the VD deficiency subgroup were higher than those of the VD insufficiency subgroup and the VD normal subgroup( P<0. 05). The SNAPPE-Ⅱ score( r =-0. 84) and the 28-day mortality rate( r =-0. 21) were negatively correlated with cord blood 25( OH) D level( P<0. 05). The median survival time of the VD deficiency subgroup and the VD insufficiency subgroup was respectively 12 d and 8 d,with no statistical significance( P > 0. 05). Conclusion:Vitamin D status is correlated with the occurrence,development and prognosis of neonatal sepsis. With the deficiency of VD,the patients’ condition is more serious and the mortality rate is higher.