重度肺部感染患儿维生素D及炎症因子变化研究

Vitamin D and inflammatory factors of children with severe pulmonary infection

目的研究维生素D等指标与儿童重度肺部感染关系。方法选取南阳医学高等专科学校第一附属医院2016年12月-2018年5月重度肺部感染儿童41例为重度组,普通感染儿童40例为普通组,体检儿童40例为健康组。观察重度组、普通组疑似感染时(T0)、感染24 h(T1)、感染48 h(T2)、感染72 h(T3)和感染控制后(T4)白细胞(WBC)、降钙素原(PCT)、维生素D、炎症因子[白介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)]和免疫指标(CD4+、CD8+)水平及健康组上述指标水平。结果T0,重度组、普通组儿童WBC、PCT、IL-6、TNF-α水平高于健康组儿童(P<0.05)。T1、T2、T3、T4,WBC、PCT、IL-6、TNF-α和CD8+水平,重度组、普通组及脓毒症、重症脓毒症患儿先升高、后下降,重度组始终高于普通组,重症脓毒症患儿始终高于脓毒症患儿(P<0.05);维生素D、CD4+,重度组、普通组及脓毒症、重症脓毒症患儿均先下降、后升高,重度组始终低于普通组,重症脓毒症患儿低于脓毒症患儿(P<0.05)。Logistic显示IL-6、TNF-α水平是致儿童重度肺部感染因素,维生素D、CD4+/CD8+是保护性因素。维生素D、CD4+/CD8+与WBC、PCT呈负相关关系,IL-6、TNF-α与WBC、PCT呈正相关关系(P<0.05)。结论维生素D、IL-6、TNF-α、CD4+/CD8+水平与儿童重度肺部感染具有相关性,对其监测,利于把握病情、降低感染风险。

OBJECTIVE To explore the correlation between vitamin D and severe pulmonary infection in children.METHODS Totally 41 children with severe pulmonary infection who were treated in the First Affiliated Hospital of Nanyang Medical College from Dec 2016 to May 2018 were assigned as the severe group,40 children with common infection were chosen as the common group,and 40 children who received physical examination were set as the healthy group.The levels of white blood cell(WBC),procalcitonin(PCT),vitamin D,inflammatory factors interleukin-6(IL-6),tumor necrosis factor-α(TNF-α),immune indexes CD4+and CD8+were observed and compared among the severe group,the common group and the healthy group at the time of suspected infection(T0),after infection for 24 hours(T1),after the infection for 48 hours(T2),after the infection for 72 hours(T3)and after the control of infection(T4).RESULTS The levels of WBC,PCT,IL-6 and TNF-αof the severe group and the common group were significantly higher than those of the healthy group at T0(P<0.05).The levels of WBC,PCT,IL-6,TNF-αand CD8+of the children in the severe group and the common group,the children with sepsis and the children with severe sepsis were firstly elevated at T1,T2,T3 and T4 and then declined;the levels of above indexes of the severe group were significantly higher than those of the common group,and the levels of above indexes of the children with severe sepsis were significantly higher than those of the children with sepsis(P<0.05).The levels of vitamin D and CD4+of the children in the severe group and the common group,the children with severe sepsis and the children with sepsis were firstly reduced and then elevated;the levels of above indexes of the severe group were significantly lower than those of the common group;the levels of above indexes of the children with severe sepsis were significantly lower than those of the children with sepsis(P<0.05).Logistic analysis showed that IL-6 and TNF-αwere associated with the severe pulmonary infection in the children,vitamin D and CD4+/CD8+were protective factors.Vitamin D and CD4+/CD8+were negatively correlated with WBC and PCT;IL-6 and TNF-αwere positively correlated with WBC and PCT(P<0.05).CONCLUSION Vitamin D,IL-6,TNF-αand CD4+/CD8+are associated with the severe pulmonary infection in the children.It is necessary to monitor the indexes so as to control the illness condition and reduce the risk of infection.