社区获得性肺炎患儿维生素A水平变化与病情危重程度的相关性研究

Study on the relationship between the change of vitamin A level and the severity of community acquired pneumonia

目的研究社区获得性肺炎(CAP)患儿维生素A水平变化与病情危重程度的相关性。方出选择2017年1月〜2017年12月如皋市人民医院儿科住院并确诊的102例CAP患儿为研究对象,根据小儿病情危重程度分为轻度肺炎组(69例)和重症肺炎组(33例),根据患儿血清维生素A水平结果分为维生素A缺乏(VAD)组(25例,血清视黄醇水平V0.35 pmol/L)、亚临床维生素A缺乏(SVAD)组(56例,血清视黄醇在0.35—1.05 Mmol/L之间)及维生素A水平正常组(21例)。检测入院时患儿血清维生素A水平,通过受试者工作特征曲线(ROC)分析CAP患儿血清维生素A水平与病情危重程度的敏感性、特异性。随访患儿出院后1年的反复呼吸道感染发生情况。结果ROC分析显示以患儿血清视黄醇水平0.56 pmol/L为最佳界值,患儿血清维生素A水平判断病情危重程度的敏感性、特异性分别为63.8%和90.9%,曲线下面积为0.83„与轻度肺炎组患儿比较,重症肺炎组患儿VAD发生率升高,差异有统计学意义(P<0.05).患儿出院后电话随访1年,102例CAP患儿中有34例患儿发生反复呼吸道感染,重症肺炎组反复呼吸道感染发生率高于轻度肺炎组[40.6%(28/69)和18.2%(6/33),X2=5.040,P=0.025]。3组患儿间比较,VAD组反复呼吸道感染发生率高于维生素A正常组[56.0%(14/25)和23.8%(5/21),X2=4.878,P=0.027]。结论CAP患儿体内维生素A水平高低与病情危重程度相关,体内维生素A水平可作为病情判断的一项辅助监测指标。

Objective To analyze the correlation between the changes of vitamin A level and the severity of critical illness in children with community acquired pneumonia・Methods 102 children with CAP were admitted to the respiratory department of our hospital from January 2017 to December 2017 as the research object.According to the severity of their illness,they were divided into mild pneumonia group(69 cases) and severe pneumonia group (33 cases) , and according to the diagnostic results of vitamin A, clinical VAdeficiency (VAD) group (25 cases, serum retinol level V0.35 mol/L) , subclinical vitamin A deficiencygroup (56 cases, serum retinol level between 0.35 and 1.05 mol/L) and normal VA level group (21 cases)・The serum vitamin A level of the children was tested on admission, and the relationship between it and thecritical condition of CAP children was analyzed through the ROC, and the incidence of recurrentrespiratory tract infection after discharge was followed up for 1 year・ Results ROC analysis showed that0.56 mol/L (Serum retinol levels) was taken as the cut-off point value, and the sensitivity and specificityof VA in determining the severity of the disease were 63.8% and 90.9% , and the area under the curve was0.83;Compared with the mild pneumonitis group, the incidence of VAD in the severe pneumonia groupwas increased, and the difference was statistically significant (P VO.O5);During 1 year of telephone follow-up, 34 of 102 patients with CAP (accounting for 33.3%) developed recurrent respiratory infection,and the incidence of recurrent respiratory infection in the severe pneumonia group was significantly higherthan that in the mild pneumonia group [40.6% (28/69) vs. 18.2% (6/33), X2 =5.040, P =0.025]. Comparedamong the three groups with different VA levels, the incidence of recurrent respiratory infection inthe VAD group was significantly higher than that in the normal VA group [56.0% (14/25) vs. 23.8% (5/21), X2 =4.878, P =0.027]. Conclusion The level of VA in children with pneumonia is related to the degreeof critical illness, which can be used as an auxiliary monitoring index for disease judgment.