肺炎患儿血清25-羟维生素D水平动态变化的临床意义

Clinical significance of 25-hydroxy vitamin D in children with community-acquired pneumonia

目的:探讨肺炎患儿血清25-羟维生素D[25-hydroxy vitamin D,25(OH)D]水平动态变化的临床意义。方法:随机选取2018-01-01~2019-01-01我院儿科确诊为社区获得性肺炎(community acquired pneumonia,CAP)的151例住院患儿为研究对象,根据病情严重程度分为轻度肺炎组(n=50)和重度肺炎组(n=101),重度肺炎组依据小儿危重病例评分分为非危重组(n=42)、危重组(n=37)和极危重组(n=22)3个亚组。另选取同期150例行健康体检合格的儿童作为对照组。检测并比较各组血清25(OH)D水平。肺炎患儿于治疗1周后复查25(OH)D,根据25(OH)D变化将肺炎患儿分为25(OH)D升高组(n=95)和25(OH)D下降组(n=56)。分析肺炎患儿出院结局。结果:肺炎组患儿血清25(OH)D明显低于对照组(P<0.01)。轻度肺炎组血清25(OH)D水平明显高于重度肺炎各亚组(P<0.01)。重度肺炎各亚组间比较,非危重组血清25(OH)D水平明显高于危重组和极危重组(P<0.01),危重组血清25(OH)D水平明显高于极危重组(P<0.01)。治疗1周后,25(OH)D升高组病情的危重程度明显低于25(OH)D下降组(P<0.01),出院结局明显优于25(OH)D下降组(P<0.01)。结论:肺炎患儿的血清25(OH)D水平低于健康儿童,血清25(OH)D水平越低的患儿病情越严重,治疗前后血清25(OH)D的变化趋势与肺炎患儿的预后密切相关。

Objective:To investigate the clinical significance of serum 25-hydroxy vitamin D[25(OH)D]in children with community acquired pneumonia(CAP).Methods:A total of 151 patients with CAP from January 2018 to January 2019 in our hospital were randomly divided into mild pneumonia group(n=50)and severe pneumonia group(n=101)according severity of illness.Severe pneumonia group were further divided into non-critical group(n=42),critical group(n=37)and extremely critical group(n=22),according pediatric critical illness score.A total of 150 children who underwent physical examination during the same period of time were enrolled as the control group.The serum levels of 25(OH)D were measured and compared on admission and after one week of treatment for the pneumonia group,and the serum level of 25(OH)D was measured on admission for the healthy control group.According to the 25(OH)D level after one week of treatment,the children with pneumonia were divided into increased 25(OH)D group and reduced 25(OH)D group,and discharge outcome were analyzed.Results:25(OH)D level of the pneumonia group was significantly lower than that of the control group(P<0.01),and 25(OH)D level of the mild pneumonia group was significantly higher than that of the severe pneumonia group(P<0.01),25(OH)D level of the non-critical group was significantly higher than that of the critical and extremely critical group(P<0.01),and 25(OH)D level of the critical group was significantly higher than that of the extremely critical group(P<0.01).After one week of treatment,severity of illness in the increased 25(OH)D group was significantly less than that in reduced 25(OH)D group,outcome in the increased 25(OH)D group was significantly better than that in the reduced 25(OH)D group(P<0.01).Conclusion:The serum level of 25(OH)D of pneumonia is lower than that in healthy children,the 25(OH)D level can reflect the severity of pneumonia in children,and the variation tendency of serum 25(OH)D before and after treatment is closely related to the prognosis of pneumonia in children.