法洛四联症患儿围手术期维生素D水平与临床结局的关系

Peri-operative vitamin D status and its association with postoperative clinical outcome in children with tetralogy of Fallot

目的了解法洛四联症(tetralogy of Fallot,TOF)患儿围手术期维生素D水平,分析其与术后临床结局的关系。方法随机纳入21例TOF患儿,留取5个时间点(术前、术后即刻及术后24、48、72 h)的静脉血,采用液相色谱-质谱法(liquid chromatography/mass spectrometry,LC/MS)测定血25羟维生素D 25-hydroxyvitamin D,25(OH)D水平(<20 ng/mL为维生素D缺乏),分析其与患儿术后临床结局指标的关系。结果21例TOF患儿的中位年龄为0.66岁,基线25(OH)D为(25.1±9.2)ng/mL(1 ng/mL=0.40 nmoL/L)。术前维生素缺乏4例(19%),术后即刻维生素缺乏17例(81%)。不同时间点25(OH)D水平的差异有统计学意义(P<0.01);控制体外循环时间后25(OH)D水平的差异无统计学意义(P>0.05)。术前维生素D缺乏与正常患儿的住院时间、心脏重症监护室(cardiac intensive care unit,CICU)时间和手术死亡率无明显相关(P>0.05)。所有时间点25(OH)D曲线下面积与住院时间、CICU时间和住院费无显著相关(P>0.05)。结论TOF患儿存在维生素D缺乏现象,体外循环对术后25(OH)D水平有显著影响;维生素D缺乏可能增加患儿对高级抗生素和血管活性药物的需求。

Objective To detect the peri-operative status of vitamin D and its association with postoperative clinical outcomes in children with tetralogy of Fallot(TOF).Methods Twenty-one children with TOF were randomly enrolled.Blood samples were collected at five time points,including preoperative,immediately after surgery,24,48,and 72 hours after surgery.The blood 25-hydroxyvitamin D 25(OH)D concentration was measured by liquid chromatography/mass spectrometry(LC/MS).Results The median age of the children was 0.66 years.The baseline 25(OH)D was(25.1±9.2)ng/mL(1 ng/mL=0.40 nmoL/L).Vitamin D deficiency rate was 19%before operation,and 81%immediately after surgery.There were significant differences of 25(OH)D concentrations at the five time points(P<0.01).However,no significant difference was showed after control of the cardiopulmonary bypass time(P>0.05).No significant difference was found among 25(OH)D level and the length of hospital stay,cardiac intensive care unit(CICU)stay,and mortality(P>0.05).Area under curve of 25(OH)D concentration was computed.There was no significant difference among the area and the length of hospital,CICU stay,and hospitalization cost(P>0.05).Conclusion Vitamin D deficiency is common in children with TOF.Cardiopulmonary bypass significantly affects the level of 25(OH)D after surgery.Vitamin D deficiency may increase the demand for treatment of advanced antibiotics and vasoactive agents.