血25-羟维生素D检测对新生儿早发型败血症的诊断价值及临床意义

Clinical significance and diagnostic value of serum 25-hydroxyvitamin D detection in neonatal early onset sepsis

目的:探讨25-羟维生素D[25(OH)D]水平在新生儿早发型败血症(EOS)中对炎症的影响及诊断价值。方法:采用前瞻性调查方法,纳入了在承德市中心医院新生儿重症监护室住院诊断为EOS 53例(EOS组),另有我院产科出生留院观察排除感染的40例患儿为对照组。比较两组新生儿的25(OH)D的季节分布、平均水平,维生素D缺乏发生的比例、水平,血25(OH)D预测新生儿EOS的ROC曲线,再根据25(OH)D水平分为维生素D缺乏组(≤15 ng/mL)、维生素D非缺乏组,比较两组间的炎性指标水平。结果:两组一般资料差异无统计学意义(P>0.05)。EOS组、对照组、所有纳入病例的维生素D不同季节总体分布情况差异有统计学意义(P<0.05);EOS组25(OH)D平均水平(11.09±6.05) ng/mL显著低于对照组(14.22±5.77) ng/mL(P<0.05);25(OH)D缺乏(≤15 ng/mL)在EOS组中有44例(83.01%),其维生素D平均水平(9.14±3.49) ng/mL显著低于对照组中26例(65.00%)的维生素D平均水平(10.57±2.28) ng/mL(P<0.05);由EOS组和对照组得出25(OH)D预测EOS的ROC曲线下面积是0.635(P=0.026),有统计学意义。早发型败血症组中白细胞计数、淋巴细胞计数、中性粒细胞计数、单核细胞计数、单核细胞数百分比在维生素D缺乏组显著高于维生素D非缺乏组(P<0.05)。结论:新生儿维生素D缺乏与早发型败血症发生有关,血25(OH)D检测对早发型败血症有预测价值,早发型败血症患儿体内存在更高的炎症反应。

Objective:To investigate the effect of 25-hydroxyvitamin D,25(OH)D,on inflammation,and to explore its diagnostic value in neonatal early septicemia.Methods:A prospective investigation was carried out in 53 cases of neonatal early-onset sepsis diagnosed in the neonatal intensive care unit of Chengde Central Hospital of Hebei Province,which were assigned into early-onset sepsis group,and40 cases who were excluded from infection were assigned into the control group.The seasonal distribution and average level of serum 25(OH)D were comapred between the two groups.The proportion and level of vitamin D deficiency cases were recorded,and the ROC curve of serum 25(OH)D was analyzed to predict the early-onset sepsis of newborns.Then,according to the level of 25(OH)D,the two groups were sub-divided into vitamin D deficiency group(≤15 ng/mL) and non deficiency group,and the inflammatory indices levels between the two groups were compared.Results:The average level of 25(OH)D was(11.09±6.05) ng/mL,which was significantly lower than(14.22±5.77) ng/mL in the control group(P<0.05).The rate of vitamin D deficiency was 83.1%(44/53) in early-onset sepsis group,with an average vitamin D level of(9.14±3.49) ng/mL,while the rate of vitamin D deficiency was 65.0%(26/40) and the 25(OH)D level was(10.57±2.28) ng/mL in control group.The area under ROC curve to predict early-onset sepsis was 0.635(P=0.026).The percentage of leukocyte count,lymphocyte count,neutrophil count,monocyte count and monocyte count in the group of vitamin D deficiency were significantly higher than in non deficiency group(all P<0.05).Conclusion:Abnormal inflammatory response exists in neonates with vitamin D deficiency,which is related to the occurrence of early-onset sepsis.And 25(OH)D detection is valuable in prediction of early-onset sepsis.