维生素D与儿童脓毒症免疫及预后的相关性分析

Analysis of relationships of vitamin D with immunity and prognosis of children with sepsis

目的 了解脓毒症儿童血清维生素D水平,探究血清维生素D与儿童脓毒症免疫及预后的相关性。方法 选取2021年12月至2022年11月河北省儿童医院儿童重症监护室收治的脓毒症患儿63例作为脓毒症组,另选取同期住院的非脓毒症患儿53例作为非脓毒症组。测定两组患儿的血清维生素D水平,分析两组患儿血清维生素D的差异及脓毒症患儿血清维生素D水平与免疫指标(淋巴细胞亚群、免疫球蛋白)的相关性。采用Logistic回归分析影响儿童脓毒症死亡的危险因素,ROC曲线评估危险因素对脓毒症患儿的预后价值。结果 (1)脓毒症组患儿血清维生素D水平低于非脓毒症组(Z=-5.740,P<0.05)。(2)相关性分析显示脓毒症组患儿血清维生素D水平与总T淋巴细胞(CD3^(+))、辅助T淋巴细胞(CD4^(+))、CD4^(+)/CD8^(+)呈正相关(r=0.308、0.264、0.272,P<0.05)。(3)单因素分析提示血清维生素D水平、PCIS评分、PSOFA评分、LAC及CD4^(+)/CD8^(+)是脓毒症患儿死亡的影响因素(Z/t值分别为-4.138、-4.390、-4.582、-3.000和-2.282,P<0.05)。Logistic回归分析结果显示血清维生素D水平和PCIS评分是脓毒症28d死亡的独立影响因素,OR值及95%CI分别为0.732(0.540~0.993)、0.785(0.642~0.960)。维生素D联合PCIS评分的AUC为0.941[95%CI(0.886~0.995)],截断值为0.226时,灵敏度为94.4%,特异度为84.4%。结论 维生素D缺乏会影响脓毒症患儿的免疫功能,血清维生素D水平是预测脓毒症患儿28d死亡的独立危险因素,维生素D与PCIS评分两者联合,可提升对儿童脓毒症28d死亡的预测价值。

Objective To survey serum level of vitamin D in children with sepsis and to explore relationships of vitamin D with immunity and prognosis of the children with sepsis.Methods The serum levels of vitamin D of 63 children with sepsis(divided into sepsis group)and 53 non-septic children(in the same period,divided into non-sepsis group)who hospitalized in Pediatric Intensive Care Unite(PICU)of Hebei Provincial Children's Hospital from December 2021 to November 2022 were detected.The difference in serum level of vitamin D of the children between the two groups,and correlations of serum vitamin D level with immune indexes(lymphocyte subsets and immunoglobulin)of the children with sepsis were analyzed.Logistic regression analysis was used to screen risk factors for mortality of the children with sepsis,and ROC curve was used to evaluate prognostic values of these risk factors for the children with sepsis.Results①The serum level of vitamin D of the children in the sepsis group was lower than that in the non-sepsis group(Z=-5.740,P<0.05).②Correlation analysis showed that the serum level of vitamin D of the children in the sepsis group was positively correlated with total T lymphocytes(CD3^(+)),helper T lymphocytes(CD4^(+))and CD4^(+)/CD8^(+)ratio(r=0.308,0.264 and 0.272 respectively,all P<0.05).③Univariate analysis showed that the serum vitamin D level,pediatric critical illness score(PCIS),pediatric sequential organ failure assessment(PSOFA)score,serum lactate(LAC)level and CD4^(+)/CD8^(+)ratio were the influencing factors of mortality of the children with sepsis(Z/t=-4.138,-4.390,-4.582,-3.000 and-2.282 respectively,all P<0.05).Logistic regression analysis shown that the serum vitamin D level and PCIS score were independent risk factors for 28-day death in sepsis(OR=0.732,95%CI:0.540-0.993,P=0.045;OR=0.785,95%CI:0.642-0.960,P=0.019).The AUC of combination of vitamin D and PCIS score was 0.941(95%CI:0.886-0.995),and when the cutoff value was determined at 0.226,the sensitivity was 94.4%and the specificity was 84.4%.Conclusion Vitamin D deficiency affects immune function of the children with sepsis.Serum vitamin D level is an independent risk factor for predicting 28-day death in children with sepsis.The combination of serum vitamin D level and PCIS score can improve the predictive value for 28-day death in children with sepsis.