手足口病患儿血清25-羟维生素D水平的临床意义及预后影响

Clinical significance and prognostic effect of serum 25-hydroxyvitamin D level in children with hand-foot-mouth disease

目的探讨手足口病患儿血清25-羟维生素D[25(OH)D]水平的临床意义及预后影响。方法对2016年6月至2018年6月在本院收治的手足口病儿童进行了一项前瞻性观察研究。69名住院的手足口病患者分为不严重组(n=25)、重度组(n=26)和危重组(n=18)。选择同期门诊体检的30名健康儿童作为对照组。在所有受试者中测量血清25(OH)D浓度,同时对重症手足口病患儿进行儿科危重病评分(PCIS),并分析血乳酸、无血清钙离子(Ca2+)、D-二聚体、乳酸脱氢酶和肌酸激酶-MB水平。结果危重手足口病组的血清25(OH)D浓度显著低于其他3个组(P<0.05),并且血清25(OH)D缺乏症的发生率显著高于其他3个组(P<0.05)。在重症手足口病患儿中,与25(OH)D正常和不足组相比,25(OH)D缺乏组具有显著更高的血乳酸、乳酸脱氢酶、肌酸激酶-MB和D-二聚体水平(P<0.05);脑干脑炎、神经元肺水肿和循环衰竭的发病率较高(P<0.05);死亡率较高(P<0.05)。此外,25(OH)D缺乏组的PCIS显著低于其他两组(P<0.05)。44名重症手足口病患儿中有9人死亡,死亡率为20.5%。Logistic回归分析结果表明,25(OH)D(OR=2.04,95%CI:1.02-4.10,P=0.044)、D-二聚体(OR=0.30,95%CI:0.10-0.94,P=0.047)和PCIS(OR=1.51,95%CI:1.06-2.14,P=0.033)是影响重度和危重手足口病患儿14天死亡率的独立因素。结论患有危重手足口病的儿童血清25(OH)D浓度显著降低,并且与手足口病的严重程度和预后相关。

Objective To explore the clinical significance and prognostic effect of serum 25-hydroxyvitamin D[25(OH)D]level in children with hand-foot-mouth disease.Methods A prospective observational study was conducted on children with hand-foot-mouth disease who were admitted to our Hospital in June 2016 to June 2018.The 69 children with hand-foot-mouth disease were divided into common(n=25),severe(n=26),and critical(n=18)hand-foot-mouth disease groups.Another 30 healthy children undergoing outpatient medical examinations during the same period were chosen as the control group.Serum 25(OH)D concentration was measured in all subjects,and pediatric critical illness score(PCIS)was performed in children with severe hand-foot-mouth disease.Blood lactate,serum calcium ions(Ca2+),D-dimer,lactate dehydrogenase and creatine kinase-MB levels were analyzed.Results The concentration of serum 25(OH)D in the critical hand-foot-mouth disease group was significantly lower than those in the other three groups(P<0.05),and the incidence of serum 25(OH)D deficiency was significantly higher than those in the other three groups(P<0.05).Compared with the 25(OH)D normal and insufficiency groups,the 25(OH)D deficiency group had significantly higher blood lactate,lactate dehydrogenase,creatine kinase-MB and D-dimer levels(P<0.05);higher incidences of brainstem encephalitis,neuronal pulmonary edema,and circulatory failure(P<0.05);and higher mortality rates(P<0.05).Furthermore,the 25(OH)D deficiency group had lower PCIS than the other two groups(P<0.05).Nine of the 44 children with critical and severe hand-foot-mouth disease died,for a mortality rate of 20.5%.Logistic regression analysis showed that 25(OH)D(OR=2.04,95%CI:1.02-4.10,P=0.044),D-dimer(OR=0.30,95%CI:0.10-0.94,P=0.047)and PCIS(OR=1.51,95%CI:1.06-2.14,P=0.033)were independent factors affecting 14-day mortality of children with severe and critical hand-foot-mouth disease.Conclusion The serum 25(OH)D concentrations are substantially reduced in children with severe hand-foot-mouth disease and are associated with the severity and prognosis of HFMD.