维生素D干预对严重脓毒症患儿免疫功能影响的临床疗效观察

Clinical observation on the effect of vitamin d intervention on immune function in children with severe sepsis

目的:观察严重脓毒症患儿维生素D缺乏情况,探讨补充维生素D能否改善严重脓毒症患儿免疫功能及预后。方法:收集2016-09—2018-06期间我院PICU收住的诊断为严重脓毒症的患儿56例,测定患儿血清25羟维生素D[25(OH)D]水平。血清25(OH)D水平>75 nmol/L为维生素D充足;50~75 nmol/L为维生素D不足;<50 nmol/L为维生素D缺乏。将维生素D不足或缺乏的严重脓毒症患儿按随机数字表法分为治疗组(维生素D加常规治疗)和对照组(予常规治疗);采用电化学发光法测定各组血清25(OH)D水平,流式细胞法、比色法检测T细胞亚群(CD3^+T、CD4^+T、CD8^+T)及免疫球蛋白(IgG、IgA、IgM)功能。并记录降钙素原(PCT)、C-反应蛋白(CRP)、血常规、血乳酸(Lac)、白蛋白(ALB)、小儿危重症评分(PCIS);机械通气时间、ICU住院时间,探讨补充维生素D能否改善严重脓毒症患儿的免疫功能及预后。结果:①56例严重脓毒症患者维生素D充足2例(3.6%),不足22例(39.3%),缺乏32例(57.1%);28 d共有16例(28.6%)患儿死亡。②不同性别、不同年龄患儿血清25(OH)D均差异无统计学意义(P>0.05)。③治疗组与对照组比较,ICU住院时间差异有统计学意义(P<0.05);两组免疫球蛋白(IgG、IgA、IgM)、T细胞亚群(CD3^+T、CD4^+T、CD8^+T)、机械通气时间及28 d病死率比较差异无统计学意义(P>0.05)。结论:①本组严重脓毒症患儿25(OH)D缺乏发生率较高;②补充维生素D不能改善PICU严重脓毒症患儿的免疫功能及预后。

Objective:To observe the deficiency of vitamin D in children with severe sepsis and to explore whether vitamin D supplementation can improve the immune function and prognosis of children with severe sepsis.Method:Fifty-six children who were diagnosed of severe sepsis at PICU in Zunyi First People’s Hospital from September 2016 to June 2018 were collected and their serum 25(OH)D levels were measured.Serum 25(OH)D level>75 nmol/L was adequate for vitamin D,50-75 nmol/L was insufficient for vitamin D,and<50 nmol/L was deficient for vitamin D.Severe sepsis children with vitamin D deficiency or deficiency were randomly divided into treatment group(vitamin D+routine treatment)and control group(routine treatment).Serum 25(OH)D levels were measured by electrochemiluminescence,T cell subsets(CD3^+T,CD4^+T,CD8^+T)and immunoglobulin(IgG,IgA,IgM)functions were measured by flow cytometry and colorimetry.The procalcitonin(PCT),C-reactive protein(CRP),blood routine,blood lactate(Lac),albumin(ALB),pediatric critical illness score(PCIS),mechanical ventilation time and ICU hospitalization time were recorded to explore whether vitamin D supplementation could improve the immune function and prognosis of children with severe sepsis.Result:①Fifty-six patients with severe sepsis were involved in the present study.Two cases(3.6%)were without vitamin D defeciency,22 cases(39.3%)were with vitamin D insufficiency,32 cases(57.1%)were with vitamin D defeciency.Sixteen cases(28.6%)died within 28 days.②There was no significant difference in serum 25(OH)D between patients of different sex and age(P>0.05).③The hospitalization time of ICU was significant different between the control group and the treatment group(P<0.05);there was no significant difference in immunoglobulin(IgG,IgA and IgM),T cell subsets(CD3^+T,CD4^+T,CD8^+T),mechanical ventilation time and 28-day mortality between the two groups(P>0.05).Conclusion:1)The incidence of 25(OH)D deficiency in children with severe sepsis in this group is higher.2)Vitamin D supplementation can not improve the immune function and prognosis of PICU children with severe sepsis.