血清25-羟维生素D水平与婴幼儿社区获得性肺炎的发生及严重程度的相关性研究

王娴娴; 单子鸿; 马莉娟; 杨君; 周瑞

doi:10.16766/j.cnki.issn.1674-4152.001826

血清25-羟维生素D水平与婴幼儿社区获得性肺炎的发生及严重程度的相关性研究

doi: 10.16766/j.cnki.issn.1674-4152.001826

蚌埠医学院第一附属医院儿科，安徽蚌埠 233004

基金项目:

国家卫生计生委医药卫生科技发展研究中心临床科研专项课题 W2016EWAH06

详细信息

通讯作者:
周瑞，E-mail: 1176034941@qq.com

中图分类号: R725.6 R446
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- 被引次数: 0
出版历程
- 收稿日期: 2020-07-15
- 网络出版日期: 2022-02-19

Correlation between serum 25-(OH)D level and incidence and severity of community acquired pneumonia in infants

Department of Pediatrics, the First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui 233004, China

摘要

摘要: 目的探讨血清25-羟维生素D[25-(OH)D]水平与婴幼儿社区获得性肺炎(CAP)的发生及严重程度的相关性。方法选取2018年1月—2019年5月蚌埠医学院第一附属医院收治的172例CAP婴幼儿作为CAP组，同期儿科门诊健康体检的50例正常婴幼儿作为对照组，再按照25-(OH)D水平不同将CAP组分为充足组(88例)、不足组(54例)和缺乏组(30例)，记录并比较各组间血清25-(OH)D、白细胞计数(WBC)、C反应蛋白(CRP)、降钙素原(PCT)、血沉(ESR)、肺外并发症及病情程度的差异，并统计分析血清25-(OH)D水平与WBC、CRP、PCT、ESR水平的相关性。结果 CAP组与对照组比较，25-(OH)D缺乏率分别为48.84%、24.00%，差异有统计学意义(P < 0.05)；充足组、不足组和缺乏组CRP水平比较差异无统计学意义(P>0.05)，在血清25-(OH)D、WBC、PCT、ESR、肺外并发症、病情程度方面比较差异均有统计学意义(均P < 0.05)，其中缺乏组的WBC、PCT、ESR、肺外并发症的发生率、疾病重症率均高于其他2组，差异有统计学意义(均P < 0.05)；Spearman秩相关分析显示：血清25-(OH)D水平与WBC、ESR呈负相关(r=-0.444、-0.326，均P < 0.05)，与CRP、PCT无相关关系(r=0.033、-0.170，均P>0.05)。结论 CAP婴幼儿的血清25-(OH)D缺乏率较正常婴幼儿偏高，与疾病的发生及严重程度相关，监测25-(OH)D水平在CAP婴幼儿病情评估中有一定的价值。
- 社区获得性肺炎 /
- 25-羟维生素D /
- 病情评估 /
- 婴幼儿
Abstract: Objective To investigate the association between serum 25 hydroxyvitamin D[25-(OH) D] level and incidence and severity of community acquired pneumonia (CAP) in infants. Methods The enrolled participants were all from the First Affiliated Hospital of Bengbu Medical College admitted from January 2018 to May 2019, including 172 infants with CAP as the CAP group and 50 normal infants as the control group. According to different concentrations of 25-(OH) D, the CAP group was divided into adequacy (88 cases), insufficiency (54 cases), and deficiency (30 cases) groups. The differences in serum 25-(OH)D, white blood cell count (WBC), C-reactive protein (CRP), procalcitonin (PCT), erythrocyte sedimentation rate (ESR), extra-pulmonary complications, and severity of disease amongst the three groups were recorded and compared. The correlation between the 25-(OH) D levels of CAP patients with WBC, CRP, PCT, and ESR levels were statistically analysed. Results Comparison of the CAP group with the control group revealed that the 25-(OH) D deficiency rates were 48.84% and 24.00%, respectively, and the difference was statistically significant (P < 0.05). No significant difference in CRP levels was observed between the adequate, insufficient, and deficient groups (P>0.05), whereas statistically significant differences were observed amongst the 25-(OH) D, WBC, PCT, ESR, extra-pulmonary complications, and degree of disease in the adequate, insufficient, and deficient groups (all P < 0.05). In particular, the levels of WBC, PCT, ESR, incidence of extra-pulmonary complications, and severe disease rate in the deficiency group were higher than those in the other two groups, and the difference was statistically significant (all P < 0.05). Spearman rank correlation analysis showed that the serum 25-(OH) D level was negatively correlated with WBC and ESR in the CAP group (r=-0.444, -0.326, P < 0.05). No correlation was observed with CRP and PCT level (r=0.033, -0.170, P>0.05). Conclusion The deficiency rate of serum 25-(OH) D in infants with CAP is higher than that of normal infants, which is correlated with the occurrence and severity of the disease. Therefore, monitoring serum 25-(OH) D can aid the assessment of CAP severity in infants.
- Community acquired pneumonia /
- 25-hydroxyvitamin D /
- Condition assessment /
- Infant

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表 1 2组婴幼儿25-(OH)D水平比较[例(%)]

组别	例数	充足	不足	缺乏(包括严重缺乏)
对照组	50	38(76.00)	8(16.00)	4(8.00)
CAP组	172	88(51.16)	54(31.40)	30(17.44)

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表 2 3组不同25-(OH)D水平的CAP患儿一般资料比较[例(%)]

组别	例数	性别(男/女，例)	月龄(x±s，月)	剖宫产	早产	喂养方式
组别	例数	性别(男/女，例)	月龄(x±s，月)	剖宫产	早产	母乳喂养	人工喂养	混合喂养
充足组	88	57/31	16.10±10.89	21(23.86)	11(12.50)	34(38.64)	37(42.05)	17(19.31)
不足组	54	38/16	17.24±13.98	18(33.33)	6(11.11)	24(44.44)	16(29.63)	14(25.93)
缺乏组	30	16/14	17.83±13.08	8(26.66)	6(20.00)	12(40.00)	8(26.67)	10(33.33)
统计量		2.450^a	0.687^b	1.519^a	1.434^a	4.517^a
P值		0.294	0.505	0.468	0.488	0.341
注：^a为χ²值, ^b为F值。

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表 3 3组不同25-(OH)D水平的CAP患儿临床资料比较(x ±s)

组别	例数	25-(OH)D(ng/mL)	WBC(10⁹/L)	CRP(mg/L)	PCT(μg/L)	ESR(mm/h)	住院日(d)
充足组	88	33.37±6.72	10.09±3.55	13.12±18.67	0.59±1.02	15.84±4.82	8.85±0.75
不足组	54	18.25±1.05^a	17.31±7.43^a	11.74±15.33	1.04±1.53^a	20.81±3.69^a	11.93±1.86^a
缺乏组	30	10.43±3.11^ab	19.05±4.23^ab	11.76±15.36	2.68±2.14^ab	29.15±6.17^ab	14.01±2.83^ab
F值		149.96	40.49	0.085	15.42	38.94	76.67
P值		< 0.001	< 0.001	0.919	< 0.001	< 0.001	< 0.001
注：与维生素D充足组比较，^aP < 0.05；与维生素D不足组比较，^bP < 0.05。

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表 4 CAP组血清25-(OH)D水平与WBC、CRP、PCT、ESR水平的相关性分析

指标	r值	P值
WBC	-0.444	< 0.001
CRP	0.033	0.705
PCT	-0.170	0.055
ESR	-0.326	< 0.001

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表 5 3组CAP患儿肺外并发症、病情程度情况比较[例(%)]

组别	例数	肺外并发症		肺外并发症分布情况					病情程度
组别	例数	有	无	肝脏损害	心肌损害	胃肠道损害	皮肤损害	其他	普通型	重症+重症化
充足组	88	10(11.36)	78(88.64)	2(20.00)	3(30.00)	4(40.00)	1(10.00)	0(0.00)	76(86.36)	12(13.64)
不足组	54	10(18.52)	44(81.48)	3(30.00)	0(0.00)	5(50.00)	2(20.00)	0(0.00)	38(70.37)	16(29.63)
缺乏组	30	16(53.33)	14(46.67)	2(12.50)	2(12.50)	8(50.00)	0(0.00)	4(25.00)	14(46.67)	16(53.33)
χ²值		24.089		10.520					19.197
P值		< 0.001		0.156					< 0.001

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