本文關(guān)鍵詞： 維生素D 免疫功能 社區(qū)獲得性肺炎 兒童　出處：《北京協(xié)和醫(yī)學(xué)院》2017年碩士論文　論文類(lèi)型：學(xué)位論文

【摘要】：目的探索維生素D與兒童社區(qū)獲得性肺炎(Community-acquired pneumonia,CAP)免疫功能、炎癥指標(biāo)及住院時(shí)間的關(guān)系。方法1.研究對(duì)象:2011.01-2012.12在首都兒科研究所附屬兒童醫(yī)院治療的29日齡-16歲CAP兒童共797例,其中完善免疫學(xué)指標(biāo)的為367例,于住院24至48小時(shí)內(nèi)采用化學(xué)發(fā)光法測(cè)定血清25(OH)D水平,流式細(xì)胞法測(cè)定CD3、CD4、CD8、CD4/CD8、CD19、Thl、Th2及Th17水平,免疫散射比濁法測(cè)定血清IgG、IgA及IgM水平,入院當(dāng)日測(cè)定感染指標(biāo)白細(xì)胞(White Blood Cell,WBC)、C反應(yīng)蛋白(C-reactive Protein,CRP)及降鈣素(Procalcitonin,PCT)水平,并記錄患兒住院時(shí)間;2.分組:根據(jù)血25(OH)D水平,將CAP患兒分為充足組、不足組、缺乏組、嚴(yán)重缺乏組;3.明確不同組別CAP患兒免疫指標(biāo)的差異,了解25(OH)D水平與差異免疫指標(biāo)的關(guān)系;4.分析不同組別炎癥指標(biāo)及住院時(shí)間的差異。結(jié)果1.共367例CAP兒童納入研究,平均年齡為3.5±3.3歲,男244例,女123例;2.充足組、不足組、缺乏組及嚴(yán)重缺乏組血清25(OH)D水平中位數(shù)(Q25,Q75)分別為:35.0(36.6,40.3)ng/ml、24.5(24.0,25.1)ng/ml、14.8(14.2,15.2)ng/ml及 7.0(6.3,7.4)ng/ml。3.充足組、不足組、缺乏組、嚴(yán)重缺乏組CD19分別為25.5± 11.7%、24.2± 10.8%、22.3± 12.3%及20.5± 12.5%,組間總體差異顯著,嚴(yán)重缺乏組CD19低于充足組,p0.05;充足組、不足組、缺乏組、嚴(yán)重缺乏組CD3分別為63.7±11.5%、63.5±13.0%、66.6±12.5%及66.7±15.7%,組間總體差異顯著,嚴(yán)重缺乏組CD3高于充足組,p均0.05;充足組、不足組、缺乏組、嚴(yán)重缺乏組Th17分別為0.4±0.4%、0.4±0.3%、0.6±0.5%及0.7±0.81%,組間總體差異顯著,嚴(yán)重缺乏組和缺乏組Th17高于充足組,p均0.05;其余免疫指標(biāo)在各組間無(wú)顯著差異;4.充足組、不足組、缺乏組及嚴(yán)重缺乏組血清CRP水平分別為:22.1±35.4mg/L、23.9±38.2mg/L、37.9±56.2mg/L 和 50.6±71.0mg/L,嚴(yán)重缺乏組 CRP 高于其他各組,p均0.05;充足組、不足組、缺乏組及嚴(yán)重缺乏組PCT分別為:0.6±0.9ng/d1、1.9±3.8ng/d1、1.6±3.6ng/d1、8.8±33.9ng/d1,嚴(yán)重缺乏組 PCT 高于其他各組,p 均0.05。5.住院時(shí)間:嚴(yán)重缺乏組平均住院時(shí)間12.5±7.2天,充足組平均住院時(shí)間9.4±5.6天,兩組之間具有統(tǒng)計(jì)學(xué)差異(P0.001)。結(jié)論1.維生素D嚴(yán)重缺乏組CD19低于充足組,維生素D缺乏組CD3高于充足組;2.維生素D嚴(yán)重缺乏組和缺乏組Th17高于充足組;3.維生素D嚴(yán)重缺乏組CRP、PCT高于其他組;4.維生素D嚴(yán)重缺乏組住院時(shí)間較充足組長(zhǎng)。
[Abstract]:Objective to explore the relationship between vitamin D and immune function, inflammatory indexes and hospital stay in children with community-acquired pneumonia. Methods: 1. A total of 797 CAP children aged between 29 days and 16 years old were treated in the Children's Hospital affiliated to the Capital Institute of Pediatrics from January to February 2011.Methods: a total of 797 children aged between 29 days and 16 years old were enrolled in the study. Among the 367 cases with perfect immunological indexes, the serum levels of 25 OHH were measured by chemiluminescence assay during 24 to 48 hours of hospitalization, the levels of CD3, CD4, CD8, CD4 / CD8, CD19, Th1, Th2 and Th17 were measured by flow cytometry, and the levels of IgA and IgM in serum were determined by immunoturbidimetry. On the day of admission, the levels of White Blood Blood Cell-C reactive protein (CRP) and calcitonin Procalcitonin (PCT) were measured, and the duration of hospitalization was recorded 2.The children with CAP were divided into sufficient group, insufficient group and lack group according to the blood 25 OHH D level. To understand the relationship between the level of 25 OHH D and the differential immunological index. 4. To analyze the difference of inflammation index and length of stay in different groups. Results 1. A total of 367 children with CAP were included in the study. The mean age was 3.5 鹵3.3 years old, 244 males and 123 females. The median serum levels of 25 OHHU D in adequate, deficient, deficient and severe deficiency groups were:: 35.036.6ng / ml 24.025.1ngr / ml 14.8ng/ ml 14.2ngrml and 7.06.37.4ngg.3. sufficient group, deficient group, deficient group, The CD19 of severe deficiency group was 24.2 鹵10.8 and 22.3 鹵12.3% and 20.5 鹵12.5, respectively. The CD19 of severe deficiency group was lower than that of sufficient group (p 0.05), and the CD3 of sufficient group, deficiency group, deficiency group and severe deficiency group was 63.7 鹵11.5 鹵63.5 鹵13.06.6 鹵12.5% and 66.7 鹵15.7, respectively. The CD3 of severe deficiency group was higher than that of sufficient group (P 0.05), the Th17 of sufficient group, insufficient group, deficiency group and severe deficiency group were 0.4 鹵0.4 鹵0.3 鹵0.3 鹵0.6 鹵0.5% and 0.7 鹵0.81, respectively. The overall difference between the two groups was significant. The Th17 of severe deficiency group and deficiency group were higher than that of sufficient group (0.05), and the other immunological indexes had no significant difference among groups. The serum CRP levels in the deficiency group and the severe deficiency group were 23.9 鹵38.2 mg / L, 37.9 鹵56.2 mg / L and 50.6 鹵71.0 mg / L, respectively. The CRP levels in the severe deficiency group were higher than those in the other groups (P < 0.05). The PCT of the deficiency group and the severe deficiency group were 1.9 鹵3.8ng / d 1.96 鹵3.6ng / d 1.88 鹵33.9ng / d 1, respectively. The PCT of the severe deficiency group was higher than that of the other groups (P < 0.05). The average hospitalization time was 12.5 鹵7.2 days in the severe deficiency group and 9.4 鹵5.6 days in the sufficient group. There was a statistical difference between the two groups (P 0.001). Conclusion 1.The CD19 of the group with severe vitamin D deficiency is lower than that of the group with sufficient vitamin D. The CD3 of vitamin D deficiency group was higher than that of adequate group 2. The Th17 of severe vitamin D deficiency group and deficiency group was higher than that of adequate group 3. The CD3 of vitamin D severe deficiency group was higher than that of other groups.
【學(xué)位授予單位】：北京協(xié)和醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R725.6

【參考文獻(xiàn)】

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