本文選題：危重患兒 + 25(OH)D�。� 參考：《廣西醫(yī)科大學》2017年碩士論文

【摘要】：目的了解兒科重癥監(jiān)護病房(PICU)危重患兒25-羥基維生素D(25(OH)D)及維生素D結(jié)合蛋白(VBDP)水平,分析其臨床意義及預后的關(guān)系。方法收集2015年2月-2016年7月入住廣西醫(yī)科大學第一附屬醫(yī)院兒科重癥監(jiān)護病房(PICU)符合條件危重癥患兒295例為研究對象(研究組);同期收集廣西醫(yī)科大學第一附屬醫(yī)院兒科門診體檢正常兒童44例作為對照(對照組)。研究組患兒于住院第1d和第7d各抽2份2ml血,1份采用電化學發(fā)光法檢測血清25(OH)D水平,1份采用酶聯(lián)免疫法檢測VDBP水平;對照組正常兒于入組當天抽取2份2ml血,采用相同方法檢測25(OH)D和VDBP水平。根據(jù)25(OH)D水平,將患兒分為25(OH)D充足組、25(OH)D不足組、25(OH)D缺乏組。比較研究組和對照組25(OH)D和VDBP水平;分析研究組主要系統(tǒng)疾病25(OH)D和VDBP水平情況;分析研究組入院第1天25(OH)D與VDBP水平、年齡、血清總Ca、BMI、PRISM III評分、器官衰竭率、機械通氣率、第28d病死率之間的關(guān)系;入住第1天和第7天的25(OH)D、VDBP水平和PRISM III評分的差異;分析住PICU危重癥患兒存活與死亡組25(OH)D、VDBP水平、PRISM III評分的差異。結(jié)果(1)研究組危重患兒295例,男175例(59.3%)、女120例(40.7%),年齡中位數(shù)為1.5(歲),對照組正常兒童44例,男23例(52.3%),女21例(47.3%),年齡中位數(shù)為3.0(歲),兩組比較差異無統(tǒng)計學意義(P0.05);(2)各系統(tǒng)疾病25(OH)D水平缺乏率、VDBP水平低下無統(tǒng)計學意義(P0.05);(3)研究組較對照組25(OH)D、VDBP水平偏低下,差異有統(tǒng)計學意義(P0.05);(4)研究組中25(OH)D充足、不足、缺乏組間血清總鈣、VDBP、BMI、第28d病死率、器官衰竭率、機械通氣率比較差異無統(tǒng)計學意義(P0.05),缺乏組較不足和充足組患兒年齡稍大、住PICU時間更長、PRISM III評分更高,差異有統(tǒng)計學意義(P0.05);(5)入住PICU第1d較第7d 25(OH)D、VDBP水平低下,PRISM III評分更高,比較差異有統(tǒng)計學意義(P0.05);(6)295例危重患兒中,第28d存活257例(87.1%)、死亡38例(12.9%),死亡組較存活組25(OH)D水平更低、PRISM III評分更高,差異有統(tǒng)計學意義(P0.05),死亡與存活組VDBP水平差異無統(tǒng)計學意義(P0.05)。結(jié)論:1.本組資料提示危重患兒存在25(OH)D、VDBP水平不足及缺乏,特別是膿毒癥或MODS及外科疾病患兒缺乏明顯。2.25(OH)D水平不足及缺乏的危重癥患兒PRISM III評分越高,住PICU時間越長及28d死亡率更高。3.危重癥患兒隨著病情好轉(zhuǎn),PRISM III評分下降,其25(OH)D及VDBP水平有所升高。
[Abstract]:Objective to investigate the levels of 25-hydroxyvitamin D (25-hydroxyvitamin D) and vitamin D binding protein (VBDP) in critically ill children in pediatric intensive care unit (PICU), and to analyze the relationship between clinical significance and prognosis. Methods from February 2015 to July 2016, 295 eligible critically ill children admitted to PICU of the first affiliated Hospital of Guangxi Medical University (study group) and the first affiliated department of Guangxi Medical University (Guangxi Medical University) were collected. 44 normal children in pediatric outpatient department were used as control group (control group). In the study group, two samples of 2ml blood samples were taken on the 1st and 7th day of hospitalization respectively. The serum 25(OH)D level was detected by electrochemiluminescence method and the VDBP level was detected by enzyme-linked immunosorbent assay (Elisa) in the control group, and two samples of 2ml blood were taken from the normal children in the control group on the day of admission. 25(OH)D and VDBP levels were detected by the same method. According to the level of 25(OH)D, the children were divided into 25 OHH D deficient group and 25 OHH deficiency group in 25(OH)D sufficient group. The levels of 25(OH)D and VDBP were compared between the study group and the control group, the levels of 25(OH)D and VDBP in the main systemic diseases in the study group were analyzed, and the levels of 25(OH)D and VDBP, age, serum total CaBMI-PRISM III score, organ failure rate, mechanical ventilation rate on the first day of admission were analyzed in the study group. The relationship between fatality rate on the 28th day, the difference of VDBP level and PRISM III score between the first day and the 7th day, and the difference between the survival and death group of 25 OHH DV DBP and III score were analyzed. Results 1) 295 critically ill children in the study group, 175 males and 40.7 females, the median age was 1.5 years old, and 44 normal children in the control group. There were 23 males and 21 females with a median age of 3.0 (P < 0.05). There was no significant difference between the two groups in the deficiency rate of 25(OH)D level and the low level of VDBP. There was no significant difference between the study group and the control group (25 OHDV DBP level was lower than that in the control group.) the level of VDBP in the study group was significantly lower than that in the control group (P < 0.05), and there was no significant difference between the two groups in the level of VDBP and the level of VDBP in the study group (P < 0.05). There was no significant difference in 25(OH)D between the two groups. There was no significant difference in the mortality rate, organ failure rate and mechanical ventilation rate between the two groups. There was no significant difference between the two groups (P 0.05). The age of the children in the deficiency group and sufficient group was a little older than that in the deficiency group, and the age of the children in the deficiency group was a little older than that in the insufficient group. The mortality rate, the organ failure rate and the mechanical ventilation rate were not significantly different between the two groups. The higher the III score of PICU was, the higher the difference was (P 0.05). The lower level of VDBP in the first day of PICU was higher than that in the 7th day. The difference was statistically significant in 6295 critically ill children. On the 28th day, 257 cases survived (87.1%) and 38 cases died (12.9%). The 25(OH)D level in the death group was lower than that in the surviving group, and the III score was higher (P 0.05). There was no significant difference in the VDBP level between the death group and the survival group (P 0.05). Conclusion 1. The data suggested that there were insufficient and deficient VDBP levels in critically ill children, especially in children with sepsis or MODS and surgical diseases. The higher the PRISM III score was, the longer the duration of PICU was and the higher the death rate was at 28d. With the improvement of the condition, the 25(OH)D and VDBP levels of critically ill children decreased with the decrease of PRISM III score.
【學位授予單位】：廣西醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R720.597

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本文編號：1915971