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目的探讨维生素D缺乏与重症监护病房(ICU)脓毒症患者预后的相关性。方法检测2012年4月至2013年8月广西医科大学第一附属医院236例入住ICU脓毒症患者的血清25(OH)D质量浓度,比较25(OH)D充足组、25(OH)D不足组、25(OH)D缺乏组的急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分、主要生化指标、ICU留住时间以及28 d病死率。多因素Cox回归分析影响预后的危险因素。结果 (1)175例(74.1%)血25(OH)D减少,其中100例(42.3%)25(OH)D不足,75例(31.8%)25(OH)D缺乏。(2)25(OH)D缺乏组与其余两组相比,ICU留住时间更长,APACHEⅡ评分、血降钙素原(PCT)、全段甲状旁腺激素(i PTH)、血培养阳性率以及28 d病死率更高(P<0.01)。随着血清25(OH)D浓度的降低,APACHEⅡ评分增高(r=-0.716,P<0.01),28 d病死率上升(r=-0.376,P<0.01)。(3)25(OH)D充足组、25(OH)D不足组以及25(OH)D缺乏组中位生存时间分别为26.0 d、23.3 d和18.4 d(P<0.05)。(4)Cox分析显示,25(OH)D<20μg/L(即维生素D缺乏)是影响预后的危险因素(OR 1.205,95%CI 1.154,1.257,P=0.006)。结论脓毒症患者维生素D缺乏发生率高,维生素D缺乏是影响其预后的独立危险因素。补充维生素D或可作为脓毒症的一种辅助治疗手段。
Objective To investigate the relationship between vitamin D deficiency and prognosis in intensive care unit (ICU) sepsis patients. Methods Serum 25 (OH) D concentrations in 236 ICU sepsis patients from April 2012 to August 2013 in the First Affiliated Hospital of Guangxi Medical University were compared between 25 (OH) D sufferers and 25 (OH) D sufferers APACHEⅡ score, major biochemical indicators, ICU retention time and 28-day mortality in the 25 (OH) D-deficient group. Multivariate Cox regression analysis of prognostic risk factors. Results (1) 175 cases (74.1%) decreased blood 25 (OH) D, 100 cases (42.3%) had insufficient 25 (OH) D and 75 cases (31.8%) lacked 25 (OH) D. (2) Compared with the other two groups, the retention time of ICU in 25 (OH) D deficiency group was longer, APACHEⅡ score, PCT, i PTH, blood culture positive Rates and 28-day mortality were higher (P <0.01). With the decrease of serum 25 (OH) D concentration, the APACHEⅡscore increased (r = -0.716, P <0.01) and the 28d mortality increased (r = -0.376, P <0.01). (3) The median survival time of 25 (OH) D adequate group, 25 (OH) D deficient group and 25 (OH) D deficient group were 26.0 d, 23.3 d and 18.4 d respectively (P <0.05). (4) Cox analysis showed that 25 (OH) D <20μg / L (vitamin D deficiency) was a risk factor for prognosis (OR 1.205,95% CI 1.154,1.257, P = 0.006). Conclusions The incidence of vitamin D deficiency in sepsis patients is high, and vitamin D deficiency is an independent risk factor affecting its prognosis. Vitamin D supplement or as an adjuvant treatment of sepsis.