CAJ | 학술논문

目的：探讨老年危重症患者血清1，25羟-维生素D3[1，25（OH）2D3]水平与急性生理功能和慢性健康状态Ⅱ（ APACHEⅡ）评分及预后的相关性，为临床治疗提供参考。方法老年危重症患者196例，检测入院第1天血清1，25（OH）2D3水平及住ICU第1个24 h的APACHEⅡ评分。根据APACHEⅡ评分分为3组：A组67例（ APACHEⅡ评分≤15分），B组89例（ APACHEⅡ评分16～25分），C组40例（ APACHEⅡ评分＞25分）；根据追踪结果，分为存活组54例与死亡组142例。结果血清1，25（OH）2D3水平依次为A组＞B组＞C组（P ＜0．05）。器官衰竭数量依次为 A 组＜B 组＜C 组（P ＜0．05）。 A、B、C 组院内死亡率分别为2．99％（2／67）、30．34％（27／89）、62．50％（25／40），3组比较，差异有统计学意义（P＜0．05）。院内死亡率依次为A组＜B组＜C组（P＜0．05）。死亡组血清1，25（OH）2D3明显低于存活组（P＜0．05），APACHEⅡ评分、器官衰竭数量明显大于存活组（P＜0．05）。老年危重症患者血清1，25（OH）2D3水平与APACHEⅡ评分呈负相关关系（P＜0．05），与院内死亡率呈正相关关系（P＜0．05）。结论血清1，25（OH）2D3水平结合APACHEⅡ评分可作为评价老年危重症患者病情及预后的重要指标。
목적：탐토노년위중증환자혈청1，25간-유생소D3[1，25（OH）2D3]수평여급성생리공능화만성건강상태Ⅱ（ APACHEⅡ）평분급예후적상관성，위림상치료제공삼고。방법노년위중증환자196례，검측입원제1천혈청1，25（OH）2D3수평급주ICU제1개24 h적APACHEⅡ평분。근거APACHEⅡ평분분위3조：A조67례（ APACHEⅡ평분≤15분），B조89례（ APACHEⅡ평분16～25분），C조40례（ APACHEⅡ평분＞25분）；근거추종결과，분위존활조54례여사망조142례。결과혈청1，25（OH）2D3수평의차위A조＞B조＞C조（P ＜0．05）。기관쇠갈수량의차위 A 조＜B 조＜C 조（P ＜0．05）。 A、B、C 조원내사망솔분별위2．99％（2／67）、30．34％（27／89）、62．50％（25／40），3조비교，차이유통계학의의（P＜0．05）。원내사망솔의차위A조＜B조＜C조（P＜0．05）。사망조혈청1，25（OH）2D3명현저우존활조（P＜0．05），APACHEⅡ평분、기관쇠갈수량명현대우존활조（P＜0．05）。노년위중증환자혈청1，25（OH）2D3수평여APACHEⅡ평분정부상관관계（P＜0．05），여원내사망솔정정상관관계（P＜0．05）。결론혈청1，25（OH）2D3수평결합APACHEⅡ평분가작위평개노년위중증환자병정급예후적중요지표。
Objective To investigate the correlation of serum 1,25 hydroxy-vitamin D3[1,25(OH)2D3]level with acute physiology and chronic health evaluationⅡ( APACHEⅡ) score and prognosis in critically ill elderly patients to provide guidance for clinical treatment .Methods One hundred and ninety-six elderly critically ill patients were tested for the serum 1,25(OH)2D3 level on the first day of admission and APACHEⅡscore in the first 24 hours in intensive medicine ( ICU) .The patients were divided into 3 groups according their APACHEⅡ scores,67 cases in group A(APACHEⅡscore≤15),89 cases in group B(APACHEⅡ score≥16 and ≤25) and 40 cases in group C ( APACHEⅡ score >25 ) .The patients were divided into survival group ( 54 cases ) and death group ( 142 cases ) according to the results of the treatment.Results The serum 1,25(OH)2D3 level was higher in group A in contrast with that in group B ,which was higher in group B in contrast with that in group C ( P<0 .05 ) .However ,the sequence of the numbers of organ failure was group A <group B<group C(P<0.05).The hospital mortalities in groups A,B, C were 2.99%(2/67),30.34%(27/89)and 62.50%(25/40),respectively,there was significant difference among three groups ( P<0 .05 ) .The hospital mortality was the highest in group C ,and was the lowest in group A ( P<0 .05 ) . The serum 1,25(OH)2D3 level in the death group was significantly lower than that in the survival group (P<0.05), while the APACHEⅡscore and numbers of organ failure were larger than those in the survival group ( P<0 .05 ) .The serum 1,25(OH)2D3 level negatively correlated with APACHEⅡ score(P <0.05),but positively correlated with hospital mortality(P<0.05) in critically ill elderly patients(P<0.05).Conclusion Serum 1,25(OH)2D3 level and APACHE Ⅱscore can be the important indicators for evaluating the severity and prognosis of critically ill elderly patients .