中华内分泌代谢杂志
中華內分泌代謝雜誌
중화내분비대사잡지
CHINESE JOURNAL OF ENDOCRINOLOGY AND METABOLISM
2013年
10期
827-831
,共5页
胡杰妤%陈朝彦%覃桦%锁颖君%罗佐杰
鬍傑妤%陳朝彥%覃樺%鎖穎君%囉佐傑
호걸여%진조언%담화%쇄영군%라좌걸
25-羟维生素D%维生素D缺乏%重症监护病房%预后
25-羥維生素D%維生素D缺乏%重癥鑑護病房%預後
25-간유생소D%유생소D결핍%중증감호병방%예후
25-hydroxyvitamin D%Vitamin D deficiency%Intensive care unit%Prognosis
目的 调查重症监护病房(ICU)危重患者不同水平的25-羟维生素D[25(OH)D]与疾病严重程度的相关性及对预后的影响.方法 检测216例入住内科ICU危重患者的血清25(OH)D水平,比较25(OH)D充足组、25(OH)D不足组、25 (OH)D缺乏组组间急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分、ICU留住时间、机械通气时间、主要生化指标和住院病死率的差异;多因素logistic回归分析筛查影响患者预后的独立因素.结果 70.8％的ICU患者出现血清25(OH)D水平下降,其中缺乏组、不足组、充足组分别占44.0％、26.8％、29.2％.维生素D缺乏组APACHEⅡ评分较高[缺乏组25 (20,28)分,不足组22(17,26)分,充足组19(18,20)分,P＜0.01],血培养阳性率高(缺乏组18.9％,不足组13.8％,充足组3.2％,P=0.015),多器官功能障碍综合征发生率高(缺乏组48.4％,不足组43.1％,充足组25.4％,P=0.025),住院病死率高(缺乏组40％,不足组24.1％,充足组15.9％,P=0.003).血清25(OH)D水平与APACHEⅡ评分、住院病死率呈显著负相关(分别r=-0.325,P＜0.01；r=-0.276,P＜0.01)；多因素分析显示维生素D缺乏(OR=3.005,95％ CI 1.321～6.875,P=0.008)是影响危重患者预后的独立危险因素.结论 ICU患者维生素D缺乏的发生率高；维生素D缺乏与患者的疾病严重程度相关,可能是影响疾病预后的一个独立危险因素.
目的 調查重癥鑑護病房(ICU)危重患者不同水平的25-羥維生素D[25(OH)D]與疾病嚴重程度的相關性及對預後的影響.方法 檢測216例入住內科ICU危重患者的血清25(OH)D水平,比較25(OH)D充足組、25(OH)D不足組、25 (OH)D缺乏組組間急性生理學與慢性健康狀況評分繫統Ⅱ(APACHEⅡ)評分、ICU留住時間、機械通氣時間、主要生化指標和住院病死率的差異;多因素logistic迴歸分析篩查影響患者預後的獨立因素.結果 70.8％的ICU患者齣現血清25(OH)D水平下降,其中缺乏組、不足組、充足組分彆佔44.0％、26.8％、29.2％.維生素D缺乏組APACHEⅡ評分較高[缺乏組25 (20,28)分,不足組22(17,26)分,充足組19(18,20)分,P＜0.01],血培養暘性率高(缺乏組18.9％,不足組13.8％,充足組3.2％,P=0.015),多器官功能障礙綜閤徵髮生率高(缺乏組48.4％,不足組43.1％,充足組25.4％,P=0.025),住院病死率高(缺乏組40％,不足組24.1％,充足組15.9％,P=0.003).血清25(OH)D水平與APACHEⅡ評分、住院病死率呈顯著負相關(分彆r=-0.325,P＜0.01；r=-0.276,P＜0.01)；多因素分析顯示維生素D缺乏(OR=3.005,95％ CI 1.321～6.875,P=0.008)是影響危重患者預後的獨立危險因素.結論 ICU患者維生素D缺乏的髮生率高；維生素D缺乏與患者的疾病嚴重程度相關,可能是影響疾病預後的一箇獨立危險因素.
목적 조사중증감호병방(ICU)위중환자불동수평적25-간유생소D[25(OH)D]여질병엄중정도적상관성급대예후적영향.방법 검측216례입주내과ICU위중환자적혈청25(OH)D수평,비교25(OH)D충족조、25(OH)D불족조、25 (OH)D결핍조조간급성생이학여만성건강상황평분계통Ⅱ(APACHEⅡ)평분、ICU류주시간、궤계통기시간、주요생화지표화주원병사솔적차이;다인소logistic회귀분석사사영향환자예후적독립인소.결과 70.8％적ICU환자출현혈청25(OH)D수평하강,기중결핍조、불족조、충족조분별점44.0％、26.8％、29.2％.유생소D결핍조APACHEⅡ평분교고[결핍조25 (20,28)분,불족조22(17,26)분,충족조19(18,20)분,P＜0.01],혈배양양성솔고(결핍조18.9％,불족조13.8％,충족조3.2％,P=0.015),다기관공능장애종합정발생솔고(결핍조48.4％,불족조43.1％,충족조25.4％,P=0.025),주원병사솔고(결핍조40％,불족조24.1％,충족조15.9％,P=0.003).혈청25(OH)D수평여APACHEⅡ평분、주원병사솔정현저부상관(분별r=-0.325,P＜0.01；r=-0.276,P＜0.01)；다인소분석현시유생소D결핍(OR=3.005,95％ CI 1.321～6.875,P=0.008)시영향위중환자예후적독립위험인소.결론 ICU환자유생소D결핍적발생솔고；유생소D결핍여환자적질병엄중정도상관,가능시영향질병예후적일개독립위험인소.
Objective To investigate the prevalence of vitamin D deficiency in medical intensive care unit (ICU) and its relationship with severity of disease and prognosis.Methods A prospective study was performed to evaluate vitamin D status in 216 patients admitted to the medical intensive care unit.The incidence of hypovitaminosis D was observed.Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE Ⅱ) score,days kept in ICU and on ventilator,main laboratory findings,and mortality rate were compared among patients with different serum 25-hydroxyvitamin D [25 (OH) D] levels.Potential risk factors for mortality were analyzed by multivariate logistic regression analysis.Results One hundred and fifty-three patients (70.8％) developed hypovitaminosis D.25 (OH) D deficiency was identified in 95 (44.0％),25 (OH) D insufficiency in 58 (26.8％),and 25 (OH) D sufficiency in 63 (29.2％) patients.APACHE Ⅱ score,positive blood culture,the incidence of multiple organ dysfunction syndrome(MODS),and mortality rate were higher in deficiency group compared with the other two groups [APACHE Ⅱ score:deficiency group 25 (20,28) score,insufficiency group 22 (17,26) score,sufficiency group 19 (18,20) score,P＜0.01 ; positive blood culture:deficiency group 18.9％,insufficiency group 13.8％,sufficiency group 3.2％,P=0.015 ; MODS:deficiency group 48.4％,insufficiency group 43.1％,sufficiency group 25.4％,P=0.025; mortality rate:deficiency group 40％,insufficiency group 24.1％,sufficiency group 15.9％,P =0.003].25 (OH)D levels were negatively correlated with APACHE Ⅱ score and mortality rate (r =-0.325,P＜0.01 ; r=-0.276,P＜0.01,respectively).Analysis by multiple logistic regression demonstrated that 25 (OH) D deficiency (OR =3.005,95 ％ CI 1.321-5.875,P =0.008) was independent risk factor for mortality.Conclusions This study demonstrates that vitamin D deficiency is highly prevalent among patients admitted into ICU.Vitamin D deficiency is associated with disease severity,and seems to be an independent risk factor for mortality.
