肺炎支原体肺炎患儿血清维生素D水平与肺外脏器受累的相关性研究
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摘要
目的研究肺炎支原体肺炎(MPP)患儿血清维生素D水平与肺外脏器受累的相关性,为临床评估提供理论依据。方法将榆林市第一医院2015年12月-2017年12月收治的158例MPP患儿分为肺外脏器受累组(n=56)和无肺外脏器受累组(n=102)。同时按照维生素D水平将患儿分为维生素D正常、不足和缺乏组,比较3组之间肺外脏器受累情况。结果与无肺外脏器受累组比较,肺外脏器受累组热程较长、白细胞计数(WBC)、血沉(ESR)、C反应蛋白(CRP)、D-二聚体(D-D)水平较高,维生素E、25-羟基维生素D[25-(OH)D]水平较低,差异有统计学意义(P<0.05);不同维生素D水平组肺外脏器受累发生率比较差异有统计学意义(P<0.05)。多元Logistic回归分析显示维生素D不足(OR=1.955,95%CI:1.479～4.233,P=0.006)或缺乏(OR=2.360,95%CI:1.687～8.125,P<0.001)是肺外脏器受累的独立危险因素。受试者工作特征(ROC)曲线分析显示血清25-(OH)D水平预测肺外脏器受累的曲线下面积(AUC)为0.840,敏感性和特异性分别为81.45%和87.76%,最佳界限值为22.48 ng/ml。结论维生素D不足或缺乏增加了MPP患儿肺外脏器受累的风险,可能是其发生的独立预测因素,临床应密切监测维生素D水平以评估患儿预后。
Objective To explore the correlation between serum vitamin D level and extra-pulmonary involvement in children with mycoplasma pneumoniae pneumonia(MPP),in order to provide theoretical evidence for clinical assessment. Methods Totally 158 MPP children admitted to Yulin First Hospital from December 2015 to December 2017 were enrolled in this study,and were divided into extra-pulmonary involvement group(n=56) and non extra-pulmonary involvement group(n=102).And all children were classified into normal vitamin D group,insufficiency group and deficiency group based on vitamin D level.Prevalence rates of extra-pulmonary involvement in different groups of vitamin D levels were compared. Results Compared with non extra-pulmonary involvement group,duration of fever in extra-pulmonary involvement group was much longer.And the levels of WBC,ESR,CRP,D-D were higher,while serum vitamin E and 25-hydroxyvitamin D[25-(OH)D] levels were significantly lower in extra-pulmonary involvement group(P<0.05).There were statistically significant differences on the prevalence rate of extra-pulmonary involvement children in different vitamin D level groups(P<0.05).Multivariate Logistic regression analysis showed that vitamin D insufficiency(OR=1.955,95%CI:1.479-4.233,P=0.006) or deficiency(OR=2.360,95%CI:1.687-8.215,P<0.001) were independent risks factor of extra-pulmonary involvement(P<0.05).ROC curve analysis showed that the area under curve(AUC) of serum 25-(OH)D level predicting extra-pulmonary involvement was 0.840,and its sensitivity and specificity were 81.45% and 87.76% respectively.The optimal cut-off point of serum 25-(OH)D level was 22.48 ng/ml. Conclusions vitamin D insufficiency or deficiency significantly increase the risk of extra-pulmonary involvement in MPP children,and may be the predictive factor for its occurrence independently.So vitamin D level should be closely monitored to evaluate prognosis of MPP children in clinical practice.
Objective To explore the correlation between serum vitamin D level and extra-pulmonary involvement in children with mycoplasma pneumoniae pneumonia(MPP),in order to provide theoretical evidence for clinical assessment. Methods Totally 158 MPP children admitted to Yulin First Hospital from December 2015 to December 2017 were enrolled in this study,and were divided into extra-pulmonary involvement group(n=56) and non extra-pulmonary involvement group(n=102).And all children were classified into normal vitamin D group,insufficiency group and deficiency group based on vitamin D level.Prevalence rates of extra-pulmonary involvement in different groups of vitamin D levels were compared. Results Compared with non extra-pulmonary involvement group,duration of fever in extra-pulmonary involvement group was much longer.And the levels of WBC,ESR,CRP,D-D were higher,while serum vitamin E and 25-hydroxyvitamin D[25-(OH)D] levels were significantly lower in extra-pulmonary involvement group(P<0.05).There were statistically significant differences on the prevalence rate of extra-pulmonary involvement children in different vitamin D level groups(P<0.05).Multivariate Logistic regression analysis showed that vitamin D insufficiency(OR=1.955,95%CI:1.479-4.233,P=0.006) or deficiency(OR=2.360,95%CI:1.687-8.215,P<0.001) were independent risks factor of extra-pulmonary involvement(P<0.05).ROC curve analysis showed that the area under curve(AUC) of serum 25-(OH)D level predicting extra-pulmonary involvement was 0.840,and its sensitivity and specificity were 81.45% and 87.76% respectively.The optimal cut-off point of serum 25-(OH)D level was 22.48 ng/ml. Conclusions vitamin D insufficiency or deficiency significantly increase the risk of extra-pulmonary involvement in MPP children,and may be the predictive factor for its occurrence independently.So vitamin D level should be closely monitored to evaluate prognosis of MPP children in clinical practice.
引文
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[11] 蔡心怡,李靓雯,郑玉灿,等.感染后肝功能损害患儿维生素D水平及其与丙氨酸氨基转移酶的相关性分析[J].南京医科大学学报:自然科学版,2017,37(6):723-727.
[12] Michos ED,Selvin E,Misialek JR,et al.25-hydroxyvitamin d levels and markers of subclinical myocardial damage and wall stress:the atherosclerosis risk in communities study[J].J Am Heart Assoc,2016,5(11):e003575.
[13] Muscogiuri G,Annweiler C,Duval G,et al.Vitamin D and cardiovascular disease:From atherosclerosis to myocardial infarction and stroke [J].Int J Cardiol,2017,230(8):577-584.
[14] 范丽,刘衡,王予川,等.血清维生素D水平与过敏性紫癜患儿病情及治疗的关系[J].中国当代儿科杂志,2017,19(7):796-799.
[2] 李少存,黄丽娜,郭初,等.胸片表现与免疫功能状态在难治性肺炎支原体肺炎患儿肺外并发症早期识别中的临床价值[J].中国妇幼保健,2018,33(2):341-343.
[3] 张霞,许建文.支原体肺炎患儿肺外并发症危险因素分析[J].中华实用诊断与治疗杂志,2015,29(5):519-520.
[4] Binks MJ,Smithvaughan HC,Marsh R,et al.Cord blood vitamin D and the risk of acute lower respiratory infection in Indigenous infants in the Northern Territory[J].Medical Journal of Australia,2016,204(6):238-243.
[5] 江载芳,申昆玲,沈颖.诸福棠实用儿科学[M].8版.北京:人民卫生出版社,2015.
[6] 中华医学会儿科学分会儿童保健学组.儿童微量营养素缺乏防治建议[J].中华儿科杂志,2010,48(7):502-509.
[7] 张会丰,韩笑,武姗姗.血清25(OH)D水平对评估儿童维生素D营养状况的意义和界值[J].中华儿科杂志,2015,53(3):164-167.
[8] Dimitri P,Luigi MG.Is there any relationship between extra-pulmonary manifestations of mycoplasma pneumoniae infection and atopy/respiratory allergy in children?[J].Pediatric Re ports,2016,8(1):6395-6401.
[9] Manaseki-Holland S,Maroof Z,Bruce J,et al.Effect on the incidence of pneumonia of vitamin D supplementation by quarterly bolus dose to infants in Kabul:a randomised controlled superiority trial[J].Lancet,2012,379(9824):1419.
[10] Kalicki B,Wawrzyniak A,Lipińska-Opaka A,et al.Influence of vitamin d and cotinine on T-regulatory cells and asthma severity in children[J].Adv Exp Med Biol,2017,102(12):1491-1501.
[11] 蔡心怡,李靓雯,郑玉灿,等.感染后肝功能损害患儿维生素D水平及其与丙氨酸氨基转移酶的相关性分析[J].南京医科大学学报:自然科学版,2017,37(6):723-727.
[12] Michos ED,Selvin E,Misialek JR,et al.25-hydroxyvitamin d levels and markers of subclinical myocardial damage and wall stress:the atherosclerosis risk in communities study[J].J Am Heart Assoc,2016,5(11):e003575.
[13] Muscogiuri G,Annweiler C,Duval G,et al.Vitamin D and cardiovascular disease:From atherosclerosis to myocardial infarction and stroke [J].Int J Cardiol,2017,230(8):577-584.
[14] 范丽,刘衡,王予川,等.血清维生素D水平与过敏性紫癜患儿病情及治疗的关系[J].中国当代儿科杂志,2017,19(7):796-799.