摘要
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% CI1.321～6.875,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。
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 1.321-6.875, 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.
出处
《中华内分泌代谢杂志》
CAS
CSCD
北大核心
2013年第10期827-831,共5页
Chinese Journal of Endocrinology and Metabolism
基金
国家临床重点专科建设项目（2011-873）
