维生素D3改善脓毒症患者病情严重程度及预后：一项前瞻性随机双盲安慰剂对照研究  

Effect of vitamin I）3 on the severity and prognosis of patients with sepsis： a prospective randomized double- blind placebo study

作　　者：丁福来[1] 臧彬[1] 符加红[1] 吉凯强[1] 

机构地区：[1]中国医科大学附属盛京医院ICU,辽宁沈阳110004

出　　处：《中华危重病急救医学》2017年第2期106-110,共5页Chinese Critical Care Medicine

基　　金：辽宁省自然科学基金（201102293）

摘　　要：目的观察维生素D3与脓毒症患者病情严重程度及预后的关系，探讨补充外源性维生素D3能否改善脓毒症患者的预后。方法采用前瞻性随机双盲安慰剂对照研究方法，选择2015年3月至11月中国医科大学附属盛京医院重症加强治疗病房（ICU）收治的57例脓毒症患者；选择同期20例全身炎症反应综合征（SIRS）患者和20例健康体检志愿者作为对照。根据2012年国际严重脓毒症及脓毒性休克治疗指南的诊断标准将脓毒症患者分为一般脓毒症组和严重脓毒症组（包括脓毒性休克）；按美国内分泌学会制定的诊断标准，根据血清25羟维生素D3〔25（OH）D3〕水平，将维生素D不足〔25（OH）D3 20～30 μg/L〕或缺乏〔25（OH）D3〈20 μg/L〕的脓毒症患者按随机数字表法分为D3治疗组（补充300 kU维生素D3）和安慰剂组（给予1 mL生理盐水）；以28 d为研究终点，将脓毒症患者分为存活组和死亡组。采用电化学发光法测定各组血清25（OH）D3水平，分析不同病情严重程度、性别、年龄脓毒症患者间25（OH）D3水平的差异。记录脓毒症患者降钙素原（PCT）、C-反应蛋白（CRP）、血常规、肝肾功能、电解质、动脉血气、急性生理学与慢性健康状况评分系统Ⅱ（APACHEⅡ）评分、序贯器官衰竭评分（SOFA）、机械通气时间、ICU住院时间，采用多因素Cox比例风险回归分析影响脓毒症患者预后的危险因素。结果① 57例脓毒症患者中一般脓毒症15例，严重脓毒症42例；D3治疗组29例，安慰剂组28例；28 d死亡8例，病死率14.04%。②脓毒症组和SIRS组血清25（OH）D3水平均明显低于健康对照组〔μg/L：3.92（〈3.00，11.22）、6.99（3.51，9.77）比17.25（13.48，22.50），均P〈0.01〕，但脓毒症组、SIRS组及不同程度脓毒症组间血清25（OH）D3水平差异无统计学意义。女性脓毒症患者（n＝24）血清25（OH）D3水平显著低于ObjectiveTo observe the relationship between vitamin D3 and the severity as well as prognosis in patients with sepsis, and to explore whether exogenous vitamin D3 can improve the prognosis in patients with sepsis.MethodsA prospective randomized double-blind placebo study was conducted. Fifty-seven patients with sepsis admitted to intensive care unit （ICU） of Shengjing Hospital Affiliated to China Medical University from March to November in 2015 were enrolled. Twenty patients with systemic inflammatory response syndrome （SIRS） and 20 healthy volunteers with normal physical examination as control were enrolled during the same time. Patients with sepsis were divided into general sepsis group and severe sepsis group （including septic shock） according to the criteria for the diagnosis of severe sepsis and septic shock in 2012. According to the diagnostic criteria established by the American Endocrine Society, and on the basis of 25-hydroxy vitamin D3 [25（OH）D3], the sepsis patients with deficiency [25（OH）D3 20-30 μg/L] or insufficiency [25（OH）D3 〈 20 μg/L] of vitamin D were divided into D3 treatment group （supplemented 300 kU vitamin D3） and placebo group （injected 1 mL physiological saline）. 28th day was set as the end point, and the patients with sepsis were divided into survival group and death group. The levels of serum 25（OH）D3 in each group were measured by electrochemical luminescence method, and the difference in 25（OH）D3 levels among patients with different severity, gender, and age were recorded. Procalcitonin （PCT）, C-reactive protein （CRP）, blood routine, liver and kidney function, electrolytes and arterial blood gas analysis, acute physiology and chronic health evaluation Ⅱ （APACHEⅡ） and sequential organ failure score （SOFA）, duration of mechanical ventilation, and length of ICU stay of patients with sepsis were observed. Multivariate Cox proportional hazard regression analysis was used to analyze the risk factors of prognosis in patients wi

关 键 词：维生素D 脓毒症 预后 重症加强治疗病房 

分 类 号：R459.7[医药卫生—急诊医学]