血清25-羟维生素D水平与急性胰腺炎预后的相关性  

Correlation analysis of serum 25 hydroxyvitamin D level and prognosis of acute pancreatitis

作　　者：刘瑜[1] 黄方[1] 严妤函 童智慧[2] 张兴虎[1] 万文辉[1] LIU Yu;HUANG Fang;YAN Yu-han;TONG Zhi-hui;ZHANG Xing-hu;WAN Wen-hui(First Department of Cadre Ward,General Hospital of Eastern Theater Command,PLA,Nanjing 210002,Jiangsu,China;Department of Critical Care Medicine,General Hospital of Eastern Theater Command,PLA,Nanjing 210002,Jiangsu,China)

机构地区：[1]东部战区总医院(原南京军区南京总医院)干部病房一科,南京210002 [2]东部战区总医院(原南京军区南京总医院)重症医学科,南京210002

出　　处：《医学研究生学报》2021年第7期706-711,共6页Journal of Medical Postgraduates

基　　金：国家自然科学基金(81701890);全军保健专项课题(17BJZ17)。

摘　　要：目的VD缺乏与多种疾病风险和(或)严重程度增加相关。文中探讨急性胰腺炎(AP)患者血清25-羟维生素D[25(OH)D]水平及其与AP严重程度和预后的相关性。方法选取2018年1月至2019年12月东部战区总医院收治AP患者508例。采用ELISA方法对AP诊断2 d内的血清25(OH)D水平进行检测。同时收集入组对象的一般人口学、实验室和辅助检查结果、临床转归等资料,基于局部因素和全身因素对AP严重程度进行分级,分析25(OH)D水平与AP严重程度的关系。依据预后对AP患者进行分组,校正年龄、性别、吸烟饮酒状态、既往史后,非条件Logistic回归分析维生素D(VD)缺乏[25(OH)D<20 ng/mL]与AP患者不同预后的相关性。结果7例患者25(OH)D检测失败。501例AP患者中VD缺乏303例(60.48%),VD不足[20 ng/mL≤25(OH)D<30 ng/mL]171例(34.13%)。VD缺乏和不足组重型和危重型AP患者比例明显偏高(P<0.01)。25(OH)D水平与APACHE II评分、SOFA评分、住院总时间、住ICU时间、降钙素原、白介素-6和C反应蛋白水平呈负相关(P<0.01)。VD缺乏是AP患者进展为脓毒症(P<0.01)、重症AP(P<0.01)、死亡(P=0.018)的独立危险因素。结论血清25(OH)D水平与AP严重程度和预后相关,VD缺乏是AP预后不良的预测因素。Objective VD deficiency is associated with increased risk and/or severity of a variety of diseases.To investigate the correlation between serum 25(OH)D[25(OH)D]levels and the severity and prognosis of acute pancreatitis(AP).Methods A total of 508 AP patients admitted to the General Hospital of the Eastern Theater Command from January 2018 to December 2019 were selected.Serum 25(OH)D levels were detected by ELISA 2 days after AP diagnosis.At the same time,the general demographic data,laboratory and auxiliary examination results,clinical outcomes and other data were collected.The severity of AP was classified based on local factors and systemic factors,and the relationship between 25(OH)D level and the severity of AP was analyzed.Patients with AP were grouped according to prognosis,and the correlation between VD deficiency[25(OH)D<20ng/mL]and different outcomes in AP patients was analyzed by unconditional Logistic regression after adjusting for age,gender,smoking and drinking status,and previous history.Results 25(OH)D test failed in 7 patients.Among 501 AP patients,303 cases(60.48%)were deficient in VD,and 171 cases(34.13%)were deficient in VD[20 ng/mL≤25(OH)D<30ng/mL].The proportion of severe and critical AP patients in VD deficient and insufficient groups was significantly higher(P<0.01).25(OH)D level was negatively correlated with APACHE II score,SOFA score,total length of hospital stay,ICU stay,procalcitonin,IL 6 and CRP levels(P<0.01).VD deficiency was an independent risk factor for progression to sepsis(P<0.01),severe AP(P<0.01),and death(P=0.018)in AP patients.Conclusion Serum 25(OH)D level is related to the severity and prognosis of AP,and VD deficiency is a predictor of poor prognosis of AP.

关 键 词：急性胰腺炎 25-羟维生素D 严重程度 预后 

分 类 号：R576[医药卫生—消化系统]