[1]王 玉,杨中文,高 丽,等.补充维生素D对脓毒症儿童炎症反应的调节及其临床干预作用的应用[J].肠外与肠内营养杂志,2020,(04):215-221.[doi:10.16151/j.1007-810x.2020.04.006]
 WANG Yu,YANG Zhong-wen,GAO Li,et al.The effects of vitamin D supplementation on the regulation of inflammation and clinical outcomes in children with sepsis[J].PARENTERAL & ENTERAL NUTRITION,2020,(04):215-221.[doi:10.16151/j.1007-810x.2020.04.006]
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补充维生素D对脓毒症儿童炎症反应的调节及其临床干预作用的应用
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《肠外与肠内营养》杂志[ISSN:1007-810X/CN:32-1477/R]

卷:
期数:
2020年04期
页码:
215-221
栏目:
论著
出版日期:
2020-07-10

文章信息/Info

Title:
The effects of vitamin D supplementation on the regulation of inflammation and clinical outcomes in children with sepsis
作者:
王 玉杨中文高 丽王倩涵马彩霞
河南省人民医院儿科,河南郑州 450003
Author(s):
WANG Yu YANG Zhong-wen GAO Li WANG Qian-han MA Cai-xia
Department of pediatrics, Henan Provincial People's Hospital, Zhengzhou 450003, Henan, China
关键词:
维生素D 脓毒症 儿童 预后 营养
Keywords:
Vitamin D Sepsis Children Clinical outcomes Nutrition
分类号:
R459.3
DOI:
10.16151/j.1007-810x.2020.04.006
文献标志码:
A
摘要:
目的:探讨补充外源性维生素D3对脓毒症病儿炎症反应的调节作用及对临床预后的影响。 方法:选取入住河南省人民医院PICU维生素D缺乏的脓毒症儿童109名,随机分为2组,除常规处理外,一组给予口服维生素D3,为治疗组,另一组则予以口服安慰剂,为对照组;两组均按≤1岁,1 ~ 5岁和≥5岁分为三个年龄段。分别于入组时及治疗5 d后,测定每名病儿的维生素D水平,血管紧张素II及TNF-α、IL-6的血浆浓度,此外观察并记录每名病儿的SOFA评分(序贯器官衰竭评分),机械通气时间,入住PICU时间,以及两组病儿的感染性休克发生率和死亡率,最后进行统计分析。 结果:入组时所有病儿的25羟维生素D水平[25-(OH)D3]均低于20 ug/mL,两组之间未见显著性差异(P > 0.05);治疗后,治疗组病儿的维生素D水平即较对照组明显上升(P < 0.05),而血管紧张素II 及TNF-α、IL-6浓度明显下降;此外服用维生素D后病儿SOFA评分为显著低于对照组[(1.8 ± 0.8) vs (2.3 ± 1.1),P <0.05];各年龄段病儿发生感染性休克的比例于组间未呈现出显著性差异;此外机械通气时间、入住PICU时间的结果显示,治疗组病儿[(2.66 ± 5.3) d,(11.47 ± 9.97) d]与对照组相比[(4.5 ± 8.1) d,(12.5 ± 10.4) d],并无显著性差异(P > 0.05);治疗组与对照组病儿的死亡率分别为9.1%和14.8%,差异无统计学意义(P > 0.05)。 结论:对于维生 素D缺乏的脓毒症病儿,补充维生素D3可以有效降低病儿的血管紧张素II及炎性因子水平,并且可使5岁以上儿童的SOFA评分显著性下降,但其对感染性休克,SOFA评分,机械通气时间,入住PICU时间和死亡率的影响还有待进一步研究。
Abstract:
Objective: To investigate the effects of vitamin D3 supplementation on the regulation of the inflammation and clinical outcomes in children with sepsis. Methods: 109 children with sepsis and vitamin D deficiency(VDD) admitted to PICU were enrolled. They were randomly divided into two groups. Fifty-five patients were given vitamin D as treatment group, the others were given placebo. Both groups were divided into three age groups: ≤1 year old, 1~5 years old and ≥5 years old. Serum vitamin D levels, angiotensin II, TNF-αand IL-6 concentrations were measured at the time of enrollment and 5 days after the treatment. In addition, SOFA score, mechanical ventilation time, PICU admission time, and the incidence and mortality of septic shock in the two groups were recorded respectively, and finally statistical analysis. Results: The levels of 25(OH)D3 in all the participates were below 20ug/ml before the treatment. There was is no significant difference between the two groups (P > 0.05). After the treatment, vitamin D levels in the treatment group were significantly higher than those of the control group (P < 0.05), while the concentrations of angiotensin II, TNF-α and IL-6 declined significantly. In addition, the children’s SOFA score was significantly lower than the control after taking vitamin D [(1.8 ± 0.8) vs (2.3 ± 1.1), P < 0.05]. There was no significant difference in the proportion of children with septic shock in different age groups. In addition, the results of mechanical ventilation time and PICU admission time showed that there was no significant difference between the treatment group and the control group [(2.66 ± 5.3) d, (11.47 ± 9.97) d] and [(4.5 ± 8.1) d, (12.5 ± 10.4) d] (P > 0.05). The mortality of the patients in the treatment group and the control group was 9.1% and 14.8%, respectively, with no statistically significant difference (P >0.05). Conclusion: For children with sepsis and vitamin D deficiency, vitamin D3 supplementation can effectively reduce the levels of angiotensin II, TNF-α and IL-6, and can significantly reduce the SOFA score in children over 5 years old, but the effects for septic shock, SOFA score, mechanical ventilation time, PICU admission time and mortality remains to be further studied.

参考文献/References:


[1]刘 娟, 钱素云. 小儿脓毒症和严重脓毒症发病情况单中心调查. 实用儿科临床杂志, 2010, 28(1): 26-29.
[2] Goldstein B, Giroir B, Randolph A; International Consensus Conference on Pediatric Sepsis. International pediatric sepsis consensus conference: definitions for sepsis and organ dysfunction in pediatrics. Pediatr Crit Care Med, 2005, 6(1): 2-8.
[3] Moromizato T,Litonjua AA, Braun AB,et a1. Association of Low Serum 25. Hydroxyvitamin D Levels and Sepsis in the Critically Ill. Crit Care Med,2014,42(1):97-107.
[4] Dellinger RP, Levy MM, Rhodes A, et a1. Surviving Sepsis Campaign:international guidelines for management of severe sepsis and septic shock 2012. Intensive Care Med, 2013, 39(2):165-228.
[5] 中华医学会儿科学会急救学组. 第四届全国小儿急救医学研讨会纪要. 中华儿科杂志,1995,33(6): 370.
[6] Prudhon C, Prinzo ZW, Briend A, et al. Proceedings of the WHO, UNICEF, and SCN Informal Consultation on Community-Based Management of Severe Malnutrition in Children. Food Nutr Bull,2006,27(3 Suppl):S99-S104.
[7] 王静文, 万园园, 刘长伟, 等. 危重患儿营养状况及其与临床结局的相关性. 中华实用儿科临床杂志, 2018, 33(19):1491-1494.
[8] Institute of Medicine (US) Committee to Review Dietary Reference Intakes for Vitamin D and Calcium, Ross AC, Taylor CL, Yaktine AL, Del Valle HB, eds. Dietary Reference Intakes for Calcium and Vitamin D. Washington (DC): National Academies Press (US); 2011.
[9] Christopher KB. Vitamin D supplementation in the ICU patient. Curr Opin Clin Nutr Metab Care, 2015, 18(2):187-192.
[10] 程时骄,许 峰. 危重症患儿维生素D水平及补充制剂选择. 中华实用儿科临床杂志, 2016, 31(6):474-477.
[11] Lucidarme O, Messai E, Mazzoni T, et al. Incidence and risk factors of vitamin D deficiency in critically ill patients: results from a prospective observational study. Intensive Care Med,2010, 36 (9): 1609-1611.
[12] De Pascale G, Vallecoccia MS, Schiattarella A, et al. Clinical and microbiological outcome in septic patients with extremely low 25-hydroxyvitamin D levels at initiation of critical care. Clin Microbiol Infect, 2016, 22 (5): 456.e7-456.e13.
[13] 尹冰如, 钱素云, 成怡冰, 等. 脓毒症/严重脓毒症患儿维生素D水平与预后. 中华急诊医学杂志, 2016, 25(6):709-713.
[14] Jeng L, Yamshchikov AV, Judd SE, et a1. Alterations in vitamin D status and anti-microbial poptide levels in patients in the intensive care unit with sepsis. J Trans Med, 2009, 7:28-32.
[15] Quraishi SA, Litonjua AA, Moromizato T, et al. Association between prehospital vitamin D status and hospital-acquired bloodstream infections. Am J Clin Nutr, 2013, 98 (4): 952-959.
[16] Cantorna MT, Snyder L, Lin YD, et al. Vitamin D and 1,25(OH) 2D regulation of T cells. Nutrients. 2015, 7(4): 3011-3021.
[17] 祁晓平,黎介寿. 1,25-二羟维生素D3的免疫调节作用. 肠外与肠内营养, 2006,13(2): 105-108.
[18] Mosekilde L. Vitamin D and the elderly. Clin Endocrinol (Oxf),2005, 62(3): 265-281.
[19] Gonzalez-Curiel I, Marin-Luevano P, Trujillo V, et al. Calcitriol prevents inflammatory gene expression in macrovascular endothelial cells. Br J Biomed Sci,2016,73(2):74-78.
[20] Martini LA, Wood RJ. Vitamin D and blood pressure connection: update on epidemiologic, clinical, and mechanistic evidence. Nutr Rev, 2008, 66(5):291-297.
[21] 王玉红, 周荣斌. 拮抗肾素-血管紧张素-醛固酮系统可能成为治疗脓毒症的新策略. 临床急诊杂志, 2011,12(4): 284-288.
[22] Sankar J, Ismail J, Das R, et al. Effect of Severe Vitamin D Deficiency at Admission on Shock Reversal in Children With Septic Shock. J Intensive Care Med, 2019, 34(5):397-403.
[23] 陈朝彦, 罗佐杰, 胡杰妤, 等. 维生素 D 缺乏与脓毒症预后相关性研究. 中国实用内科杂志, 2014, 34 (11): 1087-1090.
[24] Madden K, Feldman HA, Smith EM, et al. Vitamin D deficiency in critically ill children. Pediatrics, 2012, 130(3):421-428.
[25] 中国医师协会急诊医师分会, 中国研究型医院学会休克与脓毒症专业委员会. 中国脓毒症/脓毒性休克急诊治疗指南(2018).感染.炎症.修复, 2019, 20(1):3-22.
[26] 丁福来, 臧 彬, 符加红, 等. 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. 中华危重病急救医学, 2017, 29(2):106-110.

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备注/Memo

备注/Memo:
基金项目 :河南省医学科技攻关计划联合共建项目(2018020413) 作者简介 :王 玉,副主任医师,医学博士,从事危重症相关营养的基础和临床研究。E-mail:wangyugirl2004@126.com 通讯作者 :高 丽,E-mail:mnsgl@126.com
更新日期/Last Update: 1900-01-01