血清维生素D水平与老年人社区获得性肺炎严重程度的相关性研究

doi:10.16150/j.1671-2870.2017.06.010

摘要/Abstract

摘要： 目的: 分析血清维生素D水平变化与老年人社区获得性肺炎（community-acquired pneumonia, CAP）间的相关性,探讨其在判断老年人CAP病情严重程度中的价值。方法: 选取235例老年CAP患者,按疾病程度分为重症CAP组（39例）和普通CAP组（196例）,另选取同期行体检的健康老年人219名作为对照组。测定3组研究对象的血清25-(OH)D₃、降钙素原（procalcitonin,PCT）、超敏C-反应蛋白（high sensitive C-reactive1protein,hsCRP）、血浆CRP水平及血常规、动脉血气、电解质。采用受试者工作特征（receiver operator characteristic, ROC）曲线评价血清25-(OH)D₃检测在老年人重症CAP诊断中的价值。结果: 重症CAP组、普通CAP组及正常对照组3组间的血清25-(OH)D₃、PCT、hsCRP、CRP水平及白细胞计数、中性粒细胞百分比、血氧分压（PaO₂）、钙离子浓度差异均有统计学意义（F分别为117.66、21.79、53.21、113.86、91.83、179.83、30.46、22.34,P均<0.05）。Pearson相关分析显示,血清25-(OH)D₃水平与hsCRP、CRP、白细胞计数呈负相关（r分别为-0.81、-0.23、-0.18,P均<0.05）,而与PaO₂、钙离子浓度呈正相关（r=0.22、0.27,P<0.05）。多因素logistic回归分析显示,血清25-(OH)D₃水平降低与老年CAP的严重程度密切相关;ROC曲线分析显示,血清25-(OH)D₃临界值取29.43 mmol/L对预测老年重症CAP有较好的临床价值（曲线下面积为0.864,95%CI为0.83~0.90,P<0.05）。结论: 血清维生素D不足或缺乏与老年CAP病情严重程度密切相关,检测血清25-(OH)D₃水平在评估老年CAP病情中有一定临床意义。

关键词: 社区获得性肺炎, 维生素D, 危险因素, 重症肺炎, 老年人

Abstract: Objectives: To analyze the correlation between serum vitamin D and severity of community-acquired pneumonia (CAP) in elderly people. Methods: A total of 235 cases of elderly people with CAP were enrolled and were divided into severe CAP group(39 cases) and common CAP group (196 cases). And 219 healthy elderly people were served as controls.Levels of serum 25-(OH)D₃, procalcitonin( PCT), hsCRP, serum C-reactive protein (CRP) and electrolytes were determined, and blood routine and arterial blood gas were detected. The diagnostic value of serum 25-(OH)D₃ level for CAP was evaluated by ROC curve. Results: The levels of serum 25-(OH)D₃, PCT, hsCRP, CRP, WBC count, PMN%, PaO₂, calcium between the three groups were statistically different (F=117.66, 21.79, 53.21, 113.86, 91.83, 179.83, 30.46, 22.34, P<0.05). Pearson correlation analysis showed that serum 25-(OH)D₃ level was negatively correlated with hsCRP, CRP, WBC (r=-0.81, -0.23, -0.18, P<0.05), and positively correlated with PaO2, calcium (r=0.22, 0.27, P<0.05). The multi-variable logistic regression analysis showed that serum low level of 25-(OH)D₃ was highly correlated with the severity of CAP. The ROC curve analysis showed that serum 25-(OH)D₃ had good diagnostic value for severe CAP (area under the curve was 0.864, 95% CI was 0.83~0.90, P<0.05). Conclusions: Serum vitamin D deficiency is closely correlated with severity of CAP in elderly people and is a high risk factor for severe CAP. Early detection of serum vitamin D level has clinical significance in evaluating the severity of CAP to some extent.

Key words: Community-acquired pneumonia, Vitamin D, Risk factor, Severe pneumonia, Elderly people

中图分类号:

R563.1

周妍, 顾祎. 血清维生素D水平与老年人社区获得性肺炎严重程度的相关性研究[J]. 诊断学理论与实践, 2017, 16(06): 612-616.

ZHOU Yan, GU Yi. Study on correlation between serum vitamin D and severity of community-acquired pneumonia in elderly people[J]. Journal of Diagnostics Concepts & Practice, 2017, 16(06): 612-616.

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