永军医学英语学习笔记16：手足口病危重儿血清25-羟维生素D浓度的临床意义与预后影响

Nutrients. 2017 May 10;9(5).

Clinical Significance and Prognostic Effect of Serum 25-hydroxyvitamin D Concentrations in Critical and Severe Hand, Foot and Mouth Disease.

手足口病危重儿血清25-羟维生素D浓度的临床意义与预后影响

作者     党红星，刘成军，李静，程时骄，许峰

摘要

Abstract

目的：探讨血清25羟维生素D [ 25（OH)D]浓度与手足口病危重症的关系及评估手足口病危重儿血清25-羟维生素D浓度的临床意义与预后影响。

OBJECTIVE:

To examine the association of serum 25-hydroxyvitamin D [25(OH)D] concentrations with critical and severe hand, foot and mouth disease (HFMD) and assess the clinical significance and prognostic effect of 25(OH)D concentrations in children with HFMD.

方法：本研究为前瞻性观察研究。

METHODS:

This is a prospective observational study. 

将138例手足口病患儿分为普通组（49例）、重症组（52例）和危重组（37例）。另选取同期门诊体检的59例健康儿童作为对照组。

The 138 children with HFMD were divided into common (49 cases), severe (52 cases), and critical (37 cases) HFMD groups. Another 59 healthy children undergoing outpatient medical examinations during the same period were chosen as the control group. 

测定所有对象的血清25（OH）D浓度，每组再分为血清25（OH）D正常组（≥30ng/mL）；不足组（20-29.9ng/mL）；缺乏组（低于20 ng/mL）。

Serum 25(OH)D concentrations were measured in all the subjects, and each group was subdivided by serum 25(OH)D concentration into 25(OH)D normal (≥30 ng/mL); insufficiency (20-29.9 ng/mL), and deficiency (<20 ng/mL) groups. 

手足口病危急重症组在入住儿科ICU（PICU）时记录小儿危重病例评分（PCIS）。

The pediatric critical illness score (PCIS) was recorded for the critical and severe HFMD group upon admission to the pediatric intensive care unit (PICU). 

监测小儿危重手足口病患者血乳酸（LAC）、血清钙离子（Ca2+）、D-二聚体（DD）、乳酸脱氢酶（LDH）、肌酸激酶同工酶（CK-MB）水平；脑干脑炎、神经源性肺水肿、循环衰竭的发生情况；14天病死率。

Children with critical and severe HFMD were also monitored for blood lactate (LAC), serum calcium ions (Ca++), D-dimer (DD), lactate dehydrogenase (LDH), and creatine kinase-MB (CK-MB) levels; the incidences of brainstem encephalitis, neurogenic pulmonary edema, and circulatory failure; and the 14-day mortality rate.

结果：

RESULTS：

各组血清25（OH）D浓度普遍较低。

Serum 25(OH)D concentrations were generally low in all groups. 

与对照组（28.1 ± 6.6 ng/mL, 8%）、普通组（29.5 ± 8.1 ng/mL, 10%）和重症组（31.9 ± 9.7 ng/mL, 8%）相比，危重组患者血清25（OH）D平均浓度（20.0 ± 8.4 ng/mL）明显较低，血清25（OH）D缺乏比例（18％）明显较高(P＜0.05）。

The critical HFMD group showed a significantly lower serum 25(OH)D mean concentration (20.0 ± 8.4 ng/mL) and a higher proportion of deficiency (18%) compared with the control group (28.1 ± 6.6 ng/mL, 8%), common (29.5 ± 8.1 ng/mL, 10%) and severe (31.9 ± 9.7 ng/mL, 8%) HFMD groups (p < 0.05). 

在危重组中，25（OH）D缺乏组比25（OH）D正常组及不足组具有更低的PCIS值（P＜0.05）；而比后两组具有更高LAC、LDH、CK-MB和DD；具有（更高的）脑干脑炎、神经源性肺水肿、循环衰竭发生率及病死率（P＜0.05）。

In the critical and severe HFMD groups, the 25(OH)D deficiency group had lower PCISs than the 25(OH)D normal and insufficiency groups (p < 0.05); and had higher values than the latter two groups for LAC, LDH, CK-MB and DD; and the incidences of brainstem encephalitis, neurogenic pulmonary edema, circulatory failure, and mortality (p < 0.05). 

死亡组较存活组具有显著降低的血清25（OH）D浓度和PCIS（P＜0.05），具有较高的LAC、LDH、CK-MB和DD水平；较高的脑干脑炎、神经源性肺水肿、循环衰竭发病率（P＜0.05）。

The death group showed significantly lower serum 25(OH)D concentrations and PCISs than the survival group (p < 0.05) and had higher LAC, LDH, CK-MB and DD levels and higher incidences of brainstem encephalitis, neurogenic pulmonary edema, and circulatory failure (p < 0.05). 

Logistic回归分析显示，血清25（OH）D浓度是影响重症手足口病患儿病死率的独立因素。

Logistic regression analysis revealed that the serum 25(OH)D concentration was an independent factor that influenced mortality in children with critical and severe HFMD.

CONCLUSIONS:

结论：

在这项研究中，我们发现，血清25（OH）D浓度在手足口病危重患儿中大幅降低，并与手足口病的严重程度相关。

In this study, we find the serum 25(OH)D concentrations are substantially reduced in children with critical and severe HFMD and are associated with the severity of HFMD. 

血清25（OH）D浓度对判断重症手足口病进展和预测死亡风险具有临床价值。

The serum 25(OH)D concentrations may have clinical value for determining the progression of critical HFMD and predicting the risk of death. 

在确定25（OH）D浓度在手足口病诊断的临床价值之前，仍需进一步的证据。

Further evidence is needed before it can be stated that 25(OH)D concentrations have clinical value in HMFD diagnosis.

关键词：

KEYWORDS:

25-hydroxyvitamin D; critical illness; foot and mouth disease; hand

25羟维生素D；危重病；手足口病