Changes of 25-hydroxy vitamin D and vitamin D binding protein in critically ill chidren and its clinical significance / 中国小儿急救医学

ABSTRACT

Objective To investigate the 25-hydroxy-vitamin D[25(OH)D] and vitamin D binding protein ( VBDP) levels in critically ill children admitted to PICU,their clinical significance and the relation-ship with prognosis. Methods Two hundred and ninty-five children with critical illness admitted to PICU from February 2015 to July 2016 were enrolled as subjects( study group) and 44 healthy controls were recrui-ted. Serum 25(OH)D and VDBP levels were measured on the 1st and 7th day of PICU,then clinical data were collected for statistical analysis. Results (1) Among subjects,there were no statistically significant differ-ences in the incidences of 25(OH)D deficiency and VDBP decline(P>0. 05). (2)The levels of 25 (OH)D and VDBP in the study group were lower than those in the control group [ ( 61. 38 ± 29. 42 ) nmol/L vs. (97. 11 ± 30. 11) nmol/L; (514. 36 ± 211. 13)μmol/L vs. (840. 82 ± 448. 96)μmol/L,respectively,P <0. 05]. (3) There were no significant differences in the level of VDBP ,28-day mortality,organ failure rate and mechanical ventilation rate among 25(OH)D adequate group(n=85),inadequate group(n=97) and deficient group( n=113 ) ( P>0. 05 ) . The duration of PICU stay,PRISMⅢscores were significantly longer and higher (P<0. 05) in 25(OH)D inadequate group or deficient group than those of 25(OH)D adequate group.(4) Compare to the 7th day ,the levels of 25(OH)D and VDBP were lower (P <0.05) and PRISM Ⅲscores was higer on the 1st day in the cases staying in PICU≥7 d[ (71. 14 ± 31. 78)nmol/L vs. (60.65 ±30.77)nmol/L;(532.23 ±148.49)μmol/L vs. (484.73 ±128.17)μmol/L;2.0(0.0 ～5.0) scores vs. 5. 0(3. 0～8. 0)scores,respectively,P<0. 05]. (5) Among the 295 cases of critically ill children ,the 28-day mortality was 12. 9％(38/295),the death patients showed lower 25(OH)D status[ (51. 17 ± 29.65)nmol/L vs. (62.89 ±29.15)nmol/L,P <0.05] and higher PRISM Ⅲ score[ 8.5(5.0 ～14.3) scores vs. 4. 0(1. 0～7. 0) scores,P<0. 05 ]than those of the survival. Conclusion (1)The prevalences of 25(OH)D and VDBP insufficient and deficiency among critically ill children are high. (2) Patients with 25(OH)D insufficiency and deficiency show a poorer prognosis than those with sufficient 25(OH)D. (3) The change of 25(OH)D status is not completely consistent with the VDBP.