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中华妇幼临床医学杂志(电子版) ›› 2018, Vol. 14 ›› Issue (06) : 730 -735. doi: 10.3877/cma.j.issn.1673-5250.2018.06.017

所属专题： 文献；

论著

早产儿血清维生素D水平与院内感染的关系研究
梅英姿1, 陈道桢2, 周勤1, 余仁强1,†()   
  1. 1. 214002　江苏，南京医科大学附属无锡妇幼保健院新生儿科
    2. 214002　江苏，南京医科大学附属无锡妇幼保健院检验科
  • 收稿日期:2018-05-30 修回日期:2018-11-07 出版日期:2018-12-01
  • 通信作者: 余仁强

Relationship between serum vitamin D level and nosocomial infection in preterm infants

Yingzi Mei1, Daozhen Chen2, Qin Zhou1, Renqiang Yu1,†()   

  1. 1. Department of Neonatology, The Affiliated Wuxi Maternity and Child Health Care Hospital of Nanjing Medical University, Wuxi 214002, Jiangsu Province, China
    2. Department of Clinical Laboratory, The Affiliated Wuxi Maternity and Child Health Care Hospital of Nanjing Medical University, Wuxi 214002, Jiangsu Province, China
  • Received:2018-05-30 Revised:2018-11-07 Published:2018-12-01
  • Corresponding author: Renqiang Yu
  • About author:
    Corresponding author: Yu Renqiang, Email:
  • Supported by:
    Research Project of Maternal and Child Health by Jiangsu Provincial Commission of Health and Family Planning(F201427, F201639); Program of Maternal and Child Health Care Key Discipline Construction of Jiangsu Province(FXK201213); Municipal Science and Education Strengthening Health Engineering Project of Medical Key Discipline Construction Program and Young Medical Talent in Wuxi(ZDXK003, QNRC039); Municipal Hospital Management Center Project of Key Medical Research in Wuxi(YGZXZ1528); Project of Maternal and Child Health Research by Wuxi Municipal Commission of Health and Family Planning(FYKY201601)
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梅英姿, 陈道桢, 周勤, 余仁强. 早产儿血清维生素D水平与院内感染的关系研究[J]. 中华妇幼临床医学杂志(电子版), 2018, 14(06): 730-735.

Yingzi Mei, Daozhen Chen, Qin Zhou, Renqiang Yu. Relationship between serum vitamin D level and nosocomial infection in preterm infants[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2018, 14(06): 730-735.

目的

探讨早产儿出生时血清维生素D水平与院内感染的关系。

方法

选取2011年1月1日至2015年12月31日，于南京医科大学附属无锡妇幼保健院新生儿重症监护病房(NICU)接受治疗的出生胎龄<32周的246例早产儿为研究对象。根据早产儿是否发生院内感染，将其分为院内感染组(n＝63)与对照组(n＝183)。对于院内感染组早产儿，根据其感染类型，进一步分为败血症亚组(n＝27)与其他感染亚组(n＝36)。采用化学发光免疫分析法，检测所有早产儿出生时血清25-羟基维生素D[25(OH)VitD]水平。对院内感染组与对照组、不同亚组与对照组早产儿出生时血清25(OH)VitD水平及维生素D缺乏发生率，分别采用Wilcoxon秩和检验和χ2检验进行统计学分析。本研究遵循的程序获得南京医科大学附属无锡妇幼保健院伦理委员会审查(审批文号：2013-01-1015-01)。

结果

①院内感染组与对照组早产儿的出生胎龄、出生体重，性别、出生季节、母亲分娩方式构成比，母亲年龄、早孕期人体质量指数(BMI)、妊娠期糖尿病、妊娠期高血压疾病、绒毛膜羊膜炎发生率等一般临床资料比较，差异均无统计学意义(P>0.05)。②这246例早产儿出生时，维生素D缺乏发生率为45.5%(112/246)，院内感染发生率为25.6%(63/246)。院内感染组和对照组早产儿出生时，血清25(OH)VitD浓度及维生素D缺乏发生率分别比较，差异均无统计学意义(P>0.05)。③败血症亚组早产儿出生时，血清25(OH)VitD浓度为28.1 nmol/L(23.5～34.1 nmol/L)，显著低于对照组的32.7 nmol/L(25.3～45.4)nmol/L，并且差异有统计学意义(Z＝－2.011，P＝0.044)。败血症亚组早产儿出生时，维生素D缺乏发生率为70.4%(19/27)，显著高于对照组的43.2%(79/183)，并且差异亦有统计学意义(χ2＝6.995，P＝0.008)。其他感染亚组与对照组早产儿出生时，血清25(OH)VitD浓度及维生素D缺乏发生率分别比较，差异均无统计学意义(P>0.05)。

结论

早产儿出生时血清25(OH)VitD水平可能与院内感染发生率无相关性。维生素D缺乏可能增加早产儿院内感染败血症发生率。因为本研究纳入样本量相对较小，早产儿出生时血清25(OH)VitD水平与院内感染的关系，仍需大样本、多中心、随机对照试验进一步研究、证实。

关键词: 重症监护，新生儿, 维生素D, 骨化二醇, 维生素D缺乏, 交叉感染, 败血症, 婴儿，早产
Objective

To investigate the relationship between serum vitamin D level at birth and nosocomial infection in preterm infants.

Methods

A total of 246 preterm infants with gestational age less than 32 weeks at birth who were hospitalized in the Neonatal Intensive Care Unit (NICU) of The Affiliated Wuxi Maternity and Child Health Care Hospital of Nanjing Medical University from January 1, 2011 to December 31, 2015 were enrolled as research subjects. These preterm infants were divided into nosocomial infection group (n=63) and control group (n=183) according to whether they had nosocomial infection or not. These preterm infants in nosocomial infection group were further divided into sepsis subgroup (n=27) and other infections subgroup (n=36) according to their infection types. Serum 25-hydroxyvitamin D [25(OH)VitD] levels at birth of all preterm infants were detected by chemiluminescence immunoassay. The level of serum 25(OH)VitD and the incidence of vitamin D deficiency at birth were compared between nosocomial infection group and control group, different subgroups and control group by Wilcoxon rank sum test and chi-square test, respectively. This study was reviewed by the Ethics Committee of The Affiliated Wuxi Maternity and Child Health Care Hospital of Nanjing Medical University (Approval Number: 2013-01-1015-01).

Results

①There were no significantly differences between nosocomial infection group and control group among gestational age, birth weight, gender, birth season of preterm infants, constituent ratio of delivery mode, maternal age, body mass index (BMI) in the first trimester of pregnancy, and incidences of gestational diabetes mellitus, pregnancy hypertension, chorionic amniocentesis of pregnant mother (P>0.05). ②The incidence of vitamin D deficiency at birth and nosocomial infection of preterm infants were 45.5% (112/246) and 25.6% (63/246), respectively. There were no significantly differences between nosocomial infection group and control group in serum 25(OH)VitD level and incidence of vitamin D deficiency at birth (P>0.05). ③The level of serum 25(OH)VitD at birth in sepsis subgroup was 28.1 nmol/L (23.5-34.1 nmol/L), which was significantly lower than that 32.7 nmol/L (25.3-45.4 nmol/L) in control group, and the difference was statistically significant (Z=-2.011, P=0.044). The incidence of vitamin D deficiency at birth was 70.4% (19/27) in sepsis subgroup, which was significantly higher than that 43.2% (79/183) in control group, and the difference also was statistically significant (χ2=6.995, P=0.008). There were no significant differences in serum 25(OH)VitD level and incidence of vitamin D deficiency at birth between other infections subgroup and control group (P>0.05).

Conclusions

There may be no association between serum 25(OH)VitD level at birth and incidence of nosocomial infection in preterm infants. Vitamin D deficiency may increase the incidence of nosocomial infection sepsis. The relationship between serum 25(OH)VitD level at birth and nosocomial infection need to be further confirmed by large sample, multicenter, randomized and controlled studies.

Key words: Intensive care, neonatal, Vitamin D, Calcifediol, Vitamin D deficiency, Cross infection, Sepsis, Infant, premature
表1 院内感染组与对照组早产儿及其母亲一般临床资料比较
组别 例数 早产儿一般临床资料
出生胎龄(周，±s) 出生体重(g，±s) 性别[例数(%)] 出生季节[例数(%)]
男 女 春季 夏季 秋季 冬季
院内感染组 63 29.7±1.5 1 532±490 37(58.7) 26(41.3) 13(20.6) 13(20.6) 18(28.6) 19(30.2)
对照组 183 29.3±1.6 1 415±350 114(62.3) 69(37.7) 50(27.3) 33(18.0) 56(30.6) 44(24.1)
检验值 ? t＝1.020 t＝1.390 χ2＝0.251 χ2＝1.737
P值 ? 0.309 0.166 0.616 0.629
组别 例数 母亲一般临床资料
分娩方式[例数(%)] 年龄(岁，±s) 早孕期BMI(kg/m2，±s) 妊娠期糖尿病[例数(%)] 妊娠期高血压疾病[例数(%)] 绒毛膜羊膜炎[例数(%)]
经阴道分娩 剖宫产术分娩
院内感染组 63 46(73.0) 17(27.0) 29.2±4.9 28.6±3.7 4(6.3) 2(3.2) 10(15.9)
对照组 183 113(61.7) 70(38.3) 28.1±4.6 27.3±3.9 28(15.3) 21(11.5) 22(12.0)
检验值 ? χ2＝2.603 t＝1.654 t＝1.443 χ2＝3.318 χ2＝3.810 χ2＝2.414
P值 ? 0.107 0.100 0.151 0.069 0.051 0.299
表2 院内感染组与对照组早产儿出生时血清25(OH)VitD浓度与维生素D缺乏发生率比较
组别 例数 血清25(OH)VitD浓度[nmol/L，M(P25～P75)] 维生素D缺乏[例数(%)]
院内感染组 63 31.8(24.8～50.9) 33(52.4)
对照组 183 32.7(25.3～45.4) 79(43.2)
检验值 ? Z＝－0.315 χ2＝1.604
P值 ? 0.893 0.205
表3 败血症亚组与对照组早产儿出生时血清25(OH)VitD浓度及维生素D缺乏发生率比较
组别 例数 血清25(OH)VitD浓度[nmol/L，M(P25～P75)] 维生素D缺乏[例数(%)]
败血症亚组 27 28.1(23.5～34.1) 19(70.4)
对照组 183 32.7(25.3～45.4) 79(43.2)
检验值 ? Z＝－2.011 χ2＝6.995
P值 ? 0.044 0.008
表4 其他感染亚组与对照组早产儿出生时血清25(OH)VitD浓度及维生素D缺乏发生率比较
组别 例数 血清25(OH)VitD浓度[nmol/L，M(P25～P75)] 维生素D缺乏[例数(%)]
其他感染亚组 36 29.9(24.2～42.0) 14(38.9)
对照组 183 32.7(25.3～45.4) 79(43.2)
检验值 ? Z＝－0.771 χ2＝0.226
P值 ? 0.441 0.635
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