不同年龄反复呼吸道感染患儿维生素D含量变化与免疫功能的关系及其发病的高危因素研究

Study on relationship between changes in vitamin D level and immune function in children of different ages with recurrent respiratory tract infections and high-risk factors for occurrence of the disease

摘要

目的 探讨不同年龄反复呼吸道感染(RRTIs)患儿维生素D含量变化与免疫功能的关系及其发病的高危因素。方法 回顾性分析2020年10月至2025年10月本院收治115例RRTIs患儿的临床资料(病例组),分为0~3岁组(33例)、4~6岁组(40例)、7~14岁组(42例),另选取115例同期年龄、性别匹配的健康体检儿童(健康对照组)。统计病例组和健康对照组、不同年龄组维生素D含量、免疫功能指标,对RRTIs进行多因素分析,并采用Spearman相关分析探讨25-羟基维生素D[25-(OH)D]与免疫指标的关系。结果 病例组25-(OH)D、CD4⁺、CD4⁺/CD8⁺、IgA、IgG、IgM水平低于健康对照组(t=12.232,8.380,14.123,32.171,10.138,43.239,P<0.05),CD8⁺高于健康对照组(t=7.462,P<0.05),被动吸烟、过敏史、不良饮食习惯占比高于健康对照组(χ²=8.469,18.991,5.708,P<0.05)。多因素Logistic回归分析结果显示,25-(OH)D(OR=0.593,95%CI:0.441~0.797)、CD4⁺/CD8⁺(OR=0.602,95%CI:0.437~0.828)、IgA(OR=0.564,95%CI:0.388~0.821)、IgG(OR=0.610,95%CI:0.444~0.837)、IgM(OR=0.642,95%CI:0.483~0.853)升高是患儿RRTIs的保护因素(P<0.05),而被动吸烟(OR=2.192,95%CI:1.338~3.593)、过敏史(OR=2.312,95%CI:1.333~4.010)、不良饮食习惯(OR=2.217,95%CI:1.324~3.712)均是患儿RRTIs的危险因素(P<0.05)。与7~14岁组相比,0~3岁组患儿的25-(OH)D、CD4⁺、CD4⁺/CD8⁺、IgA、IgG、IgM水平更低(F=213.776,25.996,115.814,99.794,41.458,88.861,P<0.05)。25-(OH)D与CD4⁺、CD4⁺/CD8⁺、IgA、IgG、IgM呈正相关(r=0.484、0.593、0.451、0.588、0.519,P<0.05),与CD8⁺呈负相关(r=-0.552,P<0.05)。结论 维生素D缺乏、特定免疫功能紊乱以及环境行为因素(被动吸烟、不良饮食)与儿童反复呼吸道感染的发生密切相关。其中,维生素D水平与免疫功能指标具有相关性,且两者在低龄儿童中更为低下。这为通过筛查和纠正维生素D缺乏、改善家庭环境来干预儿童反复呼吸道感染提供了依据。

Abstract

Objective To investigate changes in vitamin D level and their relationship with immune function in children of different ages with recurrent respiratory tract infections (RRTIs),and high-risk factors for the disease. Methods Clinical data of 115 children with RRTIs who admitted to our hospital from October 2020 to October 2025 (case group) were retrospectively analyzed.They were divided into three age groups:0-3 years old group (33 cases),4-6 years old group (40 cases),and 7-14 years old group (42 cases).Additionally,115 healthy children matched for age and gender who received regular physical examination during the same period were selected as healthy control group.The serum levels of vitamin D and immune function indicators of the children in the case group and the healthy control group,and those in the three age groups were statistically analyzed.Multivariate Logistic analysis was used to analyze high-risk factors for occurrence of RRTIs.Spearman correlation analysis was used to analyze relationships between 25-hydroxy vitamin D [25-(OH)D] and immune indicators. Results The children in the case group had lower levels of 25-(OH)D,CD4 ⁺,CD4 ⁺/CD8 ⁺,immunoglobulin A (IgA),IgG and IgM compared to the healthy control group (t=12.232,8.380,14.123,32.171,10.138 and 43.239 respectively,all P<0.05),while they had higher level of CD8 ⁺ (t=7.462,P<0.05).The proportions of children exposed to passive smoking,having history of allergies and poor dietary habits in the case group were higher than those in the healthy control group (χ ²=8.469,18.991 and 5.708 respectively,all P<0.05).Multivariate Logistic regression analysis showed that 25-(OH)D (OR=0.593,95%CI:0.441-0.797),CD4 ⁺/CD8 ⁺ (OR=0.602,95%CI:0.437-0.828),IgA (OR=0.564,95%CI:0.388-0.821),IgG (OR=0.610,95%CI:0.444-0.837) and IgM (OR=0.642,95%CI:0.483-0.853) were protective factors for occurrence of RRTIs in children (all P<0.05),while passive smoking (OR=2.192,95%CI:1.338-3.593),allergy history (OR=2.312,95%CI:1.333-4.010) and poor dietary habits (OR=2.217,95%CI:1.324-3.712) were risk factors for occurrence of RRTIs in children (all P<0.05).Within the case group,the levels of 25-(OH)D,CD4 ⁺,CD4 ⁺/CD8 ⁺,IgA,IgG and IgM of the children in the 0-3 years old group were the lowest among the three age groups (F=213.776,25.996,115.814,99.794,41.458 and 88.861 respectively,all P<0.05).25-(OH)D level was positively correlated with CD4 ⁺,CD4 ⁺/CD8 ⁺,IgA,IgG and IgM (r=0.484,0.593,0.451,0.588 and 0.519 respectively,all P<0.05),while it was negatively correlated with CD8 ⁺ (r=-0.552,P<0.05). Conclusion Vitamin D deficiency,specific immune dysfunction,and environmental behavioral factors (passive smoking,poor dietary habits) are closely related to occurrence of RRTIs in children.Among Which,vitamin D level is correlated with immune function indicators,and vitamin D level and immune function indicators are both lower in younger children.This provides a basis for intervention of RRTIs through screening and correcting vitamin D deficiency and improving family environments.

关键词

儿童 / 反复呼吸道感染 / 维生素D / 免疫功能 / 相关性 / 危险因素

Key words

children / recurrent respiratory tract infection / vitamin D / immune function / correlation / risk factor

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基金资助

眉山市科技指导性计划项目(2025KJZD066)