目的 探讨肺癌患者术前血清维生素D水平与免疫功能及术后合并肺炎发生率的相关性.方法 自2015年4月至2017年4月收集准备接受肺癌根治术的早期肺癌(TNM58.45±5.43Ⅰ/Ⅱ期)患者共365例,采用串联质谱法检测血清总维生素D水平、维生素D2及维生素D3水平,根据总维生素D水平将患者分为4组:维生素D严重缺乏组105例(<10ng/ml)、维生素D缺乏组124例(10～20ng/ml),维生素D不足组78例(20～30ng/ml)及维生素D充足组58例(≥30ng/ml),维生素缺乏比例高达62.57％.采用流式细胞技术检测CD4+、CD8+、CD4+/CD8+及调节性T淋巴细胞(Treg)水平,从而判断维生素D水平与免疫功能的相关性,对观察对象进行跟踪至出院,并记录肺炎的发生情况.结果 各维生素D水平组年龄、手术部位及病理类型等基线资料间差异均不存在统计学意义(P>0.05),具有可比性.各组总维生素D及维生素D3组内差异存在统计学意义(P<0.05),且呈递减趋势,维生素D2水平组内及组间差异不存在统计学意义(P>0.05).各组CD4+、CD8+、CD4+/CD8+及Treg细胞水平组内及部分组间差异存在统计学意义(P<0.05),其中维生素D严重缺乏组CD4+(％)为(46.36±4.38)％,明显低于维生素D充足组的(58.45±5.43)％.术后肺炎发生率自严重缺乏至充足呈递减趋势,PTrend=0.003,组内差异也存在统计学意义(P<0.05).结论 肺癌患者术前血清维生素D水平越低免疫功能越差,术后并发肺炎风险越高.%Objective To investigate the correlation between preoperative serum vitamin D level and immune function and the incidence of postoperative pneumonia in patients with lung cancer. Methods A total of 365 cases of early lung cancer ready for lung cancer radical resection (TNM58.45±5.43 I/II)from April 2015 to April 2017 were collected. Using tandem mass spectrometry for the determination of total serum levels of vitamin D,vitamin D2 and vitamin D3 levels,according to the general level of vitamin D,the patients were divided into 4 groups:a serious lack of vitamin D group(105 cases)(<10ng/ml),vitamin D deficiency group(124 cases)(<20 and 10ng/ml),vitamin D deficiency group(78 cases)(<30 and 20ng/ml)and adequate vitamin D group(58 cases)(more than 30ng/ml),vitamin deficiency ratio was as high as 62.57％. The levels of CD4+,CD8+,CD4+/CD8+ and regulatory T lymphocytes(Treg)were detected by flow cytometry,and the correlation between vitamin D level and immune function was analyzed. The patients were followed up after discharge,and the incidence of pneumonia was recorded. Results There was no significant difference in age,surgical site and pathological type between the groups with vitamin D level(P>0.05). The difference of total vitamin D and vitamin D3 in each group was statistically significant(P<0.05),which showed a decreasing trend. There was no significant difference in the level of vitamin D2 within groups(P>0.05). The levels of CD4+,CD8+,CD4+/CD8+ and Treg cells in each group were statistically different within groups(P<0.05),which the CD4+(％)of vitamin D deficiency group was(46.36±4.38)％,significantly lower than that of vitamin D sufficient group(58.45±5.43)％. The incidence of postoperative pneumonia showed a decreasing trend from severe lack to sufficient,PTrend=0.003, the difference within the group was also statistically significant(P<0.05). Conclusion The lower the serum vitamin D level and the worse the immune function in patients with lung cancer,the higher the risk of pneumonia after operation.
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