维生素D缺乏相关扩张型心肌病患儿的临床特征、重症监护需求及预后：5年儿科重症监护病房经验
Clinical Profile, Intensive Care Needs and Outcome of Children with Dilated Cardiomyopathy Associated with Vitamin D Deficiency: A 5-year PICU Experience.
作者信息
Kumar Surjeet, Randhawa Manjinder Singh, Angurana Suresh Kumar, Nallasamy Karthi, Bansal Arun, Kumar Manoj Rohit, Sachdeva Naresh, Jayashree Muralidharan
机构信息
Division of Pediatric Emergency and Critical Care, Department of Pediatrics, Advanced Pediatrics Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Department of Cardiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
出版信息
Indian J Crit Care Med. 2023 Jul;27(7):510-514. doi: 10.5005/jp-journals-10071-24484.
AIM
To describe the clinical profile, treatment details, intensive care needs, and long-term outcome of children with dilated cardiomyopathy (DCM) associated with Vitamin D deficiency (VDD).
MATERIALS AND METHODS
Case records of 14 children with DCM associated with VDD [25(OH)D3 levels <20 ng/mL] admitted to the pediatric intensive care unit (PICU) of a tertiary care teaching hospital between January 2017 and December 2021 were retrospectively analyzed for clinical features, echocardiographic findings, treatment details, intensive care needs, and outcomes.
RESULTS
The median (IQR) age was 6 (2-9) months and 71% (=10) were males. The common modes of presentation included respiratory distress or failure (78.6%), congestive cardiac failure (71.4%), cardiogenic shock (37.5%), and seizures and encephalopathy (14.3% each). The median (IQR) serum calcium was 8.7 (7-9.5) mg%, ionized calcium 0.7 (0.7-1.1) mmol/L, alkaline phosphatase 343 (316-415) IU/L, phosphate 3.5 (2.6-4.5) mg%, PTH 115 (66-228) pg/mL, and 25(OH)D3 5 (3-7) ng/mL. The median (IQR) left ventricular ejection fraction (LVEF) at admission was 22 (17-25)%. The treatment included intravenous calcium infusion (35.7%), vitamin D supplementation in all (57.1% parenteral and 42.9% oral), mechanical ventilation (35.7%), and vasoactive drugs (57.1%). There was no mortality. The median (IQR) duration of PICU and hospital stay was 76 (31-98) hours and 6 (4.7-10) days, respectively. Out of 14 children, 10 (71.4%) were followed-up till median (IQR) of 10 (7-58) months. All were asymptomatic and had normal LEVF (except one had residual moderate mitral regurgitation).
CONCLUSION
Vitamin D deficiency is a potentially treatable and reversible cause of DCM in children.
HOW TO CITE THIS ARTICLE
Kumar S, Randhawa MS, Angurana SK, Nallasamy K, Bansal A, Kumar MR, . Clinical Profile, Intensive Care Needs and Outcome of Children with Dilated Cardiomyopathy Associated with Vitamin D Deficiency: A 5-year PICU Experience. Indian J Crit Care Med 2023;27(7):510-514.
目的
描述与维生素D缺乏（VDD）相关的扩张型心肌病（DCM）患儿的临床特征、治疗细节、重症监护需求及长期预后。
材料与方法
回顾性分析2017年1月至2021年12月间收入一家三级医疗教学医院儿科重症监护病房（PICU）的14例与VDD相关的DCM患儿[25(OH)D3水平<20 ng/mL]的病例记录，分析其临床特征、超声心动图检查结果、治疗细节、重症监护需求及预后。
结果
中位（四分位间距）年龄为6（2 - 9）个月，71%（=10例）为男性。常见的表现形式包括呼吸窘迫或衰竭（78.6%）、充血性心力衰竭（71.4%）、心源性休克（37.5%）以及惊厥和脑病（各14.3%）。中位（四分位间距）血清钙为8.7（7 - 9.5）mg%，离子钙0.7（0.7 - 1.1）mmol/L，碱性磷酸酶343（316 - 415）IU/L，磷酸盐3.5（2.6 - 4.5）mg%，甲状旁腺激素115（66 - 228）pg/mL，25(OH)D3 5（3 - 7）ng/mL。入院时左心室射血分数（LVEF）的中位（四分位间距）值为22（17 - 25）%。治疗包括静脉输注钙剂（35.7%）、所有患儿均补充维生素D（57.1%为肠外补充，42.9%为口服）、机械通气（35.7%）以及血管活性药物（57.1%）。无死亡病例。PICU住院时间和住院总时间的中位（四分位间距）值分别为7（31 - 98）小时和6（4.7 - 10）天。14例患儿中，10例（71.4%）随访至中位（四分位间距）时间10（7 - 58）个月。所有患儿均无症状，LVEF正常（1例有中度二尖瓣反流残留）。
结论
维生素D缺乏是儿童DCM的一个潜在可治疗且可逆的病因。
如何引用本文
Kumar S, Randhawa MS, Angurana SK, Nallasamy K, Bansal A, Kumar MR, . 与维生素D缺乏相关的扩张型心肌病患儿的临床特征、重症监护需求及预后：5年PICU经验。《印度重症医学杂志》2023；27(7):510 -
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