婴儿佝偻病诊断问题探讨

Discussion of diagnosis criteria of vitamin D deficiency rickets in infant:analysis of 56 cases

目的通过对56例婴儿进行佝偻病相关指标的调查、检测与分析,探讨婴儿佝偻病诊断中存在的问题。方法对56例健康婴儿进行喂养史、临床症状的询问,并进行体格检查,做出有无佝偻病及其分期诊断。同时取血查血清钙、磷、碱性磷酸酶、25(OH)D、骨碱性磷酸酶浓度及左腕X线摄片、胫骨中段定量超声骨密度检查。结果单纯根据临床症状、体征,诊断活动期佝偻病者34例,绝大多数为轻度佝偻病,55例检测了血钙,正常52例。血磷无一例低于1·29mmol/L。骨碱性磷酸酶正常12例,大于200U/L者44例。52例检测了血清25(OH)D浓度,正常33例。所有病例左腕X线无一例异常发现。45例做了胫骨中段超声骨密度检查,28例正常,17例降低。在正常组与佝偻病组之间,骨碱性磷酸酶及超声骨密度百分位数的差异均有显著性(P<0·05)。结论对于佝偻病的诊断,既不能单以临床表现来判断,也不能过分强调某一项辅助检查的作用。在不具备条件检测血清25(OH)D浓度时,将临床表现、骨碱性磷酸酶和超声骨密度三者结合分析的“三结合”标准以及应用“佝偻病综合征”的诊断名称可能更符号当前的实际情况。

Objective To explore tire problem existed in the diagnosis of infantile vitamin D deficiency tickets, Methods Fifty six of infants for healthy examination were investigated.The feeding history and symptotms that relative to tickets was acquired from their parents and physical examination was performed by special pediatrician in each infant. Simultaneously whether the infants have rickets or not were determined only according to clinical manifestation. Then serum calcium, phosphorus, bone alkaline phosphatase （BAP） and 25-hydroxy vitamin D [25 （OH） D] were tested.The X ray fdm on left wrist and bone density on middle sites of tibia by quanfitativeultrasound （QUS） was also measured in all of the infants. Results Thirty four of eases were diagnosed as rickets aceording toclinical manifestation. Most of them who had tickets had light symptoms and skeletal signs. Serum calcium was normal in 52 infants. Serum phosphorus in all of infants was more than 1.29 mmol/L. NBAP was normal in 12 infants. BAP was more than 200 IU/L in 44 infants and among them 28 infants were considered as rickets. Serum 25 （OH） D was measured in 52 infants with 33 normal. However one of the three infants was considered without rickets.The X ray film on left wrist was normal in all of the infants.The bone density by quantitative ultrasound was measured in 45 infants.The bone density were reduced （lower than 15 percentage） in 2/16 （12.5%） and 15/29 （51.7%） cases in normal and rickets group respectively.There was a significantly statistic difference between normal and rickets group not only hone density by quantitative ultrasound but also in BAP. Conclusion We should not diagnosie vitamin D deficiency rickets only by clinical findings or BAP.Combined analysis of combining of clinical manifestation, BAP and hone density by quantitative ultrasound and diagnosis as “Rickets Syndrome” is more reasonable currently. Serum 25（OH）D measurement is a reliable parameter and be monitored to prevent deficiency or toxication.