婴幼儿血清25-羟维生素D水平与佝偻病的关系

Relationship between Level of Serum 25-Hydroxyvitamin D Concentration and Rickets

目的通过对婴幼儿进行佝偻病指标调查、检测与分析,了解北京地区婴幼儿血清维生素D水平,探讨维生素D缺乏性佝偻病诊断中需注意问题。方法对北京地区2004年2月-2005年8月收治72例年龄为2-24个月的体检和就诊婴幼儿,进行临床症状询问,进行体格检查,根据临床表现初步作出有无佝偻病诊断。取血查其血清25羟-维生素D[25-（OH）D]及血清钙、磷、碱性磷酸酶（ALP）和小儿骨源性碱性磷酸酶（NBAP）水平。部分小儿行左腕X线片检查。结果单纯根据临床症状、体征诊断为无佝偻病正常组婴幼儿30例,年龄（10.75±6.27）个月;判断为佝偻病者42例,年龄（9.05±5.55）个月。二组血清25-（OH）D、ALP及NBAP均无统计学差异。血清25-（OH）D水平降低者二组各有1例;较正常值增高者21例。佝偻病组无1例血清钙、磷水平降低,其平均值反而较正常组为高。二组分别有23例及31例行左腕X线摄片检查,无1例异常发现。结论北京地区大多数婴幼儿血清25-（OH）D及钙、磷水平正常。单纯以临床表现判断有无佝偻病时,既存在过度诊断问题,也有漏诊可能;应尽可能对疑诊患儿进行血清25-（OH）D水平检测,避免维生素D应用不足或过量。

Objective To explore the serum 25 - hydroxyvitamin DE25 - （OH） D] level in children in Beijing city and discuss the problems exiting in diagnosis of vitamin D deficiency rickets. Methods Seventy - two children aged 2 to 24 months by routine health examination were investigated, and whether the children had rickets or not were determined only according to clinical manifestation. Simultaneously the serum 25 -（OH） D, calcium,phosphorus, alkaline phosphatase（ALP） and bone -alkaline phosphatase（NBAP） were tested. The X ray on left wrist was performed in children partly. Results Forty - two cases were diagnosed as rickets with an average age of （9.05 ±5.55 ） months and 30 cases without rickets with an average age of （ 10.75 ± 6.27 ） months. There was no significant difference between the normal and the rickets group in levels of serum 25 - （OH） D, ALP and NBAP. Levels of serum 25 - （OH） D were lower in 1 case only（ 〈 25 nmol/L） in each group, however there was more than 125 nmol/L in 21 cases all together. The average levels of serum calcium and phosphorus were dramatically higher [n rickets group than those in normal group. The X ray on left wrist was normal in 54 of children. Conclusions Serum 25 - （OH） D levels were normal in most children in Beijing city. Diagnosing rickets by clinical manifestations alone may lead to overdiagnosis or missed diagnosis, so the test of serum 25 -（OH） D levels is proposed for suspected children to prevent the insufficiency or over-dosage of vitamin D use.