新生儿及其母亲骨营养状况的研究

Bone nutritional status in neonates and their mothers

目的通过对产妇及其新生儿在分娩当天进行血25-（OH）D3、血钙和血磷浓度的测定以及在产后3d内采用骨定量超声仪对母儿进行骨超声波速度（speed of sound，SOS）的测量来评价母儿的骨营养状况和两者的相关性。方法32例足月分娩产妇在分娩当天测定血清25-（OH）D3、血钙和血磷浓度，对其分娩的新生儿在出生时留取脐血进行血25-（OH）D3、血钙和血磷浓度的测定。产妇在分娩后3d内进行桡骨定量超声SOS值的测量，同时对新生儿也进行胫骨SOS值的测量，分析母儿骨SOS值之间的相关性。选取与本实验组孕妇同年龄段健康妇女39例作为对照组，进行桡骨SOS值的测量，比较产妇组与正常妇女组骨SOS值之间有无差异。结果（1）新生儿脐血中25-（OH）D3的浓度（14．7±7．8）nmol／L平均为孕妇血25-（OH）D3浓度（30．3±10．2）nmol／L的37．3％，两者之间呈正相关（r=0．680，P=0．000）；（2）新生儿脐血的血钙浓度（2．36±0．28）mmol／L和血磷浓度（1．57±0．76）mmol／L与孕妇的血钙（2．09±0．17）mmol／L和血磷浓度（1．04±0．28）mmol／L之间无相关性（r=0．146，P=0．467；r=0．148，P=0．445），新生儿脐血中的血钙浓度和血磷浓度显著高于其母血中的血钙和血磷浓度（t=4．35，P=0．000；t=10．58，P=0．000）；（3）新生儿骨SOS值（3054±76）m／s与其母亲的骨SOS值（4170±241）m／s之间无相关性（r=-0．223，P=0．220）；（4）新生儿脐血25-（OH）D3的浓度与其骨SOS值有显著相关（r=0．412，P=0．026）；（5）正常妇女的骨SOS值（4258土100）m／s高于产妇组的骨SOS值（4170±241）m／s，两组比较差异有统计学意义（T=2．062，P=0．043）。结论胎儿维生素D的营养状况与母体维生素D的营养状况密切相关，维生素D的营养状况与胎儿的骨骼发育密切相关。上海地区在秋冬季有较多孕妇可能有维生素D缺乏，应加强对孕产妇骨营养状况的监测。

Objective To investigate bone nutritional status of neonates and their mothers as well as the correlation between them by estimating the concentrations of 25-（OH）D3, calcium and phosphorus in maternal blood and cord blood at birth, and by measuring the bone speed of sound （SOS） of neonates and their mothers with quantitative ultrasound within 3 days after birth. Methods The concentrations of 25-（OH）D3, calcium and phosphorus in the serum were estimated both from 32 pregnant women who had a term delivery and from the umbilical cord at birth. Within 3 days after delivery, the bone SOS values of the mothers measured from their radius and neonates from their tibia were estimated and the correlation between the mothers and their neonates was analyzed. Thirty-nine non-pregnant healthy women who at the same age as the pregnant women were selected as control group and had their bone SOS measured. The difference of bone SOS between pregnant and healthy non-pregnant women was compared. Results There was positive correlation between cord blood and maternal blood 25-（OH）D3 concentration [（14.7±7.8） nmol/L and （30. 3±10.2） nmol/L, r= 0. 680, P=0. 0001. The calcium and phosphorus concentration in cord blood [（2.36±0.28）mmol/L and （1.57 ± 0.76） mmol/L] were significant higher than that in maternal blood E（2.09 ± 0.17） mmol/L and （1.04±0.28） retool/L], but no correlation was found （r=0. 146, P=0. 467：r=0. 148, P=0. 445）. No significant correlation was shown in the bone SOS between the infants and their mothers[（3054± 76）m/s and （4170± 241）m/s, r= -0. 223, P= 0. 220]. The concentration of 25-（OH）D3 in cord blood was closely correlated with the bone SOS of infants（r=0. 412, P=0. 026）. The SOS of healthy women was obviously higher than that of pregnant women [（4258 ± 100）m/s vs （4170±241）m/s, P= 0. 043]. Conclusions There are close correlations between fetus and their mothers in vitamin D status and also between vitamin D status and fetus bone development. Some pregnant women may be short of vitamin D in autumn and winter in Shanghai and we should monitor the bone nutritional states for pregnant women.