极低出生体重儿血清钙磷碱性磷酸酶变化特点及临床意义

The characteristic and significance of serum calcium,phosphorus and alkaline phosphatase in very low birth weight infants

目的探讨极低出生体重儿(VLBWIs)的骨代谢特点及变化趋势。方法95例VLBWIs作为观察组,生后3d内、2、4周检测血清钙、磷、碱性磷酸酶(ALP)。30例足月正常体质量儿作为对照组,生后3d内检测血清钙、磷、ALP。结果观察组3d内血清钙为(1.92±0.33)mmol/L,对照组为(2.24±0.19)mmol/L,P<0.001;观察组与对照组血清磷差异无统计学意义;观察组血清ALP为(199.9±90.4)U/L,对照组为(133.0±36.4)U/L,P<0.001。2周时两组血清钙、ALP均呈上升趋势,血清磷水平均呈下降趋势。4周血磷有所回升,血钙保持稳定,ALP继续升高明显;出生体质量、3d内ALP、3d内血钙、4周后血磷与4周后血ALP密切相关,为其影响因素。观察组自发性骨折3例。结论出生体质量是VLBWIs骨营养的影响因素。动态监测血清钙、磷、ALP可以早期评价VLBWIs的骨营养状态。

Objective To evaluate the bone metabolism and its predicting factor markers in very low birth weight infants （VLBWIs）. Methods Clinical data and serum calcium, phosphorus and alkaline phosphatase （ALP） were measured within 3 days, 2 weeks and 4 weeks after birth in 95 very low birth weight infant. 30 term infants with serum calcium, phosphorus and alkaline phosphatase （ALP） measurement within 3 days as control group. Results （ 1 ） In VLBWIs within 3 days of age, mean serum calcium was （1.92 ±0. 33） mmol/L, which were lower than those in term infants （2.24 ±0. 19 mmol/L） , P 〈0. 001 ; There was no significant difference on mean serum phosphorus of VLBWIs and term infants. ALP was （199. 9 ±90. 4） U/L, higher than that in term infants （133.0 ±36. 4 U/L）, P 〈0. 001. （2） In VLBWIs Serum calcium, ALP were elevated and phosphorus diminished 2 weeks of age. At 4 weeks of age, serum calcium keep stable, phosphorus raised back, ALP keep raising. （3） Birth weight, calcium and ALP with in 3 days of age and phosphorus at 4 weeks of age were correlated with ALP of 4 week of life. （4） 3 cases of spontaneous fracture happened in VLBWIs. Conclusion Birth weight of VLBWIs has influence on born metabolism. Dynamic monitors of phosphorus and ALP will benefit the early evaluation of born metabolism in VLBWIs.