血清25-羟维生素D在佝偻病诊断中的应用价值

Role of serum 25-hydroxyvitamin D in the diagnosis of vitamin D deficiency rickets

目的探讨血清25-羟维生素D[25(OH)D]在维生素D缺乏性佝偻病早期诊断中的意义。方法检测对照组(73例)、可疑组(45例)和佝偻病组(65例)的血清25(OH)D、钙、磷、碱性磷酸酶浓度,并通过ROC曲线对血清25(OH)D的诊断价值进行评价。结果对照组、可疑组和佝偻病组的血清25(OH)D水平分别为112±37、83±30和72±31 nmol/L,后两者均显著低于对照组(F=26.174,P<0.01),可疑组与佝偻病组差异无统计学意义(P>0.05)。可疑组和佝偻病组的维生素D缺乏率均显著高于对照组(χ2=33.346,P<0.01)。血清25(OH)D的ROC曲线下面积为0.760(95%CI:0.692～0.820,P<0.01),最佳临界点为90.7 nmol/L时,灵敏度为68.49%,特异度为72.73%;可疑组和佝偻病组的血钙、磷、碱性磷酸酶浓度与对照组比较差异均无统计学意义(P>0.05)。结论血清25(OH)D水平在可疑及确诊佝偻病的患儿中显著降低,可以反映维生素D的营养状况,适用于佝偻病的早期筛查。

Objective To study the role of serum 25-hydroxyvitamin D in the early diagnosis of vitamin D deficiency rickets.Methods Concentrations of serum 25（OH）D,calcium,phosphorus and alkaline phosphatase were measured in normal control（n=73）,suspected rickets（n=45） and confirmed rickets groups（n=65）.Receiver operating characteristic（ROC） curve was used to evaluate the diagnostic value of serum 25（OH）D for rickets.Results Serum 25（OH）D levels in the suspected and confirmed rickets groups were 83±30 and 72±31 nmol/L respectively,which was lower than in the normal control group（112±37 nmol/L）（P0.01）.There was no significant difference between the suspected and confirmed rickets groups（P0.05）.Vitamin D deficiency rates in the suspected and confirmed rickets groups were higher than in the control group（P0.01）.The ROC curve area of serum 25（OH）D for the diagnosis of rickets was 0.760（95%CI 0.692-0.820,P0.01）,and the optimal operating point was 90.70 nmol/L（sensitivity 68.49%,specificity 72.73%）.There was no significant difference in levels of calcium,phosphorus and alkaline phosphatase between the three groups（P0.05）.Conclusions Serum 25（OH）D levels in infants with suspected and confirmed rickets are significantly reduced and this may reflect vitamin D deficiency.Therefore,it may be useful to check serum 25（OH）D levels in screening for rickets.