深圳市3岁以下儿童维生素D缺乏阳性率月龄分布特点及对儿童健康管理的启示

Characteristics of the Positive Rate of Vitamin D Deficiency in Each Range of Months After Birth of Children Under 3 Years Old in Shenzhen and Its Enlightenment in the Health Management of Children

目的了解深圳市0-3岁儿童维生素D缺乏阳性率的月龄分布特点,为0-3岁儿童的健康管理提供指导。方法选取截至2014-12-31在深圳市妇幼保健院保健部、北京大学深圳医院儿童保健门诊、福田区龙尾社区健康服务中心及福田区梅山社区健康服务中心建档的0-3岁儿童为研究对象。结合婴幼儿发育阶段及健康管理监测月龄时间点,从＂深圳市妇幼保健信息系统＂导出0-、3-、6-、9-、12-、18-、24-、30-36月龄儿童维生素D缺乏的症状体征及实验室检查结果。结果本研究共纳入12 329例研究对象,维生素D缺乏阳性率为19.47%（2400/12 329）,常住儿童、暂住儿童维生素D缺乏阳性率分别为19.38%（1755/9056）、19.71%（645/3 273）,差异无统计学意义（χ-2=0.16,P〉0.05）。常住儿童〈3月龄及〈6月龄者维生素D缺乏阳性率分别为10.74%（48/447）、14.77%（167/1131）,均低于暂住儿童的16.81%（40/238）、18.80%（91/484）,差异有统计学意义（χ-2=5.11、4.11,P〈0.05）。0岁-、1岁-、2-3岁儿童维生素D缺乏阳性率分别为20.85%（851/4082）、20.29%（838/4131）和17.27%（711/4116）,呈下降趋势（χ_（趋势）-2=16.72,P〈0.01）。〈6月龄儿童维生素D缺乏阳性率为15.98%（258/1 615）,低于6-〈12月龄儿童的24.04%（593/2467）,差异有统计学意义（χ-2=38.45,P〈0.01）。0-3岁儿童维生素D缺乏阳性率出现2个高峰,暂住儿童和流动儿童第1个高峰分别在6-〈9月龄和9-〈12月龄,第2个高峰均在18-〈24月龄。结论深圳市0-3岁儿童维生素D缺乏阳性率仍处于较高水平;维生素D缺乏病的监测中,应重点关注6-〈12月龄及18-〈24月龄儿童,同时,对暂住儿的监测时间应比常住儿童提前。

Objective To investigate the characteristics of the positive rate of vitamin D deficiency（VDD） in each range of months after birth of children under 3 years old in Shenzhen,and provide guidance for the health management of children under 3 years old.Methods Children under 3 years old who established record in the Department of Children Health Management of Shenzhen Maternal and Child Health Care Hospital,the Child Health Clinic of Peking University Shenzhen Hospital,Longwei and Meishan Community Health Service Center of Futian District,by December 31 in 2014 were enrolled as research subjects.With references to the development stages of infants and children and the ranges of months after birth for health management monitor,indications of VDD and laboratory examination results of children of 0-,3-,6-,9-,12-,18-,24- and 30- 36 months old were collected from the ＂ System of Shenzhen Maternal and Child Health Care＂.Results A total of 12 329 subjects were enrolled.The positive rate of VDD was 19.47%（2 400/12 329）,and the positive rates of VDD of permanent resident children and temporary resident children were 19.38%（1 755/9 056） and 19.71%（645/3 273） without significant difference between them（χ~2= 0.16,P〉0.05）.The positive rates of VDD of permanent resident children under three months old and under six months old were 10.74%（48/447） and 14.77%（167/1 131）,lower than those of temporary resident children which were 16.81%（40/238） and 18.80%（91/484） with significant differences（χ~2 = 5.11,4.11;P 〉0.05）.The VDD positive rates of children aged 0-,1- and 2-3 years were 20.85%（851/4 082）,20.29%（838/4131） and 17.27%（711/4 116） respectively with a declining trend as age increased（χ_（trend）~2= 16.72,P〈0.01）.The VDD positive rate of children under 6 months old was 15.98%（258/1 615）,lower than that of children under 6 to 12 months old which was 24.04%（593/2 467） with significant difference（χ~2= 38.45,P〈0.01）.The VDD positive rate of children aged0-3 years old saw two peaks,with the first peak in 6-〈 9 months range for temporary resident children and in 9- 〈12 months range for migrant children and the second peak in 18- 〈24 months for both.Conclusion Children aged 0- 3 in Shenzhen sill have high VDD positive rate.In the monitor of VDD deficiency,children aged 6- 〈12 months old and 18- 〈24 months old should be paid more attention,and the monitor on temporary resident children should be conducted earlier than that of permanent resident children.