早产儿血清25羟基维生素D3水平与超声骨密度的相关性研究

Research on the correlation between serum 25-hydroxy vitamin D_3 and ultrasound bone mineral density in premature infants

目的探讨早产儿血清25羟基维生素D_3水平与超声骨密度的相关性。方法选取2014年5月~2017年2月在南方医科大学附属小榄医院出生、住院的新生儿76例,其中足月儿组30例,早产儿组46例,记录出生时的基本情况,利用定量超声技术测定早产儿组和足月儿组出生后24 h内胫骨中段骨密度值(SOS),测定早产儿组和足月儿组出生24 h内血清25羟基维生素D_3、甲状旁腺素(PTH)、钙(Ca)、磷(P)及碱性磷酸酶(ALP)水平。早产儿组以出生时血浆25羟基维生素D_3水平第50百分位数(38 ng/ml)为截点,分为早产儿A组(≥38 ng/m,共26例)和早产儿B组(<38 ng/ml,共20例),分别分析早产儿组和足月儿组、早产儿A组和早产儿B组上述检测指标的差异,以及早产儿组血浆维生素D水平与超声骨密度的相关性。结果 (1)出生时早产儿组25羟基维生素D_3水平低于足月儿组,差异有统计学意义(P<0.01)。(2)早产儿组胫骨骨密度值均低于足月儿组(P<0.01);(3)早产儿组和足月儿组新生儿ALP、P无明显差异(P>0.05)。(4)早产儿A组和早产儿B组两组之间胫骨骨密度、PTH、钙离子、25羟基维生素D_3水平比较均有显著性差异(P<0.01),早产儿A组和早产儿B组之间血清磷和ALP水平未见明显差异(P>0.05)。(5)早产儿组出生时25羟基维生素D水平与Ca、胫骨骨密度、PTH呈正相关(P<0.05),系数分别为0.582、0.754、0.382,与P、ALP无相关性,系数分别为-0.74、-0.16(P>0.05)。结论 (1)早产儿出生时胫骨骨密度、血清25羟基维生素D_3水平明显低于足月儿;(2)出生时血清25羟基维生素D_3水平高的早产儿胫骨超声骨密度优于血清25羟基维生素D_3水平低的早产儿,故补充25羟基维生素D_3对促进早产儿骨生长、预防早产儿代谢性骨病有重要意义。

Objective To investigate the correlation between serum 25-hydroxy vitamin D3 levels and bone mineral density in premature infants.Methods 76 neonates were born and hospitalized in Xiaolan Hospital Affiliated to Southern Medical University from May 2014 to February 2017.Among them,there were 30 cases of term infants and 46 eases of preterm infants.The basic situation was recorded at birth,The bone mineral density （SOS） of the middle tibia was measured within 24 hours after birth in the preterm infantile and term infants by quantitative ultrasound.The serum 25-hydroxy vitamin D3,parathyroid hormone （PTH）,calcium （Ca）,phosphorus （P） and alkaline phosphatase （ALP） levels in the preterm infants were measured at the 50th percentile （38 ng/ml） （≥38 ng/ml,26 cases） and preterm children B group （〈38 ng/ml, 20 eases） were analyzed in preterm children and term infants,premature children A group and premature children The difference of the above indexes between group B and the level of plasma vitamin D and the bone mineral density in premature infants.Results ①The levels of 25-hydroxy vitamin D3 in premature infants were lower than those in term infants （P〈0.01）.②The bone mineral density of the tibia in the premature infants group was lower than that in the infants group （P〈0.01）.③There was no significant difference in ALP and P between preterm infants and term infants （P〉0.05）. There were significant differences in tibial bone mineral density,PTH,ealcium ion and 25-hydroxy vitamin D3 between group A and group B （P〈0.01）,but no signifieant differenee in serum phosphorus and ALP between the two groups （P〉0.05）.⑤There was a positive correlation between the level of 25-hydroxy vitamin D3 and Ca,tibia1 bone mineral density and PTH （P〈0.05）,and had no correlation with P and ALP （P〉0.05）.Conclusion ①The density of tibial bone and the content of 25-hydroxy vitamin D3 in premature infants were significantly lower than those of term infants. ②The bone mineral density of tibial ultrasound in preterm infants with high levels of 25-hydroxy vitamin D3 was higher than that of preterm infants with low levels of vitamin D3,Therefore,Supplementation of 25-hydroxy vitamin D3 to promote premature infant bone growth,prevention of metabolic bone disease in premature children is important.