骨碱性磷酸酶、血25-(OH)D联合其他实验室指标诊断小儿维生素D缺乏性佝偻病的价值

Value of bone alkaline phosphatase,blood 25-(OH) D combined with other laboratory indexes in clinical diagnosis of vitamin D deficiency rickets in children

目的探索骨碱性磷酸酶、血25-(OH)D联合其他实验室指标诊断小儿维生素D缺乏性佝偻病的价值。方法选取2015年2月-2016年5月在该中心保健门诊就诊的1 200例儿童作为研究对象,抽取这些儿童的末梢血测定血液内25-(OH)D、骨碱性磷酸酶、血钙水平,同时测骨密度,其中355例儿童拍左手腕骨的X线片。依据《中华儿科杂志》维生素D缺乏性佝偻病防治建议,确定佝偻病的诊断标准,判定相应实验室方法检测佝偻病的灵敏度和特异度。结果在743例25-(OH)D<50 nmol/L的儿童中,有179例为佝偻病患者,占24.09%;在457例25-(OH)D≥50 nmol/L的儿童中,有28例为佝偻病患者,占6.13%;佝偻病儿童血液中25-(OH)D浓度为(38.6±10.6)nmol/L,显著低于未患病儿童(60.6±11.3)nmol/L,差异有统计学意义(t=25.748,P<0.05);在690例骨碱性磷酸酶异常的儿童中,138例患有佝偻病;467例骨密度异常的儿童中,118例患有佝偻病;320例血钙异常的患儿中,57例患有佝偻病;355例X片检查的阳性患者87均患有佝偻病。结论血液中25-(OH)D的浓度为诊断佝偻病的较好指标。而血液中骨碱性磷酸酶的浓度测定的特异度和灵敏度也较别的指标灵敏,可以用于筛查佝偻病。在25-(OH)D和骨碱性磷酸酶浓度异常的条件下联合其他指标可以很大程度地提高对患者佝偻病的识别性。

Objective To explore the value of bone alkaline phosphatase（ BAP）,blood 25-（ OH） D combined with other laboratory indexes in clinical diagnosis of vitamin D deficiency rickets in children. Methods A total of 1 200 children from healthcare clinic of the hospital from February 2015 to May 2016 were selected as research objects,the levels of 25-（ OH） D,BAP,and calcium in peripheral blood were detected,bone mineral density（ BMD） was measured,X-ray photography of left hand carpal bones was performed among 355 children.According to prevention and control suggestion of vitamin D deficiency rickets recommended by Chinese Journal of Pediatrics,the diagnostic criteria of rickets was confirmed,the sensitivity and specificity of corresponding laboratory methods in detecting rickets were determined. Results There were 179 cases of rickets in 743 children with 25-（ OH） D 50 nmol/L,accounting for 24. 1%; while there were 28 cases of rickets in 457 children with 25-（ OH） D ≥50 nmol/L,accounting for 6. 13%. The concentration of 25-（ OH） D in the children with rickets was（ 38. 6±10. 6） nmol/L,which was statistically significantly lower than that in the children without rickets [（ 60. 6±11. 3） nmol/L]（ t =25. 748,P〈0. 05）. There were 138 cases of rickets in 690 children with abnormal BAP concentration,118 cases of rickets in 467 children with abnormal BMD,and 57 cases of rickets in 320 children with abnormal blood calcium concentration. A total of 87 patients had rickets in355 children taking X-ray examination. Conclusion The concentration of blood 25-（ OH） D is a good index in diagnosis of rickets,and the concentration of BAP in blood can be an index for screening rickets due to high specificity and sensitivity of BAP test. 25-（ OH） D and BAP combined with other indexes can improve the identification of rickets to a large extent.