极低出生体重早产儿出生时及母亲维生素D缺乏与支气管肺发育不良关系的研究

Association between bronchopulmonary dysplasia and vitamin D deficiency of very low birth weight preterm infants at birth and mothers

目的探讨极低出生体重儿出生时及母亲血液中25-羟基维生素D(25-OHD)的缺乏是否为导致早产儿后期发生支气管肺发育不良(BPD)的一个重要高危因素。方法以郑州市儿童医院2014年3月至2015年6月收治的新生儿呼吸窘迫综合征并且体重≤1 500g的早产儿为研究对象,入院时留取静脉血(出生3天内)及从出生医院获取母亲分娩后静脉血标本,并进行25-OHD水平测定;按出生后28天后是否合并BPD分为BPD组及未BPD组。结果 80例早产儿有24例(30.00%)合并新生儿BPD,50例未合并BPD,死亡或自动出院6例。BPD组患儿机械通气时间、持续正压通气(CPAP)、总用氧时间、住院天数、PDA患儿数均明显高于非BPD组,差异均有统计学意义(t值分别为9.047、6.275、11.395、15.398,χ~2=4.010,均P<0.05)。BPD组患儿及母亲血清25-OHD明显低于非BPD组(t值分别为7.003、9.082,均P<0.05);所有BPD组患儿血中25-OHD均<10ng/m L,提示严重缺乏。Logistic回归分析显示出生时25-OHD血清水平是BPD的高危因素,母亲和新生儿血清中25-OHD每增加1ng/m L可能分别使BPD发生率降低24%(OR:0.76,95%CI:68~86,P<0.001)和39%(OR:0.61,95%CI:48~76,P<0.001)。结论通过研究证实极低出生体重早产儿出生时及母亲血清中25-OHD水平较低,是后期发生BPD的一个高危因素。然而仍需进一步研究早期补充足量维生素D是否可以预防BPD及后期其他肺部疾病的发生。

Objective To investigate whether deficient 25-hydroxy vitamin D（ 25-OHD） levels of very low birth weight preterm infants at birth and mothers are important high risk factors of bronchopulmonary dysplasia（ BPD） in very low birth weight preterm infants. Methods Preterm infants no more than 1500 g of birth weight with respiratory distress syndrome（ RDS） who were admitted in Zhengzhou Children Hospital during March 2014 and June 2015 were enrolled. Levels of 25-OHD of infants were obtained at admission（ within 3 days after birth） to neonatal intensive care unit（ NICU） and of mothers were determined. Infants were divided into BPD group and no-BPD group according to whether complicating BPD after 28 days. Results Among 80 infants,24 cases（ 30. 00%） developed BPD,50 cases did not,and 6 cases died or discharged privately. Mechanical ventilation time,continuous positive airway pressure（ CPAP）,total oxygen use time,hospitalization length and number of patent ductus arterious（ PDA） cases were significantly higher in BPD group than in non-BPD group（ t value was 9. 047,6. 275,11. 395 and 15. 398,respectively,χ^2= 4. 010,all P〈0. 05）. Both maternal and neonatal 25-OHD levels in BPD group were signicantly lower than those in no-BPD group（ t value was 7. 003 and 9. 082,respectively,both P〈0. 05）. All of the infants in BPD group had a 25-OHD level lower than 10ng/m L,which indicated serious lack. Logistic regression analysis revealed that 25-OHD level at birth was the high risk factor of BPD. The incidence of BPD was de-creased by 24%（ OR： 0. 76,95% CI： 68-86,P 0. 001） and 39%（ OR： 0. 61,95% CI： 48-76,P 0. 001） for every 1ng/m L increase of 25-OHD in mother and neonatal serum.Conclusion The study shows that lower maternal and neonatal vitamin 25-OHD levels are high risk factors of BPD development in very low birth weight preterm infants. However,further studies are needed to delineate whether supplement of vitamin D to preterm infants at early stage can prevent BPD and other diseases.