天津市婴幼儿维生素D水平及维生素D补充剂应用现状调查

A survey of Vitamin D level and the rate of Vitamin D supplementation in infants and young children in Tianjin

目的对天津市3030例婴幼儿维生素D水平及维生素D补充剂应用状况进行调查，了解本地区婴幼儿维生素D营养状况以及维生素D补充剂应用过程中存在的问题。方法对所有研究对象采用酶联免疫吸附法测定血清25羟维生素D[25（OH）D]水平，将研究对象按年龄分为≤6个月、〉6～12个月、〉12—24个月、〉24—36个月4组，分析比较不同年龄／季节婴幼儿维生素D平均水平的差异。从中选取341例进行家长问卷调查，并测定其血红蛋白（Hb）和血清骨碱性磷酸酶（BALP）水平，比较不同喂养方式、孕周、出生体质量、Hb、BALP与维生素D水平的关系。结果婴幼儿25（OH）D平均水平为（60．24-26．2）nmol／L（12．9—286．0nmol／L），缺乏率约为36．6％（1109／3030例）。〉24～36个月组维生素D水平为（47．22±21．93）nmol／L，明显低于其他各年龄组，差异有统计学意义（F=50．006，P〈0．01），秋季维生素D水平为（62．00±27．42）nmol／L，明显高于其他季节，差异有统计学意义（F=2．750，P〈0．05），早产儿25（OH）D水平为（50．21±18．27）nmol／L，显著低于足月儿，差异有统计学意义（F=12．355，P〈0．01）。维生素D补充剂的应用率为97．1％（331／341例）。结论天津地区婴幼儿维生素D补充剂的应用率虽然很高，但仍存在一定比例维生素D缺乏，这与补充过程中的依从性较差有关，因此加强宣教，提高家长的认知和认同，有效建立孕期及出生后各年龄段维生素D补充剂应用状况及维生素D水平的监测机制，可以考虑纳入现有妇幼保健建设体系中。

Objective To investigate the Vitamin D levels of 3 030 infants and young children and the application rate of Vitamin D supplements. To evaluate the nutritional status of Vitamin D and to find out the problems in the application of Vitamin D supplements. Methods Enzyme linked immunosorbent assay was used to determine the level of 25 - hydroxyvitamin D [ 25 （ OH ） D ] in all the subjects. The subjects were divided into 4 groups according to their ages ： ≤6 months, 〉 6 - 12 months, 〉 12 - 24 months, 〉 24 - 36 months. The average levels of Vitamin D in different ages and seasons were compared. Three hundred and forty - one cases were randomly selected to undergo a parent questionnaire survey and a laboratory test including hemoglobin （Hb） and bone alkaline phosphatase （BALP）. The association of 25 （OH） D level with feeding methods,gestational age, birth weight, Hb, and BALP were compared. Results The average level of 25 （OH）D was （60.2 ±26.2） nmol/L with the minimum of 12.9 nmol/L and the maximum of 286.0 nmol/L. The total deficiency rate was 36.6% （ 1 109/3 030 eases） , and young children who were 〉 24 - 36 months old had the lowest level of 25 （OH） D[ （47.22 ± 21.93 ） nmol/L] （ F = 50. 006 ,P 〈 0.01 ）. The levels of Vitamin D in autumn were（ 62.00 ± 27.42） nmol/L, which were significantly higher than those in other seasons （F = 2. 750, P 〈 0. 05 ）. The levels of 25 （OH） D in preterm infants were （62.00 ± 27.42 ） nmol/L, which were significantly lower than those in full term infants （ F = 12. 355, P 〈 0.01 ）. The application rate of Vitamin D supplements was 97.1% （ 331/ 341 cases）. Conclusions Although the application rate of Vitamin D supplementation in infants and young children is very high, there is still a certain proportion of Vitamin D deficiency. This may be because of the poor compliance of the supplementary process. Therefore,it is necessary to strengthen the publicity and education and improve the parental cognition and recognition. During pregnancy and age after birth, effective monitoring mechanism of Vitamin D levels and the application of Vitamin D supplements should be considered into the existing maternal and child health care system.