脐血25羟基维生素D_3对早期婴儿特应性皮炎的预测作用

Predictive value of cord blood 25(OH)D_3 for early infantile atopic dermatitis

目的探讨脐血25羟基维生素D_3[25(OH)D_3]对婴儿特应性皮炎的预测价值,为婴儿早期特应性皮炎的一级预防提供参考指征。方法选择2015年7~9月期间出生的新生儿,于生后立即采集脐血并检测脐血25(OH)D_3水平。所有婴儿分别于生后6周、3个月、6个月时进行门诊随访,记录特应性皮炎的发生情况。结果最终有67例婴儿全部完成了为期6个月的随访过程,纳入本研究。有23例(34%)出现特应性皮炎,其中91%(21/23)的婴儿特应性皮炎出现在生后的第1个月。根据特应性皮炎的发生情况将婴儿分为特应性皮炎组(n=23)和健康对照组(n=44),特应性皮炎组脐血25(OH)D_3水平低于正常组(P<0.05)。根据脐血25(OH)D_3水平分为<30 nmol/L(n=21)和≥30 nmol/L组(n=46),<30 nmol/L组婴儿特应性皮炎发病率高于≥30 nmol/L组(P<0.05)。ROC分析结果显示:曲线下面积(AUC)为0.648,标准误为0.075,95%CI为0.502~0.795,灵敏度为52.2%,特异度为79.5%,阳性预测值为57.1%,阴性预测值为76.1%,故脐血25(OH)D_3对AD的诊断价值较低。Logistic回归分析结果显示:低脐血25(OH)D_3水平、母孕期喜食海鲜、特应性家族史阳性、混合喂养4个因素是影响特应性皮炎发生的危险因素(P<0.05)。结论脐血25(OH)D_3水平与特应性皮炎的发病风险呈现负性相关关系,但是对特应性皮炎的诊断价值较低。

Objective To explore the predictive value of cord blood 25（OH）D3[25（OH）D3] for infantile atopic dermatitis（AD）, and to provide a reference for primary prevention of early infantile AD. Methods The neonates born from July to September, 2015 were enrolled. The cord blood samples were collected at birth to measure the level of 25（OH）D3. Outpatient follow-up was conducted for all the infants at 6 weeks, 3 months, and 6 months after birth. A survey was performed to investigate the incidence of AD. Results A total of 67 neonates completed a 6-month followup. The incidence of AD was 34%（23/67）, and 91%（21/23） of these cases occurred in the first month after birth. The 23 AD children had a significantly lower cord 25（OH）D3 level than those without AD（P0.05）. The children with a cord 25（OH）D3 level 30 nmol/L showed a significantly higher incidence of AD than those with a cord 25（OH）D3 level ≥30 nmol/L（P0.05）. The receiver operating characteristic（ROC） analysis showed that the area under the ROC curve of cord 25（OH）D3 in predicting AD was 0.648（standard error： 0.075; 95%CI： 0.502-0.795）. Its sensitivity, specificity, positive predictive value, and negative predictive value were 52.2%, 79.5%, 57.1%, and 76.1%, respectively. Logistic regression analysis showed that low cord 25（OH）D3 level, preference for seafood during pregnancy, atopic family history, and mixed feeding were risk factors for infantile AD（P0.05）. Conclusions Cord 25（OH）D3 level is inversely associated with the risk of infantile AD, but it has a low diagnostic value for this disease.