昆明市呼吸道感染儿童维生素D营养状况

Vitamin D Nutritional Status of Children with Respiratory Tract Infection in Kunming City

目的评价昆明地区住院呼吸道感染儿童维生素D(Vit D)营养状况,为合理补充Vit D防治呼吸道感染性疾病提供依据。方法以6月～5岁住院呼吸道感染患儿为研究对象,化学发光免疫法检测血清25-羟维生素D [25-(OH)D]水平,直接免疫荧光抗体法检测呼吸道合胞病毒,流感病毒A、B,副流感病毒1、2、3,腺病毒,肺炎支原体;问卷调查呼吸道感染及Vit D营养相关因素。结果 (1) 523名住院呼吸道感染患儿进入分析,其中男291名,女232名,昆明地区6月～5岁呼吸道感染儿童25 (OH) D水平呈偏态分布,25 (OH) D总体水平为(27.3±12.1) ng/mL,其中5例(0.9%) Vit D缺乏[25 (OH) D<10 ng/mL],320例(61.2%) Vit D不全[25 (OH) D 10～30 ng/mL],198例(37.9%) Vit D均衡[25 (OH) D 30～100 ng/mL],无Vit D过量,Vit D缺乏及不全总计达62.1%;(2) 523例呼吸道感染患儿Vit D缺乏及不全率在性别、季节分布上差异无统计学意义(P>0.05),不同年龄段25 (OH) D水平、Vit D缺乏及不全率差异有统计学意义(P=0.01),随年龄增大,Vit D营养状况越差;(3) 25 (OH) D水平、Vit D缺乏及不全率与呼吸道病毒感染、反复上呼吸道感染、肺炎严重程度有关,25 (OH) D水平与肺炎支原体、细菌感染相关,与临床诊断上、下呼吸道感染、肺炎、是否合并喘息、热性惊厥无关。结论昆明地区6月～5岁呼吸道感染儿童Vit D营养状况有待进一步改善,2岁以上儿童为Vit D缺乏不全高危人群,建议昆明地区6月～5岁儿童加强Vit D制剂补充提高Vit D营养状况,可能有利于该年龄段儿童呼吸道感染的防治。

Objective To evaluate vitaminD （VitD ） status of children hospitalized with respiratory tractinfection in Kunming,and provide the evidence for suPlying vitamin D reasonably to prevent and treat respiratoryinfectious diseases in children. Methods Children aged6～60 months with respiratory tract infections in hospitalwere recruited as the research objects,serum 25 hydroxy vitamin D [25 （OH） D] levels were measured bychemiluminescence immunoassay,direct immunofluorescence antibody method was used to detect the antibodyies ofrespiratory syncytial virus, influenza A andB, parainfluenza1, 2, 3, adenovirus, and mycoplasmapneumoniae;The related factors of respiratory tract infection and VitD nutrition were collected though questionnairesurvey. Results （1） Total of 523 inpatient children with respiratory tract infection were enrolled into the study,including 291 males and 232 females.25 （OH） D levels of 523 subjects were skewed distribution. The averagelevels of serum 25- （OH ） D of subjects were（27.3±12.1） ng/mL 1.5 cases（0.9%） were deficiency VitD [25 （OH） DP〈10 ng/mL],320 cases（61.2%） were VitD insufficiency [25 （OH） D 10～30 ng/mL],198 cases（37.9%） were VitD sufficiency [25 （OH） D 30～100ng ml-1] ,no VitD poisoning.The prevalence of VitDdeficiency and insufficiency was total 62.1%. （2 ） The prevalences of VitD deficiency and insufficiency and 25（OH ） D levels were no statistical difference for the distribution of gender or season,and that of different ages existedstatistical differences,The VitD nutritional status was worse with the increasing of age. （3） Virus respiratory tractinfection,recurrent uPer respiratory tract infections and severity of pneumonia were significantly associated with theprevalences of VitD deficiency and insufficiency and 25 （OH ） D levels.The infection of mycoplasma pneumoniaeand bacteria was associated with 25 （OH ） D levels.There was no relationship between those of uPer or lowerrespiratory tract infection,pneumonia,wheezing,febrile convulsion and VitD nutritional status.ConclusionsThe vitamin D nutritional status of children aged of6～60 months hospitalized with respiratory tract infection inKunming needs to be improved.Children older than 24 months were the high risk group of vitamin D deficiency andinsufficiency . SuPlementation of vitamin D and improvement VitD nutritional status may be beneficial to preventionand treatment of respiratory tract infectious diseases among children aged6～60 months.