早产儿血清25羟基维生素D与骨密度相关性探讨

Correlation between serum 25 hydroxy vitamin D and bone mineral density in preterm infants

目的 探讨出生胎龄〈32周早产儿在新生儿重症监护病房（NICU）期间适宜的血清25羟基维生素D[25（OH）D]水平及合理的维生素D（VitD）补充剂量.方法 对2016年3月至2017年12月于我科住院符合条件的早产儿,生后1周在建立肠内喂养的条件下补充VitD 900 IU/d,以生后4周血清25（OH）D浓度不同分组,A组38例≥25 ng/ml,B组24例15～25 ng/ml,在纠正胎龄40周时检测骨密度值.另外选取40例同期健康足月新生儿为对照组,胎龄40周时检测骨密度,与试验组比较.结果 A组38例早产儿生后4周、8周血清25（OH）D浓度分别为（29.23±3.08）ng/ml、（35.13±4.67）ng/ml,纠正胎龄40周时13.2％（5/38）骨密度值偏低.B组24例早产儿生后4周、8周血清25（OH）D浓度分别为（20.12±3.95）ng/ml、（22.36±4.82）ng/ml,纠正胎龄40周时75.0％（18/24）骨密度值低.对照组12.5％（5/40）骨密度值偏低,A组与对照组比较差异无统计学意义（χ2=0.06,P〉0.05）,B组与对照组比较差异有统计学意义（χ2=25.45,P〈0.001）.结论 早产儿应在确保钙、磷合理供给的基础上,及时补充VitD 900 IU/d或以上,使其25（OH）D血清浓度维持在约29.23 ng/ml,并每4周复查血清25（OH）D浓度.

Objective To analyze the reasonable and suitable level of serum 25 hydroxy vitamin D [25 （OH） D] and Vitamin D（Vit D） supplement of premature infants born less than 32 weeks in the neo-natal intensive care unit. Methods For eligible premature infants hospitalized in our department from March 2016 to December 2017,Vit D 900 IU/d was supplemented one week after birth under the conditions of es-tablishing enteral feeding. The selected cases were divided into two groups based on different blood concentra-tion of serum 25（OH）D at four weeks after birth,for 38 cases≥25 ng/ml as group A and 24 cases 15 to 25 ng/ml as group B. Their bone mass density（ BMD） were tested at correct gestational age of 40 weeks and compared with 40 term infants as control group at the same period. Results The serum concentrations of 25（OH） D in group A were （29.23 ±3.08）ng/ml at 4 weeks and （35.13 ±4.67）ng/ml at 8 weeks after birth respectively. At correct gestational age of 40 weeks,13. 2％（5/38） cases demonstrated the lower BMD. The serum concentrations of 25（OH） D in group B were （20. 12 ± 3. 95）ng/ml at 4 weeks and （22. 36 ± 4. 82）ng/ml at 8 weeks after birth respectively. At correct gestational age of 40 weeks,75. 0％（18/24） cases demonstrated the lower BMD. The differences between group A and control group were not statistically sig-nificant（χ2 =0. 06,P〉0. 05）,and differences between group B and control group were statistically signifi-cant（χ2 =25. 45,P〈0. 001）. Conclusion Premature should be given Vit D 900 IU/day or more with rea-sonable and sufficient calcium and phosphorus to maintain their concentration of serum 25（OH）D at about 29. 23 ng/ml and re-check their concentration of serum 25 （ OH） D every four weeks.