学龄前儿童骨密度与血清25-(OH)D水平的相关性

The correlation between bone mineral density and serum 25-(OH)D level in preschool children

目的调查学龄前儿童骨密度(BMD)状况及其与血清25-羟维生素D[25-(OH)D]的关系。方法收集2017年3月~2018年3月629例在三亚市妇幼保健院儿童保健科门诊体检行BMD检查的0~7岁学龄前儿童为研究对象,采用定量超声仪测量BMD,根据BMD水平将研究对象分为BMD正常组(n = 492)和BMD异常组(n = 137)。采用多因素Logistic回归分析法分析学龄前儿童BMD的影响因素;采用酶联免疫吸附法测定25-(OH)水平,比较不同25-(OH)D水平儿童的BMD,并采用Pearson积矩相关分析学龄前儿童BMD与血清25-(OH)D相关性。结果学龄前儿童BMD异常率为21.78%。5~7岁儿童BMD异常率较高,1岁儿童其次。女童、1岁及5~7岁儿童BMD异常率高于男童、2~4岁儿童(P < 0.05);活动时间≤3 h/周、睡眠时间≤8 h/d、日照时间≤7 h/d的学龄前儿童BMD异常率高于活动时间>3 h/周、睡眠时间>8 h/d、日照时间>7 h/d儿童(P < 0.05);挑食、维生素D摄入≤400 U/d、奶制品摄入≤150 mL/d、豆制品摄入≤4次/周、水果摄入≤5次/周的学龄前儿童BMD异常率高于不挑食、维生素D摄入>400 U/d、奶制品摄入>150 mL/d、豆制品摄入>4次/周、水果摄入>5次/周儿童(P < 0.05)。与2岁儿童比较,1岁、5~7岁是BMD异常的独立危险因素(OR = 1.113、1.373、1.433、1.479,P < 0.05),活动时间、睡眠时间、日照时间、挑食情况、维生素D摄入、奶制品摄入、豆制品摄入、水果摄入是学龄前儿童BMD异常的影响因素(OR = 1.377、1.654、1.642、1.525、1.788、1.598、1.384、1.443,P < 0.05)。随着25-(OH)D水平的降低,SOS值逐渐增大,Z值逐渐减小,BMD异常率逐渐增加(P < 0.05)。学龄前儿童SOS与血清25-(OH)D呈负相关(r =-0.729,P < 0.05),Z值与血清25-(OH)D呈正相关(r = 0.761,P < 0.05)。结论学龄前儿童BMD异常率较高,尤其多见于1岁以前及5~7岁儿童,对BMD异常高危儿童应合理补充维生素D和钙剂,并加强户外活动,注意饮食均衡。

Objective To investigate the bone mineral density (BMD) in preschool children and its relationship with serum 25-hydroxyvitamin D [25-(OH)D]. Methods From March 2017 to March 2018, 629 preschool children aged 0-7 who underwent BMD examination in the Outpatient Department of Child Health Care of Sanya City Womenfolk and Infant Health Care Hospital were collected as subjects. BMD was measured by quantitative ultrasound, according to BMD level, the subjects were divided into normal BMD group (n = 492) and abnormal BMD group (n = 137). The influencing factor of BMD of preschool children was analyzed by multivariate Logistic regression analysis. The level of 25-(OH) was determined by ELISA, the BMD of children with different 25-(OH)D level was compared. Pearson product moment correlation analysis was used to analyze the correlation between BMD and serum 25-(OH)D in preschool children. Results The abnormal rate of BMD in preschool children was 21.78%, which in children aged 5-7 was higher than that in others, followed by children aged 1. The abnormal rate of BMD in girls, children aged 1-year-old and 5-7-year-old was higher than that in boys and children aged 2-4-year-old (P < 0.05). The abnormal rate of BMD in preschool children with activity time ≤3 h/week, sleeping time ≤8 h/d, sunshine time ≤7 h/d was higher than that of children whose activity time >3 h/week, sleeping time >8 h/d and sunshine time >7 h/d (P < 0.05). The abnormal rate of BMD in preschool children with picky diet, vitamin D intake ≤400 U/d, dairy intake ≤150 mL/d, bean products intake ≤4 times/week, fruit intake ≤5 times/week was higher than those of children without picky diet, vitamin D intake > 400 U/d, dairy intake >150 mL/d, bean products intake > 4 times/week, fruit intake > 5 times/week (P < 0.05). Compared with 2-year-old children, 1-year-old and 5-7-year-old was independent risk factors for abnormal BMD (OR = 1.113, 1.373, 1.433, 1.479, P < 0.05). Activity time, sleeping time, sunshine time, picky diet, vitamin D intake, dairy intake, bean products intake, fruit intake was the influencing factor of abnormal BMD in preschool children (OR = 1.377, 1.654, 1.642, 1.525, 1.788, 1.598, 1.384, 1.443, P < 0.05). With the decrease of 25-(OH)D level, SOS value increased gradually, Z value decreased gradually, and abnormal rate of BMD increased gradually (P < 0.05).There was a negative correlation between SOS and serum 25-(OH) D in preschool children (r =-0.729, P < 0.05), and a positive correlation between Z value and serum 25-(OH) D (r = 0.761, P < 0.05). Conclusion The abnormal rate of BMD in preschool children is higher, especially in children aged 1 and 5-7 years. Vitamin D and calcium should be supplemented reasonably for children at high risk of BMD, outdoor activities should be strengthened, and balanced diet should be paid attention to.