极低出生体重儿脐血维生素D水平与早发型败血症的相关性研究

Cord blood vitamin D levels and its relationship to early-onset sepsis in the very low birth weight infants

目的探讨胎龄<34 周且出生体重<1 500 g的极低出生体重儿脐血25 羟维生素D [25(OH)D]水平与早发型败血症(early-onset sepsis ,EOS)之间的关系.方法收集2017年1月1日至2017年12月31日符合条件的极低出生体重儿脐血159例,其中EOS组31例(男17例,女14例),非EOS组128例(男67例,女61例),检测两组患儿25(OH)D水平并比较组间差异.定义25(OH)D<10 ng/ml为严重缺乏,10~20 ng/ml为缺乏,20~30 ng/ml为不足,>30 ng/ml为充足.结果 EOS组和非EOS组患儿的性别构成、胎龄、出生体重、Apgar评分等比较差异均无统计学意义(P>0. 05).EOS组25(OH)D平均水平为(9. 08 ± 4. 21)ng/ml,非EOS组为(11. 91 ± 5. 37)ng/ml,两组比较差异有统计学意义(P=0. 007). EOS组25(OH) D严重缺乏率为67. 7%(21/31),非EOS组为41. 4%(53/128);EOS组25(OH)D缺乏率为32. 3%(10/31),非EOS组为52. 3%(67/128). EOS组和非EOS组总体缺乏率差异无统计学意义(P=0. 152).分析所有极低出生体重儿脐血25( OH) D的ROC曲线, 25(OH)D预测EOS的cut-off界值为10. 06 ng/ml.结论极低出生体重儿脐血维生素D缺乏率高达95%,提示临床中需更加重视这类早产儿的维生素D补充.低维生素D水平(<10 ng/ml)提示临床上需注意EOS的可能.

Objective To investigate the association between serum 25(OH)D levels and the incidence of early-onset sepsis(EOS) in the very low birth weight infants(VLBWI) and the gestational age below 34 weeks. Methods The cord blood of 159 VLBWI were collected between January and December 2017, including 31 clinically diagnosed EOS and 128 non-EOS patients.Serum 25(OH)D<10 ng/ml was defined as severe vitamin D deficiency, 25(OH)D 10 to 20 ng/ml as vitamin D deficiency, 25(OH)D 20 to 30 ng/ml as vitamin D insufficiency and 25(OH)D >30 ng/ml as vitamin D sufficiency. Results There were no differences in gender, gestational age, birth weight and Apgar score between the EOS group and the non-EOS group(P>0.05). Serum 25(OH)D was(9.08±4.21)ng/ml in the EOS group and(11.91±5.37)ng/ml in the non-EOS group(P=0.007). The rate of severe vitamin D deficiency was 67.7%(21/31)in the EOS group and 41.4%(53/128) in the non-EOS group.The rate of vitamin D deficiency was 32.3%(10/31)in the EOS group and 52.3%(67/128)in the non-EOS group.But there was no difference of vitamin D deficiency distribution in the two groups(P=0.152). The cut-off value of serum 25(OH)D level in predicting EOS was 10.06 ng/ml. Conclusion The incidence of vitamin D deficiency is as high as 95%, calling for urgent attention on vitamin D supplementation in those VLBWI.Low 25(OH)D level(<10 ng/ml)might be predictive of EOS.