重庆市开州地区0～6岁儿童25-羟基维生素D水平调查及相关危险因素分析

Investigation of 25-Hydroxyvitamin D Level and Analysis of Related Risk Factors in Children Aged 0～6 Years in Kaizhou District of Chongqing

目的分析重庆市开州地区0~6岁儿童25-羟基维生素D[25-(OH)D]水平及相关危险因素,为防治因25-(OH)D缺乏或不足引起的相关疾病提供依据。方法选取1 486例0~6岁儿童为研究对象,采用磁微粒化学发光免疫分析法进行25-(OH)D检测,从性别、年龄、季节方面分析25-(OH)D水平,并对可能引起其缺乏或不足的相关危险因素进行单因素及多因素分析。结果 1 486例0~6岁儿童血清25-(OH)D缺乏率为21.6%(321/1 486),不足率为29.54%(439/1486),充足率为48.86%(726/1 486),男女儿童间25-(OH)D缺乏、不足和充足率差异无统计学意义(χ^2=0.472,P>0.05);3~6岁儿童25-(OH)D水平显著低于<1岁、1~2岁和2~3岁儿童(26.18±7.52 ng/ml vs 29.66±8.88 ng/ml,31.36±9.83 ng/ml and 30.84±8.24 ng/ml),差异具有统计学意义(F=19.529,P<0.01),不同年龄段的儿童25-(OH)D缺乏率、不足率和充足率差异具有统计学意义(χ^2=23.730,P<0.01);夏、秋季儿童25-(OH)D水平高于春、冬季(33.11±9.29 ng/ml,32.73±9.46 ng/ml vs 27.28±8.82 ng/ml,26.51±7.23 ng/ml),不同季节的25-(OH)D缺乏率、不足率和充足率差异具有统计学意义(χ^2=89.795,P<0.01)。单因素分析显示:单独母乳喂养、未规律服用维生素D制剂、挑食或厌食、户外活动时间<2h/天、父母文化程度低、反复腹泻是引起受检儿童25-(OH)D缺乏或不足的影响因素(χ^2=5.823,25.758,10.531,5.666,6.973,4.707,均P<0.05);多因素分析显示:挑食或厌食、反复腹泻是引起0~6岁受检儿童25-(OH)D缺乏或不足的独立危险因素(χ^2=85.690,6.392,均P<0.05)。结论开州地区0~6岁儿童25-(OH)D缺乏或不足的情况较为严重,应在春、冬季和儿童在3~6岁阶段进行维生素D制剂补充;加强儿保教育,纠正引起儿童25-(OH)D缺乏或不足的相关危险因素。

Objective To analyze the level of 25-hydroxyvitamin D[25-(OH)D] and its related risk factors in children aged 0~6 years in Kaizhou of Chongqing in order to provide evidence for the prevention and treatment of related diseases caused by 25-(OH)D deficiency or insufficiency. Methods A total of 1 486 children aged 0~6 years were selected as subjects. 25-(OH)D was detected by magnetic particle chemiluminescence immunoassay. The levels of 25-(OH)D were analyzed in terms of sex, age and season, and the related risk factors that might cause their deficiency or deficiency were analyzed by single factor and multi-factor analysis. Results The serum 25-(OH) D deficiency rate was 21.6%(321/1 486), deficiency rate was 29.54%(439/1 486) and adequacy rate was 48.86%(726/1 486) in 1 486 children aged 0~6 years. There was no significant difference in 25-(OH) D deficiency, insufficiency and adequacy rate between boys and girls (χ^2=0.472, P>0.05). The level of 25-(OH)D in children aged 3~6 years was significantly lower than that in children aged < 1,1~2 and 2~3 years(26.18±7.52 ng/ml vs 29.66±8.88 ng/ml, 31.36±9.83 ng/ml and 30.84±8.24 ng/ml),respectively, the difference was statistically singnificant(F=19.529,P<0.01). There were significant differences in the rate of 25-(OH)D deficiency, insufficiency and adequacy among children of different ages (χ^2=23.730,P<0.01). The levels of 25-(OH)D in summer and autumn was higher than that in spring and winter(33.11±9.29 ng/ml,32.73±9.46 ng/ml vs 27.28±8.82 ng/ml,26.51±7.23 ng/ml). There were significant differences in the rate of 25-( OH)D deficiency, insufficiency and adequacy in different seasons (χ^2=89.795,P<0.01). Univariate analysis showed that breastfeeding alone, irregular use of vitamin D preparations, picky or anorexia, outdoor activities less than 2 hours/day, low educational level of parents and recurrent diarrhea were risk factors for 25-(OH) D deficiency or insufficiency (χ^2=5.823, 25.758, 10.531, 5.666, 6.973, 4.707, all P<0.05). Analysis showed that picky eating, anorexia and recurrent diarrhea were independent risk factors for 25-(OH) D deficiency or deficiency in children aged 0~6 years (χ^2= 85.690, 6.392, all P<0.05).Conclusion The situation of 25-(OH) D deficiency and insufficiency in children aged 0~6 years in Kaizhou is serious.Vitamin D supplementation should be carried out in spring, winter and children aged 3~6 years, and the education of child care should be strengthened to correct the related risk factors of 25-(OH)D deficiency and insufficiency in children.