热性惊厥患儿血清25-羟基维生素D的多维度分析

Multi-dimensional analysis of serum 25-hydroxyvitamin D in children with febrile seizures

目的分析四川省泸州地区热性惊厥儿童血清25-羟基维生素D[25(OH)D]营养状况及其与性别、年龄、季节的关系,为本地区儿童补充维生素D及预防热性惊厥的发生提供参考依据。方法选取2015年1月至2018年7月西南医科大学附属医院诊断为热性惊厥住院患儿167例为热性惊厥组,选择同时期门诊健康体检的0~8岁儿童170例为健康对照组。提取患儿血清总钙、血清25(OH)D、血红蛋白水平,按性别、年龄、季节等分析热性惊厥与血清25(OH)D的相关性。结果1.本地区健康对照组25(OH)D水平为(40.6±3.07)μg/L,热性惊厥组25(OH)D水平为(27.18±6.68)μg/L,2组比较差异有统计学意义(t=3.15,P=0.03);25(OH)D水平随着年龄的增长而下降;所有热性惊厥患儿的血清总钙和血红蛋白均未发现降低。2.热性惊厥发病规律:每年1月份是发病最多的季节(35例,20.96%),2岁是高发年龄(72例,44.91%),男童明显多于女童(1.73∶1.00)。3.本地区热性惊厥患儿冬季、夏季血清25(OH)D水平最低(27.47~30.37)μg/L、春、秋季较高(31.58~35.13)μg/L,冬季[(27.47±1.80)μg/L]与春季[(31.58±1.31)μg/L]、秋季[(35.13±3.93)μg/L]间25(OH)D水平比较差异均有统计学意义(均P<0.05)。4.热性惊厥患儿血清25(OH)D值在夏季与最高温度成反比[气温>35℃时,25(OH)D<30μg/L]。夏季气温超过35℃后25(OH)D呈下降趋势。本地区儿童经太阳照射皮肤吸收维生素D的最适宜气温为25~35℃。结论四川省泸州地区儿童热性惊厥的发生与维生素D缺乏密切相关。2岁男童在每年的1月份最易发生热性惊厥。除了冬季外,在户外活动减少的夏季高温时期,应对儿童(尤其2岁以上孩童)合理补充维生素D预防热性惊厥。

Objective To analyze the serum 25-hydroxyvitamin[25(OH)D]nutritional status of children with febrile seizures in Luzhou area of Sichuan Province,and the relationship of 25(OH)D with gender,age and the local season,so as to provide reference for vitamin D supplementation and prevention of febrile seizures in children in this area.Methods One hundred and sixty-seven children diagnosed with febrile seizures in the Affiliated Hospital of Southwest Medical University from January 2015 to July 2018 were enrolled in the febrile seizures group,and 170 children aged 0-8 years who underwent health examinations in the outpatient department in the same period were included in the healthy control group.The serum total calcium,serum 25(OH)D and hemoglobin level of children with febrile seizures were analyzed.The correlation of febrile seizures with the level of serum 25(OH)D was evaluated from the aspects of children gender,age and season.Results(1)The serum 25(OH)D level of healthy children[(40.6±3.07)μg/L]was significantly higher than that of the children with febrile seizures[(27.18±6.68)μg/L],and the diffe-rence was statistically significant(t=3.15,P=0.03).The serum 25(OH)D level in children with febrile seizures decreased with age.There was no deficiency found in serum total calcium and hemoglobins of all children with febrile seizures.(2)The incidence rate of febrile seizures was the highest in January(35 cases,20.96%)and in 2-year-old toddlers(72 cases,44.91%).Boys were significantly more susceptible to febrile seizures than girls(1.73∶1.00).(3)The serum 25(OH)D level of children with febrile seizures in the region decreased in winter and summer(27.47-30.37μg/L),and increased in spring and autumn(31.58-35.13μg/L).The serum 25(OH)D level of children in winter[(27.47±1.80)μg/L]was statistically significantly different from that in spring[(31.58±1.31)μg/L]and in autumn[(35.13±3.93)μg/L](all P<0.05).The serum 25(OH)D level in children with febrile seizures were inversely proportional to the high temperature in summer[T>35℃,25(OH)D<30μg/L].The 25(OH)D level showed a downward trend when the temperature exceeded 35 degrees Celsius.The optimum temperature for children in this area to absorb vitamin D by sun-irradiation was 25-35℃.Conclusions The occurrence of febrile seizures in children of all ages in Luzhou is closely related to the deficiency of vitamin D.Two-year-old boys are prone to be attacked by febrile seizures in January of each year.In addition to winter,children,especially those over 2 years old,are advised to supply vitamin D in high temperature periods in summer when outdoor activities are reduced.