早产儿脐血血清25羟维生素D与呼吸窘迫综合征的关联性研究

Association between serum 25(OH)D level in cord blood and respiratory distress syndrome among preterm neonates

目的探讨早产儿脐血血清25羟维生素D[25(OH)D]水平与呼吸窘迫综合征(RDS)的关系,为RDS的临床预防提供新思路。方法将2018年3月—2020年5月收治入复旦大学附属妇产科医院NICU的179例早产儿纳入分析,于出生时采集脐血,使用化学发光微粒子免疫检测法分析测定脐血血清25(OH)D水平。根据是否诊断RDS分为RDS组和对照组,将血清25(OH)D水平是否低于20 ng/ml分为维生素D减少组和充足组,并分别分析和比较两组各影响因素的差异。结果25.1%早产儿脐血25(OH)D水平缺乏(<10 ng/ml)、42.5%不足(10~<20 ng/ml),32.4%正常(≥20 ng/ml)。RDS组脐血血清25(OH)D水平[(11.3±7.2)ng/ml]显著低于对照组[(15.88±8.4)nmol/L],t=3.469,P<0.01);RDS组脐血血清25(OH)D减少发生率为89.0%(121/136),显著高于对照组[46.5%(20/43),χ^(2)=35.221,P<0.01)]。通过单因素和多因素分析,新生儿胎龄≤32周和脐血血清25(OH)D<20 ng/ml是早产儿发生RDS的独立危险因素(OR=39.694,5.696,P<0.05)。结论早产儿维生素D缺乏发生率高,低维生素D水平可能增加RDS发生率。

Objective To investigate the relationship between serum 25 hydroxy vitamin D[25(OH)D]level and respiratory distress syndrome(RDS)in preterm infants,in order to provide new ideas for clinical prevention of RDS.Methods A total of 179 preterm infants admitted to NICU,Obstetrics and Gynecology Hospital Affiliated to Fudan University from March 2018 to May 2020 were included in the analysis.Cord blood was collected at birth,and the serum 25(OH)D level in cord blood was determined by chemiluminescent microparticle immunoassay.The infants were divided into RDS group and control group according to the diagnosis of RDS.According to whether serum 25(OH)D level was lower than 20 ng/ml,the infants were divided into vitamin D reduction group and normal group.The differences on the influencing factors between the two groups were analyzed and compared.Results Among all preterm infants,25.1%were deficient in 25(OH)D level(<10 ng/ml),42.5%were deficient(10—<20 ng/ml),and 32.4%were normal(≥20 ng/ml).The level of 25(OH)D in cord blood of RDS group[(11.3±7.2)ng/ml]was significantly lower than that of the control group[(15.88±8.4)nmol/L,t=3.469,P<0.01)].The prevalence of 25(OH)D decrease in RDS group was 89.0%(121/136),which was significantly higher than that in control group[46.5%(20/43),χ^(2)=35.221,P<0.01)].Multivariate analysis result indicated that gestational age and decreasing serum 25(OH)D level in cord blood were independent risk factors for RDS in preterm infants(OR=39.694,5.696,P<0.05).Conclusion The prevalence of vitamin D deficiency in preterm infants is high,and it may increase the incidences of RDS.