维生素D水平与极低出生体重儿临床结局的相关性研究

Association between vitamin D level at birth and clinical outcomes in very low birth weight infants

目的分析出生时血清25-羟维生素D[25-(OH)D]水平对极低出生体重儿临床结局的影响,为早产儿相关疾病的预防和治疗提供新的方向。方法选取2019年9月-2020年9月在济宁医学院附属医院NICU住院治疗的105例极低出生体重儿为研究对象,根据出生24h内血清25-(OH)D水平,将患儿分为维生素D严重缺乏组(A组)、维生素D缺乏组(B组)及维生素D正常组(对照组),对三组母婴一般资料、住院期间的治疗情况、合并症及临床转归进行比较。结果所有患儿出生时血清25-(OH)D平均值为(14.33±3.60)ng/ml,维生素D缺乏的发生率为79.1%。夏秋季节出生的患儿血清25-(OH)D明显高于冬春季节(t=2.71,P=0.01)。A组、B组患儿的出生体重、出生体重Z评分及1min Apgar评分均较对照组低(F=0.86、5.43、9.05,P<0.01)。母亲年龄越大,维生素D水平越低,差异有统计学意义(F=8.40,P<0.01)。A组、B组患儿住院时间、用氧时间、机械通气时间、无创通气时间均高于对照组,差异有统计学意义(F=19.65、7.45、15.97、4.87,P<0.01或<0.05)。A组、B组患儿呼吸窘迫综合征(RDS)、支气管肺发育不良(BPD)及早产儿视网膜病变(ROP)的发生率增高,三组比较差异有统计学意义(χ^(2)=17.37,P<0.05)。Logistic回归分析显示出生时维生素D缺乏是极低出生体重儿发生RDS(OR=6.604,95%CI:1.828~23.862,P=0.004)、BPD(OR=8.199,95%CI:1.428~47.067,P=0.018)的危险因素,维生素D水平越低,患儿发生RDS、BPD的风险越高。结论极低出生体重儿血清25-(OH)D缺乏发生率较高;低水平血清25-(OH)D可能会延长极低出生体重儿氧疗及呼吸支持时间,也可能会增加BPD、RDS及ROP的发生率,延长其住院时间。

Objective To analyze the influence of serum 25-(OH)D level on the clinical outcomes of very low birth weight infants,in order to provide new orientation for the prevention and treatment of related disease in preterm infants.Methods From September 2019and September 2020,a total of 105very low birth weight infants hospitalized in Neonatal Intensive Care Unit(NICU)of Affiliated Hospital of Jining Medical College were selected as study subjects.According to the level of serum 25-(OH)D within 24hours after birth,infants were divided into severe vitamin D deficiency group(group A),vitamin D deficiency group(group B)and control group.General characteristics,length of hospital stay,complications and clinical outcomes of infants in the three groups were compared.Results A total of 105infants with very low birth weight were included.The mean serum 25-(OH)D was(14.33±3.60)ng/ml at birth.The incidence of vitamin D deficiency was 79.1%.The serum 25-(OH)D level of infants born in summer and autumn was significantly higher than that in winter and spring(t=2.71,P=0.01).The birth weight of the infants for group A and group B was lower than those of the control group(F=0.86,P<0.01;Z score:F=5.43,P=0.01).1-minute Apgar score of the infants for group A and group B were lower than those of the control group(F=9.05,P<0.01).The older the mother was,the higher the incidence of vitamin D deficiency was,and the difference between the three groups was statistically significant(F=8.40,P<0.01).The length of hospital stay,duration of oxygen use,duration of ventilation in infants with vitamin D deficiency were significantly higher than those in the control group,with statistically significant differences among the three groups(F=19.65,7.45,15.97,4.87,P<0.05).The incidence of RDS、BPD and ROP in infants with vitamin D deficiency was higher than control group,the difference between the three groups was statistically significant(χ^(2)=17.37,P<0.05).Logistic regression analysis showed that vitamin D deficiency at birth was a risk factor for RDS(OR=6.604,95%CI:1.828-23.862,P=0.004)、BPD(OR=8.199,95%CI:1.428-47.067,P=0.018).Conclusions Serum 25-(OH)D deficiency is prevalent in very low birth weight infants.For very low birth weight infants,low serum 25-(OH)D level may increase the duration of oxygen therapy and respiratory support,increase the incidence of BPD,RDS and ROP,and prolong the length of hospital stay.