极低出生体重儿代谢性骨病骨折危险因素分析

Risk factors of metabolic bone disease associated fracture in very low birth weight infants

目的探讨极低出生体重儿代谢性骨病(metabolic bone disease, MBD)骨折的危险因素。方法选取2012年1月至2019年12月湖南省儿童医院新生儿科收治的胎龄<32周、出生体重< 1 500 g, 并按时完成1.5年随访(6个月以前每月1次, 6个月后每3个月1次)的MBD患儿进行回顾性分析。根据X线是否发生骨折分为骨折组和非骨折组, 比较两组患儿的相关临床资料, 分析发生骨折的危险因素。结果入选MBD早产儿62例, 骨折组11例, 非骨折组51例。MBD早产儿发生骨折的相关因素包括宫内生长受限、出生体重<1 000 g、胎龄、呼吸支持时间和肠外营养时间(P<0.05)。Logistic回归分析显示, 宫内生长受限(OR=2.159, 95%CI 1.536~2.759)、肠外营养时间长(OR=1.143, 95%CI 1.042~1.270)是MBD早产儿发生骨折的独立危险因素, 差异有统计学意义(P<0.05)。骨折组碱性磷酸酶高于非骨折组, 25(OH)D低于非骨折组, 差异有统计学意义(P<0.05)。结论宫内生长受限是MBD早产儿发生骨折的危险因素, 碱性磷酸酶增高和25(OH)D降低是提示MBD早产儿发生骨折的骨代谢指标。

Objective To study the risk factors of metabolic bone disease(MBD)associated fracture in very low birth weight premature infants.Methods From January 2012 to December 2019,premature infants(gestational age<32 weeks,birth weight<1500 g)were admitted to our hospital and followed-up regularly for 1.5 years(once every month within first 6 months,then once every 3 months).The infants were assigned into two groups according to X-ray diagnosis:the fracture group and the non-fracture group.The clinical data of the two groups were compared and the risk factors of fracture were analyzed.Results A total of 62 preterm infants with MBD were included in this study,including 11 in the fracture group and 51 in the non-fracture group.The risk factors of MBD associated fracture included intrauterine growth restriction(IUGR),birth weight<1000 g,gestational age,respiratory support duration and total parenteral nutrition(TPN)duration(P<0.05).Logistic regression analysis showed that IUGR(P<0.05,OR=2.159,95%CI 1.536~2.759)and TPN duration(P<0.05,OR=1.143,95%CI 1.042~1.270)were independent risk factors for fracture.Serum alkaline phosphatase(ALP)in the fracture group was significantly higher than the non-fracture group and 25(OH)VitD was significantly lower than the non-fracture group(P<0.05).Conclusions IUGR and TPN duration are risk factors for MBD associated fracture in preterm infants.As biochemical markers of bone metabolism,ALP and 25(OH)VitD levels have clinical value predicting MBD associated fracture.