维生素D缺乏性佝偻病患者血清PTH、VDBP表达水平及相关性分析

Serum PTH and VDBP Expression Levels and Correlation Analysis in Patients with Vitamin D Deficiency Rickets

目的探讨维生素D缺乏性佝偻病(VDDR)患儿血清甲状旁腺素(PTH)、维生素D结合蛋白(VDBP)水平及其临床意义。方法选取2018年7月至2021年6月我院诊治的138例VDDR患儿为佝偻病组,同期138例体检正常幼儿为健康组。比较两组一般资料、血清PTH、VDBP、骨碱性磷酸酶(BALP)、25-羟基维生素D3[25-(OH)D3]水平;分析VDDR患儿血清PTH、VDBP水平与25-(OH)D3、BALP的相关性,并评估血清PTH、VDBP水平对VDDR的诊断价值。结果佝偻病组幼儿每天户外活动时间>2 h、母乳喂养至6个月、4个月添加辅食、母亲文化水平高中以上占比及血清VDBP水平低于健康组(P<0.05),血清PTH水平高于健康组(P<0.05)。VDDR患儿血清PTH水平与25-(OH)D3、BALP呈负相关(P<0.05),血清VDBP水平与25-(OH)D3、BALP呈正相关(P<0.05);血清PTH、VDBP水平诊断VDDR的曲线下面积(AUC)分别为0.887、0.882,截断值分别为100.32 pg/ml、484.79μg/ml,此时对应敏感度分别为87.0%、89.1%,特异度分别为79.3%、74.6%;PTH、VDBP联合诊断VDDR的AUC为0.925,其敏感度、特异度分别为86.2%、89.9%。幼儿每天户外活动时间、母亲文化水平、VDBP、25-(OH)D3是影响VDDR发生的保护因素(P<0.05),PTH是影响VDDR发生的危险因素(P<0.05)。结论VDDR患儿血清PTH较高,VDBP水平较低,PTH、VDBP均与25-(OH)D3、BALP显著相关,且二者联合更有利于临床诊断VDDR。

Objective To investigate levels and clinical significance of serum parathyroid hormone(PTH)and vitamin D-binding protein(VDBP)in children with vitamin D deficiency rickets(VDDR).Methods From July 2018 to June 2021,138 children with VDDR diagnosed and treated in our hospitalwere selected as rickets group,and 138 children with normal physical examination during the same period were selected as healthy group.General data,serum PTH,VDBP,bone alkaline phosphatase(BALP),and 25-hydroxyvitamin D3[25-(OH)D3]were compared between two groups.Correlation of serum PTH and VDBP levels with 25-(OH)D3 and BALP in children with VDDR was analyzed,and diagnostic value of serum PTH and VDBP for VDDR were evaluated.Results Children in rickets group had lower proportions of daily outdoor activities>2 hours,breast-feeding to 6 months,supplementary food added at the 4th month,mothers with education level above high school,and serum VDBP level than healthy group(P<0.05),and higher serum PTH level than healthy group(P<0.05).Serum PTH in children with VDDR was negatively correlated with 25-(OH)D3 and BALP(P<0.05),and serum VDBP level was positively correlated with 25-(OH)D3 and BALP(P<0.05).The area under the curve(AUC)for diagnosis of VDDR by serum PTH and VDBP levels was 0.887 and 0.882,respectively,and cut-off value was 100.32 pg/ml and 484.79μg/ml respectively.At this time,corresponding sensitivity was 87.0%and 89.1%respectively,and specificity was 79.3%and 74.6%respectively.The AUC of PTH combined VDBP for diagnosis of VDDR was 0.925,sensitivity and specificity were 86.2%and 89.9%,respectively.Children s daily outdoor activity time,mother s educational level,VDBP,25-(OH)D3 were protective factors affecting occurrence of VDDR(P<0.05),and PTH was a risk factor affecting occurrence of VDDR(P<0.05).Conclusion Children with VDDR would have higher serum PTH and lower VDBP.Both PTH and VDBP would be significantly related to 25-(OH)D3 and BALP,and combination of two would be more conducive to clinical diagnosis of VDDR.