东莞地区儿童维生素D缺乏现状及维生素D对血清铁蛋白及红细胞参数的影响

Status of vitamin D deficiency in children in Dongguan area and the effect of vitamin D on serum ferritin and red blood cell parameters

目的 研究东莞地区儿童维生素D缺乏现状及维生素D对血清铁蛋白及红细胞参数的影响。方法 回顾性分析2020年7月至2022年6月在东莞市儿童医院体检的6 600例1个月~17岁儿童的临床体检资料,所有儿童均进行血清25-羟维生素D [25(OH)D]浓度筛查,其中1 060例儿童同时进行血清铁蛋白检测。分析所有体检儿童血清25(OH)D的缺乏现状及特点;根据1 060例儿童血清25(OH)D的不同水平,将25(OH)D<30 ng/mL者作为25(OH)D缺乏组(n=360),25(OH)D≥30 ng/mL者作为25(OH)D正常组(n=700)。比较维生素D缺乏组与正常组儿童的红细胞参数及铁蛋白水平,采用多因素Logistic回归法分析铁蛋白及红细胞参数对维生素D水平的影响,并绘制受试者工作特征曲线(ROC)分析部分红细胞参数及铁蛋白对维生素D缺乏的预测价值。结果 6 600例体检儿童中共检出维生素D不足者1 501例(22.74%),维生素D缺乏者467例(7.08%),未检出严重缺乏者及维生素D中毒者,储存铁减少216例(3.3%);血清25(OH)D水平不足及缺乏的高检出(>30%)季节主要分布于春季(3月~5月)、夏季(6月~8月)和冬季(12月~次年2月),月份主要分布于1月、2月、3月、7月和8月;随着年龄递增,血清25(OH)D平均水平逐渐下降,且不同年龄段之间的血清25(OH)D水平比较差异具有统计学意义(P<0.05)。血清25(OH)D缺乏组儿童的年龄、铁蛋白、血红蛋白浓度、红细胞压积、平均红细胞体积、平均血红蛋白含量明显高于25(OH)D正常组,差异均有统计学意义(P<0.05),但性别分布比较差异无统计学意义(P>0.05);多因素Logistic回归分析结果显示,铁蛋白、红细胞压积、平均红细胞体积指标均是患儿发生血清25(OH)D缺乏的影响因素(P<0.05);经ROC分析结果显示,铁蛋白预测患儿发生血清25(OH)D缺乏的曲线下面积(AUC)为0.595,其截断值为62.9 ng/mL,灵敏度为52.8%,特异度为64.3%;红细胞压积预测患儿发生血清25(OH)D缺乏的AUC为0.665,其截断值为0.37%,灵敏度为64.2%,特异度为61.0%;平均红细胞体积预测患儿发生血清25(OH)D缺乏的AUC为0.679,其截断值为83.15fL,灵敏度为48.9%,特异度为78.4%。结论 东莞地区1个月~17岁儿童维生素D不足和缺乏检出率高,且发生集中在春季、夏季和冬季,随着年龄递增,血清25(OH)D平均水平逐渐下降。铁蛋白、红细胞压积、平均红细胞体积指标用于小儿血清25(OH)D缺乏早期诊断及疗效评估具有一定临床价值。

Objective To investigate the status of vitamin D deficiency in children in Dongguan area and the effect of vitamin D on serum ferritin and red blood cell parameters.Methods A retrospective analysis was conducted on the clinical examination data of 6600 children aged 1 month to 17 years who underwent physical examinations at Dong-guan Children's Hospital from July 2020 to June 2022.All children underwent serum 25-hydroxyvitamin D[25(OH)D]concentration screening,and 1060 of them also underwent serum ferritin testing.The current situation and characteris-tics of serum 25(OH)D deficiency in all the children undergoing physical examination was analyzed.Based on the differ-ent levels of serum 25(OH)D in 1060 children,children with 25(OH)D<30 ng/mL were selected as the 25(OH)D defi-ciency group(n=360),and children with 25(OH)D≥30 ng/mL were selected as the 25(OH)D normal group(n=700).The red blood cell parameters and ferritin levels were compared between the two groups.Multivariate logistic regres-sion method was used to analyze the impact of ferritin and red blood cell parameters on vitamin D levels,and receiv-er operating characteristic curve(ROCs)were drawn to analyze the predictive value of some red blood cell parameters and ferritin on vitamin D deficiency.Results Among the 6600 children,there were 1501 cases(22.74%)with vita-min D insufficiency,467 cases(7.08%)with vitamin D deficiency,0 case with severe deficiency,0 case with vitamin D poisoning,and 216 cases(3.3%)with reduced iron storage.High prevalence(>30%)of serum 25(OH)D insufficiency and deficiency were mainly detected in spring(March to May),summer(June to August)and winter(December to Feb-ruary of next year),mainly in January,February,March,July,and August.With the increase of age,the average serum 25(OH)D level gradually decreased,and there were significant differences in serum 25(OH)D levels among different age groups(P<0.05).The age,ferritin,hemoglobin concentration,hematocrit,mean corpuscular volume,and mean hemoglo-bin in the 25(OH)D deficiency group were significantly higher than those in the 25(OH)D normal group(P<0.05),but there was no significant difference in gender distribution(P>0.05).The results of multivariate logistic regression analy-sis showed that ferritin,hematocrit,and mean red blood cell volume were all influencing factors for the occurrence of se-rum 25(OH)D deficiency in children(P<0.05).ROC analysis results showed that the area under the curve(AUC)of ferri-tin for predicting serum 25(OH)D deficiency in children was 0.595,with a cutoff value of 62.9 ng/mL,sensitivity of 52.8%,and specificity of 64.3%.The AUC of hematocrit for predicting serum 25(OH)D deficiency in children was 0.665,with a cutoff value of 0.37%,sensitivity of 64.2%,and specificity of 61.0%.The AUC of average red blood cell volume for predicting serum 25(OH)D deficiency in children was 0.679,with a cutoff value of 83.15 fL,sensitivity of 48.9%,and specificity of 78.4%.Conclusion The prevalence of vitamin D insufficiency and deficiency in children aged 1 month to 17 years old in Dongguan area is high,and the prevalence is concentrated in spring,summer,and win-ter.The average serum 25(OH)D level gradually decreases with age.The indexes of ferritin,hematocrit,and mean eryth-rocyte volume have certain clinical value for early diagnosis and efficacy evaluation of serum 25(OH)D deficiency in children.