早产儿维生素D水平与呼吸窘迫综合征的关系

Association between vitamin D level and respiratory distress syndrome in premature infants

目的探讨早产儿血清25羟维生素D[25(OH)D]水平与呼吸窘迫综合征(RDS)的关系。方法将复旦大学附属妇产科医院两院区的新生儿科重症监护室(NICU)自2018年3月至2021年12月收入院治疗的早产儿纳入统计并分析,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。根据这些早产儿是否可被诊断为RDS,将其划分RDS组和对照组;根据脐血血清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;根据脐血血清25(OH)D水平是否低于10ng/mL分为维生素D不足组和缺乏组;分别分析比较各组间各影响因素的差异。结果纳入研究的239例早产儿血清25(OH)D水平为2.5~50.1 ng/mL,平均水平为(15.3±8.2)ng/mL,血清25(OH)D充足者56例(23.4%),减少者183例(76.6%),减少者中不足者118例(49.4%),缺乏者65例(27.2%)。RDS组早产儿的脐血血清25(OH)D水平[(14.3±7.0)ng/mL]明显低于对照组[(17.9±10.5)ng/mL,t=-3.087,P=0.002],两组的25(OH)D水平均为维生素D不足。以20ng/mL为截断值,RDS组脐血血清25(OH)D减少发生率为81.6%(142/174),显著高于对照组[63.1%(41/65),χ^(2)=9.059,P=0.003]。通过单因素和多因素分析,新生儿胎龄小于32周、出生体质量小于2000g和脐血血清25(OH)D减少是早产儿发生RDS的独立危险因素(分别为P<0.001、P<0.001和P=0.013)。结论早产儿维生素D减少发生率高,低维生素D水平可能增加RDS发生率。

Objective To investigate the relationship between serum 25-hydroxyvitamin D[25(OH)D]levels and respiratory distress syndrome(RDS)in premature infants.Methods The premature infants admitted to the neonatal intensive care unit(NICU)of the two areas of Fudan University Affiliated Obstetrics and Gynecology Hospital from March 2018 to December 2021 was included in the analysis.Cord blood was collected at birth,and the serum 25(OH)D levels in cord blood were determined using chemiluminescence microparticle immunoassay analysis.These preterm infants were divided into the RDS and the control groups according to whether diagnosed with RDS,according to whether the vitamin D levels of cord blood were less than 20 ng/mL into vitamin D reduction group and adequate group,according whether less than 10 ng/mL into vitamin D severe deficiency group and deficiency group,the differences of influencing factors between groups were analyzed and compared.Results The cord blood serum levels of 25(OH)D in 239 preterm infants were 2.5-50.1 ng/mL,with an average value of(15.3±8.2)ng/mL.Among the preterm infants,56(23.4%)had adequate serum 25(OH)D,183(76.6%)were reduced,in which 118(49.4%)were deficient and 65(27.2%)were severe deficient.The levels of cord blood serum 25(OH)D[(14.3±7.0)ng/mL]in the RDS group were significantly lower than that in the control group[(17.9+10.5)ng/mL,t=-3.087,P=0.002],and the levels of 25(OH)D in both groups were vitamin D reduction.Taking 20ng/mL as the cut-off value,the incidence of cord blood serum 25(OH)D reduction was 81.6%(142/174)in the RDS group,which was significantly higher than that in the control group[63.1%(41/65),x2=9.059,P=0.003].Neonates with gestational age less than 32 weeks,birth weight less than 2000 g,and cord blood serum 25(OH)D reduction were independent risk factors for RDS in preterm infants(P<0.001,P<0.001,and P=0.013)by univariate and multivariate analyses.Conclusion Preterm infants have a high incidence of vitamin D reduction,and low vitamin D levels may increase the incidence of RDS.