婴幼儿全血主要金属元素暴露水平与反复肺炎风险关系病例对照研究

Association of major metal elements and their ratios in whole blood with risk of recurrent pneumonia in children younger than 36 months:a hospital-based case-control study

目的探讨婴幼儿全血中5种主要金属元素(钙、铁、锌、铜、镁)含量与其反复肺炎风险的关系,为婴幼儿反复肺炎的预防控制提供参考依据。方法于2018年9月—2019年2月,采用病例对照研究比较86例反复肺炎婴幼儿(病例组)和174例健康婴幼儿(对照组)全血中5种主要金属元素含量及比值之间的差异,通过多因素logistic回归分析婴幼儿反复肺炎的危险因素,采用ROC曲线分析元素比值对婴幼儿反复肺炎的预测意义。结果病例组全血钙含量[(1.59±0.22)mmol/L]低于对照组[(1.66±0.17)mmol/L];钙缺乏率(22.09%)、铜含量[(17.62±6.18)μmol/L]、镁/钙比值(0.95±0.14)、铜/锌比值(0.25±0.07)均高于对照组的2.87%、(14.11±2.97)μmol/L、(0.90±0.12)、(0.20±0.04)。多因素logistic回归分析结果表明,低血钙(OR=0.120,95%CI=0.027~0.530)、高血铜(OR=1.209,95%CI=1.127~1.298)、高镁/钙比值(OR=1.039,95%CI=1.015~1.063)和高铜/锌比值(OR=1.216,95%CI=1.137~1.301)与婴幼儿反复肺炎风险增加有关。ROC曲线分析显示,镁/钙比值、铜/锌比值及两者联合预测婴幼儿反复肺炎的AUC分别为0.608、0.707、0.758(P<0.05)。结论反复肺炎婴幼儿伴有全血钙含量降低,钙缺乏率、铜含量、镁/钙比值和铜/锌比值升高,且镁/钙比值、铜/锌比值对婴幼儿反复肺炎风险有一定的预测价值。

Objective To study the association between the concentration of calcium,iron,zinc,copper,and magnesium and their ratios in whole blood and the risk of recurrent pneumonia in infants and young children,and to provide guidelines for the prevention and control of recurrent pneumonia in the population.Methods A case-control study was conducted among 86 children(<36 months of age)with recurrent pneumonia who were hospitalized between September 2018 and February 2019,and 174 age-matched healthy children who underwent physical examinations during the same period at Tongshan County People's Hospital in Hubei province.Relevant information on the participants was obtained from the hospital's electronic medical records,and venous blood samples were collected to measure the concentrations of the five metal elements and their ratios.Multivariate logistic regression analysis was used to assess risk factors for recurrent pneumonia in infants and young children;and receiver operating cure(ROC)analysis was used to determine the significance of ratios of mental elements in predicting recurrent pneumonia.Results The cases had a lower calcium concentration than the controls(1.59±0.22 vs.1.66±0.17 mmol/L),with a deficiency rate of 22.09%,but a higher copper concentration(17.62±6.18 vs.14.11±2.97μmol/L)and a higher magnesium/calcium ratio(0.95±0.14 vs.0.90±0.12)and copper/zinc ratio(0.25±0.07 vs.0.20±0.04).Multivariate logistic regression analysis showed that low blood calcium(odds ratio[OR]=0.120,95%confidence interval[CI]:0.027 to 0.530),high blood copper(OR=1.209,95%CI:1.127 to 1.298),high magnesium/calcium ratio(OR=1.039,95%CI:1.015 to 1.063),and high copper/zinc ratio(OR=1.216,95%CI:1.137 to 1.301)were associated with an increased risk of recurrent pneumonia in infants and young children.ROC curve analysis showed that the area under the curve(AUC)of magnesium/calcium ratio,copper/zinc ratio,and their combination in predicting recurrent pneumonia in infants were 0.608,0.707,and 0.758,respectively(P<0.05 for all).Conclusion The children less than 36 months of age with recurrent pneumonia have reduced whole blood calcium but increased calcium deficiency rate,copper concentration,magnesium/calcium ratio,and copper/zinc ratio,and magnesium/calcium and copper/zinc ratios could predict the risk of recurrent pneumonia in the children to some extent.