婴幼儿佝偻病简易诊断指标的探讨

Discussion on diagnostic indexes of rickets for infant and toddler

目的 :通过检测血液中骨碱性磷酸酶 (BALP)含量与分析临床表现 ,探讨婴幼儿佝偻病简易临床诊断的指标及其价值。方法 :有维生素D摄入不足病史和佝偻病非特异性神经精神症状的 0～ 3岁儿童 83名 ,测定末梢血BALP含量 ,对BALP含量≥ 2 5 0U·L- 1 并出现骨骼改变的小儿 ,给予英康利 1支 (含维生素D 3 0万IU)口服 ,1个月后复查血BALP含量。结果 :婴幼儿年龄越小 ,BALP阳性率越高 ;BALP阳性与骨骼改变之间有显著的相关关系 ,患儿BALP检测的敏感度高于骨骼检查 ;骨骼改变以次要体征肋外翻和前囟门增大为主 ,伴骨骼改变的婴幼儿经维生素D治疗效果明显。结论 :维生素D缺乏病史、佝偻病症状和BALP阳性 3个指标可作为婴幼儿佝偻病活动期的简易诊断指标 ,骨骼改变不宜分主要和次要体征 。

Objective To discuss diagnostic indexes of rickets for infant and toddler and its significance. Methods Bone alkaline phosphatase (BALP)was tested in 83 cases of children aged 0 to 3 with a history of vitamin D dificiency and nonspecific symptoms of rickets. Those whose BALP were more than 250-U·L -1 with changes of bones were given Yingkangli containing vitamin D 300-000-IU, and their BALP was tested one month later. Results The younger the patients, the higher the positive rate of BALP. There was a significant relation between positive BALP and the changes of bones.The index of BALP positive was more sensitive than changes of bones,such as rib ectropion (41.2%) and enlarged quadrangular fonticulus (26.5%). Those infants and toddlers with the changes of bones had dramatically effect when treated with vitamin D.Conclusion The history of the lacking of vitamin D, the nonspecific symptoms of rickets, and positive BALP can be taken as the simple diagnostic indexes of rickets for infants and toddlers. The changes,either first or secondary manifestion of bones is an indicator of active rickets.