维生素D缺乏性佝偻病实验室指标的诊断价值探讨  

Discussion of clinical diagnostic value of vitamin D deficiency rickets

作　　者：霍亭竹[1] 陈静[1] 杨尧[2] 吴康敏[1] 

机构地区：[1]四川大学华西第二医院儿科,四川成都610041 [2]凉山彝族自治州第一人民医院儿科,四川西昌615099

出　　处：《中国儿童保健杂志》2013年第8期802-805,共4页Chinese Journal of Child Health Care

基　　金：四川省卫生厅科学研究基金(040138)

摘　　要：【目的】探讨血25-(OH)D3、骨碱性磷酸酶等临床常用的实验室检查对维生素D缺乏性佝偻病的诊断价值。【方法】对1 190名0～4岁儿童进行临床体检,随机选取部分儿童抽取静脉血测定骨碱性磷酸酶、血25-(OH)D3、钙、磷、碱性磷酸酶及骨密度、左手腕骨X片。比较其检测佝偻病的灵敏度、特异度。通过ROC曲线对25-(OH)D3、骨密度诊断价值进行评价。【结果】佝偻病患儿血25-(OH)D3明显低于对照组,25-(OH)D3的ROC线下面积为0.633(95%CI:0.581～0.684),具有中度诊断性。针对西昌人群,维生素D不足诊断浓度最合适诊断点为72.86nmol/L。利用该界值点诊断佝偻病的灵敏度为65.35%,特异度56.02%。骨密度、钙、磷、碱性磷酸酶、骨碱性磷酸酶多种检查指标可做为佝偻病的辅助检查手段,诊断性稍差,联合25-(OH)D3和骨碱性磷酸酶诊断早期、活动期佝偻病灵敏度提高至76.67%,特异度90.91%。【结论】血25-(OH)D3浓度为诊断佝偻病的良好指标。骨碱性磷酸酶灵敏度、特异度相比优于其他指标,可用于人群筛查。骨碱性磷酸酶和25-(OH)D3项目的条件下联合辅助诊断,提高对维生素D缺乏性佝偻病的识别性。[Objective] To investigate the diagnostic values of vitamin D deficiency rickets,including serum 25-（OH） D3, bone alkalinity phosphatase（BALP） ,total calcium and so on. [Methods] A total of 1 190 children were tested and in- vestigated aged 0 - 4 years old. Part of them were randomly selected to check BALP, 25-（OH）Da, total calcium, phosphorus, alkalinity phosphatase,bone mineral density（BMD） and taken X-ray. [Results] Serum 25-（OH）D3 in rickets was signifi- cantly lower than the control group,the area of 25-（OH）Da＇s ROC curve is 0. 633 （95%CI：0. 581-0. 684） which was mod- erate diagnostic. For Xichang crowd,the most appropriate concentration for cutoff point of diagnosing Vitamin D Deficiency is 72.86 nmol/L. Using this cutoff point to diagnose rickets,the sensitivity is 65.35% ,and the specificity is 56.02%//00. Bone density, calcium, phosphorus, alkaline phosphatase, bone alkaline phosphatase can be used as indicators of a variety of inspec- tion rickets secondary screening tool,as their diagnostic are weak. Combine 25-（OH） D3 and bone alkaline phosphatase to di- agnosis early and active phase rickets,the sensitivity increased to 76.67% ,and specificity increased to 90.91%. [Conclu- sion] Serum 25-（OH）D3 concentration is a good index for Rickets diagnosis. BALP is more sensitive and specific,which can be used for Vitamin D Deficiency Rickets screen. It clearly indicates we can diagnose better when we combined BALP and 25-（OH）D3＇s results,especially recognizing more patients in their early period or active period.

关 键 词：佝偻病 碱性磷酸酶 骨化二醇 

分 类 号：R153.2[医药卫生—营养与食品卫生学]