血清25-羟维生素D在诊断婴儿佝偻病的临床意义  

The value of serum 25-hydroxyvitamin D level in the diagnosis of rickets in infants

作　　者：金春华[1] 张丽丽[1] 王晓燕[1] 张悦[1] 高海涛[1] 王建红[1] 李娜[1] 王贺茹[1] 宋文红[1] 刘卓[1] 吴光驰[1] 

机构地区：[1]首都儿科研究所附属儿童医院保健科,北京100020

出　　处：《北京医学》2013年第10期824-827,共4页Beijing Medical Journal

摘　　要：目的探讨血清25-羟维生素D[25（OH）D]对评估婴儿维生素D缺乏及诊断佝偻病的临床意义。方法选择2009年12至2010年2月各项产前检查均正常的孕妇,在胎盘娩出后取脐带血清2 ml,随访新生儿至4个月,取婴儿空腹静脉血2 ml,与脐带血清同时检测25（OH）D。结果 73例新生儿脐带血血清的25（OH）D浓度中位数为20.8 nmol/L（12.5~42.4）nmol/L。4月龄婴儿血清25（OH）D中位数上升至117.6 nmol/L,﹤50 nmol/L者10例（13.7%）,9例为纯母乳喂养。4个月时存在疑似佝偻病症状和体征者63例,有4项及4项以上可疑佝偻病临床表现者血清25（OH）D为（71.6±56.7）nmol/L,明显低于具备4项以下可疑佝偻病临床表现者[（109.9±41.4）nmol/L;t=2.209,P=0.031]。前者维生素D摄入量也低于后者,但差异无统计学意义[（213.4±186.8）IU vs.（360.8±206.7）IU,P﹥0.05]。有2项及2项以上表现并接受左腕骨正位X线片者9例,2例有影像学改变者,其血清25（OH）D均正常,但近期均有服用鱼肝油史;7例无影像学改变的患儿中,25（OH）D﹤50 nmol/L者3例。结论血清25（OH）D可作为近期维生素D营养状态的指标,对诊断婴儿维生素D缺乏性佝偻病可能存在局限性。Objective To identify the clinical value of serum 25-hydroxyvitamin D [25（OH）D] level for the evaluation of vitamin D deficiency and the diagnosis of rickets in infants.Methods The 25（OH）D concentrations were determined in blood samples of neonates（cord blood） and infants（venous blood） and the infants were followed up for 4 months.Results The median 25（OH）D concentrations was 20.8 nmol/L in 73 neonates.After vitamin D3 supplemention,the 25（OH）D level of infants increased from 20.8 nmol/L to 117.6 nmol/L.Serum 25（OH）D levels 50 nmol/L was present in 10 cases（13.7%,10/73）,9 of them were receiving breast feeding.Sixty-three cases of the follow-up infants had suspected rickets signs and symptoms,including shallow sleep,sweating,easy to panic,night cry,pillow bald and skull softening.Serum 25（OH）D were（71.6±56.7）nmol/L and（109.9±41.4）nmol/L（t = 2.209,P = 0.031） in infants who had ≥4 or4 of above signs and symptoms.Vitamin D intake was lower in infants who had ≥4 above signs and symptoms.Nine of the infants with≥2 above symptoms took the left carpal anteroposterior X-rays image,2 of whom were highly suspected as rickets while their serum 25（OH）D level were 50.1 nmol/L and 88.3 nmol/L.The mean daily vitamin D intake was 218 IU and 260 IU in infants who were highly suspected as rickets.Conclusion The serum 25（OH）D level is a nutritional surrogate marker for the assessment of vitamin D status.The role of serum 25（OH）D in diagnosing vitamin D deficiency rickets has some limitations.

关 键 词：维生素D缺乏 25-羟维生素D 佝偻病 婴儿 

分 类 号：R723[医药卫生—儿科]