早产儿维生素D补充效果及骨代谢指标的随访研究  

Follow-up of the Effect of Vitamin D Supplementation and Bone Metabolism Indexes of Preterm Infants

作　　者：刘颖[1] 翟岩[1] 郭金和[1] 贺万香[1] 

机构地区：[1]北京大学深圳医院,广东省深圳市518036

出　　处：《中国全科医学》2016年第7期790-793,共4页Chinese General Practice

摘　　要：目的探讨目前早产儿补充维生素D(VD)方案的有效性,并对骨代谢评价指标进行随访。方法选取2014年6—12月在北京大学深圳医院新生儿重症监护室(NICU)住院的早产儿60例,记录性别、胎龄(GA)、出生体质量(BM)、头围、身长,检测血清骨钙素(OC)、25-羟维生素D3〔25(OH)D3〕、钙、磷水平。于生后能耐受经口喂养时〔平均(6.4±2.3)d〕添加VD 800 U/d,于28 d随访复测以上指标,并与出生时进行比较。结果 60例早产儿出生时血清25(OH)D3水平为(17.0±7.0)μg/L,血清OC水平为(81.6±31.6)μg/L;VD缺乏(VDD)43例(71.7%),母孕期补VD不足是早产儿VDD的危险因素〔OR=6.83,95%CI(1.66,27.99)〕。37例早产儿经过规律添加VD,生后28 d与刚出生时体质量、身长、头围及血清钙水平比较,差异均有统计学意义(P<0.05);而血清磷、25(OH)D3、OC水平比较,差异无统计学意义(P>0.05)。37例早产儿生后28 d,VDD 28例(75.7%),低磷血症(血清磷<1.8 mmol/L)是VDD的危险因素〔OR=7.33,95%CI(1.40,38.34)〕。结论通过800 U/d补充VD方案不能及时改善早产儿骨代谢状况,VD仍处于缺乏状态。监测血清25(OH)D3、OC和磷水平可很好地反映早产儿骨代谢状态。Objective To explore the effectiveness of vitamin D（ VD） supplement and to evaluate the bone metabolism indexes of preterm infants by follow- up. Methods A total of 60 preterm infants who were hospitalized in the neonatal intensive care unit（ NICU） of Peking University Shenzhen Hospital from June to December in 2014 were enrolled. We recorded their gender,gestational age,birth weight,head circumference and height,and detected the levels of serum osteocalcin（ OC）,25（ OH） D3,calcium and phosphorus. When the infants could be orally fed 〔averagely（6. 4 ± 2. 3） days after birth〕,VD supplement was given by 800 U / d. After 28- day follow- up,the indexes mentioned above were detected again and compared with those at birth. Results The serum 25（ OH） D3 level of these 60 preterm infants at birth was（17. 0 ± 7. 0） μg / L,and the serum OC level was（ 81. 6 ± 31. 6） μg / L. VD deficiency（ VDD） occurred in 43（ 71. 7%） infants, and the lack of VD supplement during their mothers＇ pregnancy was a risk factor for VDD in these infants 〔OR = 6. 83,95% CI（ 1. 66,27. 99） 〕. After regular addition of VD supplement,37 preterm infants were significantly higher in weight,height,head circumference and serum calcium level on the 28 th day after birth than those at birth（ P〈0. 05）,but they saw no significant changes in serum phosphate,25（ OH） D3 and OC levels（ P〉0. 05）. On 28 th day after birth,28 infants still had VDD among the 37 infants,and hypophosphatemia（ serum phosphate 1. 8 mmol / L） was found to be a risk factor for VDD 〔OR = 7. 33,95% CI（1. 40,38. 34） 〕. Conclusion The VD supplement by 800 U / d can not effectively improve the bone metabolism of infants and reverse VD deficiency. The monitor of the levels of 25（ OH） D3,OC and phosphorus can reflect the status of bone metabolism of preterm infants.

关 键 词：婴儿 早产 维生素D 骨化二醇 维生素D缺乏 骨钙素 血清钙 血清磷 

分 类 号：R723.244[医药卫生—儿科]