动态监测极早产儿血25(OH)D水平及其对肺部疾病的影响  

Dynamic monitoring of blood 25(OH)D level and its effect on pulmonary disease in very premature infants

作　　者：锡洪敏[1] 杨丽娟[2] 尹向云[1] 杨萍[1] 马丽丽[1] 李向红[1] Xi Hongmin;Yang Lijuan;Yin Xiangyun;Yang Ping;Ma Lili;Li Xianghong(Department of Neonatology,The Affiliated Hospital of QingDao University,Qingdao 26600,China;Department of Neonatology,BinZhou Medical University Hospital,Binzhou 256600,China)

机构地区：[1]青岛大学附属医院新生儿科,山东青岛266000 [2]滨州医学院附属医院新生儿与新生儿重症科,山东滨州256600

出　　处：《临床荟萃》2022年第8期717-722,共6页Clinical Focus

摘　　要：目的动态监测极早产儿维生素D水平并探讨其对极早产儿肺部疾病的影响。方法选取2019年6月-2020年12月期间于青岛大学附属医院新生儿重症监护室(neonatal intensive care unite,NICU)住院、并经得家长知情同意的胎龄<32周的极早产儿共126例,于生后24 h、1月、2月(或出院时)检测血清25-(OH)D水平。根据生后血清25-(OH)D水平,将极早产儿分为3组,维生素D缺乏组(n=71),25(OH)D<12 ng/ml;维生素D不足组(n=46),25(OH)D 12~<20 ng/ml;维生素D充足组(n=9),25(OH)D>20~≤100 ng/ml。所有早产儿在喂养耐受后给予维生素AD(其中维生素D 500 IU,维生素A 1500 IU)每日1粒,及维生素D3400 IU;收集早产儿一般临床资料,比较各组间呼吸窘迫综合征(respiratory distress syndrome,RDS)、呼吸机使用时间、住院时间、早期肺高压、动脉导管未闭(patent ductus arteriosus,PDA)、支气管肺发育不良(bronchopulmonary dysplasia,BPD)发生情况。结果(1)共纳入极早产儿126例,胎龄为26~31^(+6)周,平均胎龄(29.75±1.52)周,其中男65例(51.59%),女61例(48.41%)。出生时维生素D缺乏组、不足组、充足组3组间的胎龄、出生体重、头围、身长等一般资料比较,差异均无统计学意义(P>0.05)。(2)出生时维生素D平均水平为(10.57±4.79)ng/ml,维生素D缺乏率达92.86%。每日口服维生素D900 IU,1月龄时(18.14±2.88)ng/ml,维生素缺乏率为72.3%,2月龄时(21.13±7.48)ng/ml,维生素D缺乏率为53.17%,无维生素D过量。(3)出生时维生素D缺乏组的RDS、BPD发生率明显升高,差异有统计学意义(P<0.05)。但出生时维生素D水平与BPD的严重程度无明显相关性(P=0.984)。不同维生素D水平组间Apgar评分、咖啡因使用时间、机械通气比率、无创通气时间、总用氧时间、PDA、住院时间及早期肺高压差异无统计学意义(P>0.05)。结论(1)极早产儿普遍存在维生素D缺乏,补充维生素D 900 IU后,2月龄维生素D缺乏率仍然占53.17%,建议对早产儿进行Objective To monitor the vitamin D level dynamically and to explore its effect on lung diseases of very preterm infants.Methods A total of 126 very premature infants<32 weeks were enrolled,who were admitted to the NICU of Affiliated Hospital of Qingdao University from June 2019 to December 2020 with informed consent of their parents.Serum 25-(OH)D levels were measured at postnatal 24h and postnatal month 1 and 2.All preterm infants were given vitamin AD(vitamin D 500 IU,vitamin A 1500 IU)daily and vitamin D3400 IU after feeding tolerance.General clinical data were collected from the three groups which comprised Vitamin D deficiency group(n=71,25-[OH]D<12 ng/ml),insufficient group(n=46,25-[OH]D≥12~<20 ng/ml),and sufficient group(n=9,25-[OH]D≥20~≤100 ng/ml).The incidence of respiratory distress syndrome(RDS),duration of mechanical ventilation,hospital stay,early pulmonary hypertension(PH),patent ductus arteriosus(PDA),and bronchopulmonary dysplasia(BPD)were included as comparator,and statistical analysis was conducted.Results A total of 126 premature infants were included,ranging from 26 to 31+6 weeks with an average gestational age of(29.75±1.52)weeks,including 65 males(51.59%)and 61 females(48.41%).There were no significant differences in gestational age,birth weight,head circumference and body length among the three groups(P>0.05).The average level of vitamin D at birth was(10.57±4.79)ng/ml,and the rate of vitamin D deficiency reached 92.86%.Vitamin D900IU was taken orally daily.The mean level of vitamin D was(18.14±2.88)ng/ml and(21.13±7.48)ng/ml at month 1 and month 2 with deficiency rate 73.8%and 53.17%,no vitamin D overdose.The incidence of RDS or BPD was significantly higher in the vitamin D deficiency group at birth(P<0.05).However,there was no significant correlation between different vitamin D levels and the severity of BPD(P=0.984).There was no significant differences in postnatal Apgar score,duration of caffeine use,rate of mechanical ventilation,duration of non-invasive ventilation,duration

关 键 词：婴儿 早产 维生素D 肺部疾病 

分 类 号：R722[医药卫生—儿科]