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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 investigate the clinical significance of serum 25-hydroxyvitamin D [25 (OH) D] in assessing infant vitamin D deficiency and diagnosis of rickets. Methods Pregnant women with normal prenatal examinations from December 2009 to February 2010 were selected. Umbilical cord serum (2 ml) was delivered after placenta delivery. Neonates were followed up for 4 months. Infants with fasting venous blood (2 ml) and umbilical cord serum Detection 25 (OH) D. Results The median neonatal umbilical cord blood serum 25 (OH) D concentration of 20.8 nmol / L (12.5 ~ 42.4) nmol / L. The median serum 25 (OH) D of 4-month-old infants increased to 117.6 nmol / L, and 10 (13.7%) were less than 50 nmol / L. Nine of the infants were exclusively breastfed. At 4 months, there were 63 patients with suspected symptoms and signs of rickets, and the serum 25 (OH) D level of 71.6 ± 56.7 nmol / L in 4 or more suspects with clinical manifestations of rickets was significantly lower than those with 4 suspects The clinical manifestations of rickets were [(109.9 ± 41.4) nmol / L; t = 2.209, P = 0.031]. The former vitamin D intake is also lower than the latter, but the difference was not statistically significant [(213.4 ± 186.8) IU vs. (360.8 ± 206.7) IU, P> 0.05]. There were 2 and 2 or more manifestations and received left carpal X-ray film were 9 cases, 2 cases of imaging changes, the serum 25 (OH) D were normal, but recently have taking cod liver oil history; 7 cases without Imaging changes in children, 25 (OH) D <50 nmol / L in 3 cases. Conclusions Serum 25 (OH) D may serve as an indicator of the nutritional status of vitamin D in recent years. It may have limitations in the diagnosis of vitamin D deficiency rickets in infants.