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目的探讨定量超声(QUS)技术评价早产儿骨发育的作用及早产儿骨发育的影响因素。方法选取2009年2～7月本院NICU住院的早产儿为观察组,按2∶1比例随机选择同期出生的足月儿为对照组,用定量超声仪测量生后2d之内胫骨声波速度(SOS),同时检测出生24h内血钙、镁、磷和碱性磷酸酶,分析不同胎龄、体重、性别、母妊娠期高血压疾病及生化指标等因素对SOS值的影响,对有意义的因素进行多元回归分析。结果(1)胫骨SOS值早产儿低于足月儿;胎龄≤30周早产儿低于胎龄34～36周早产儿和足月儿,胎龄31～33周早产儿低于胎龄34～36周早产儿和足月儿;出生体重<1500g新生儿低于1500～2500g和>2500g的新生儿,P均<0.05;不同性别之间SOS值差异无统计学意义(P>0.05);早产适于胎龄儿低于早产小于胎龄儿,P<0.001;母妊娠期高血压疾病组早产儿高于非妊娠期高血压疾病组,P<0.05。(2)SOS值与胎龄(r=0.347,P<0.001)、母妊娠期高血压疾病(r=0.215,P=0.016)、宫内发育迟缓(r=0.367,P<0.001)、血钙(r=0.259,P=0.004)和血镁(r=0.234,P=0.008)正相关,与血磷(r=-0.201,P=0.025)负相关;多元回归分析发现胎龄、宫内发育迟缓和镁是影响SOS的重要因素(P<0.001)。结论QUS可以准确的评价胎儿骨营养状态,胎龄、宫内生长迟缓和镁是胎儿骨发育的重要影响因素。
Objective To investigate the role of quantitative ultrasound (QUS) in the evaluation of bone development in preterm infants and the influencing factors of bone development in premature infants. Methods The preterm neonates hospitalized for NICU in our hospital from February to July in 2009 were selected as the observation group. Full-term infants born at the same period were selected as the control group according to the ratio of 2: 1, and the sonic velocity of the tibia within 2 days after birth SOS) were detected at the same time. The levels of serum calcium, magnesium, phosphorus and alkaline phosphatase within 24 hours after birth were measured. The effects of different gestational age, body weight, gender, gestational hypertension and biochemical parameters on SOS were analyzed. Factors of multiple regression analysis. Results (1) The tibial SOS was lower in preterm infants than that in term infants. The gestational age ≤30 weeks in preterm infants was lower than gestational age in 34-36 weeks of preterm infants and term infants, gestational age 31-33 weeks of preterm infants was lower than gestational age 34 ~ 36 weeks of preterm and term infants; birth weight <1500g newborns less than 1500 ~ 2500g and> 2500g newborns, P <0.05; SOS between different genders was no significant difference (P> 0.05); P <0.001 for gestational age preterm birth and less than gestational age for preterm labor, P <0.05 for preterm infants with hypertensive disorder of pregnancy and gestational hypertension. (2) There were significant differences between SOS and gestational age (r = 0.347, P <0.001), maternal hypertensive disorders (r = 0.215, P = 0.016), intrauterine growth retardation (r = 0.259, P = 0.004) and serum magnesium (r = 0.234, P = 0.008), but negatively correlated with serum phosphorus (r = -0.201, P = 0.025) .Multivariate regression analysis showed that gestational age and intrauterine development Delayed and magnesium are important factors affecting SOS (P <0.001). Conclusion QUS can accurately evaluate the nutritional status of fetal bone, gestational age, intrauterine growth retardation and magnesium are important factors affecting fetal bone development.