目的 探讨血25-(OH)D₃、骨碱性磷酸酶等临床常用的实验室检查对维生素D缺乏性佝偻病的诊断价值。 方法 对1 190名0~4岁儿童进行临床体检,随机选取部分儿童抽取静脉血测定骨碱性磷酸酶、血25-(OH)D₃、钙、磷、碱性磷酸酶及骨密度、左手腕骨X片。比较其检测佝偻病的灵敏度、特异度。通过ROC曲线对25-(OH)D₃、骨密度诊断价值进行评价。结果 佝偻病患儿血25-(OH)D₃明显低于对照组,25-(OH)D₃的ROC线下面积为0.633(95%CI:0.581~0.684),具有中度诊断性。针对西昌人群,维生素D不足诊断浓度最合适诊断点为72.86 nmol/L。利用该界值点诊断佝偻病的灵敏度为65.35% ,特异度56.02%。骨密度、钙、磷、碱性磷酸酶、骨碱性磷酸酶多种检查指标可做为佝偻病的辅助检查手段,诊断性稍差,联合25-(OH)D₃和骨碱性磷酸酶诊断早期、活动期佝偻病灵敏度提高至76.67%,特异度90.91%。 结论血25-(OH)D₃浓度为诊断佝偻病的良好指标。骨碱性磷酸酶灵敏度、特异度相比优于其他指标,可用于人群筛查。骨碱性磷酸酶和25-(OH)D₃项目的条件下联合辅助诊断,提高对维生素D缺乏性佝偻病的识别性。

Objective To investigate the diagnostic values of vitamin D deficiency rickets,including serum 25-(OH)D₃,bone alkalinity phosphatase(BALP),total calcium and so on. Methods A total of 1 190 children were tested and investigated aged 0~4 years old.Part of them were randomly selected to check BALP,25-(OH)D₃,total calcium,phosphorus,alkalinity phosphatase,bone mineral density(BMD) and taken X-ray. Results Serum 25-(OH)D₃ in rickets was significantly lower than the control group,the area of 25-(OH)D₃'s ROC curve is 0.633 (95%CI:0.581~0.684) which was moderate diagnostic.For Xichang crowd,the most appropriate concentration for cutoff point of diagnosing Vitamin D Deficiency is 72.86 nmol/L.Using this cutoff point to diagnose rickets,the sensitivity is 65.35%,and the specificity is 56.02%.Bone density,calcium,phosphorus,alkaline phosphatase,bone alkaline phosphatase can be used as indicators of a variety of inspection rickets secondary screening tool,as their diagnostic are weak.Combine 25-(OH) D₃ and bone alkaline phosphatase to diagnosis early and active phase rickets,the sensitivity increased to 76.67%,and specificity increased to 90.91%.Conclusion Serum 25-(OH)D₃ concentration is a good index for Rickets diagnosis.BALP is more sensitive and specific,which can be used for Vitamin D Deficiency Rickets screen.It clearly indicates we can diagnose better when we combined BALP and 25-(OH)D₃`s results,especially recognizing more patients in their early period or active period.