早产儿骨代谢指标的影响因素分析

doi:10.11852/zgetbjzz2024-0410

摘要/Abstract

摘要： 目的分析早产儿骨代谢指标相关影响因素,为新生儿骨代谢异常的早发现和早预防提供临床依据。方法收集2022年1月1日—12月1日西北妇女儿童医院符合入选标准的早产儿189例,进行回顾性分析。分别对胎龄、出生体重与出生时骨代谢指标[血清钙、磷、25(OH)D、碱性磷酸酶(ALP)]进行相关性分析。针对早产儿代谢性骨病(MBDP)高危人群(胎龄＜32周),分析其围生期不同影响因素对出生时血清钙、磷、25(OH)D以及ALP水平的影响。结果早产儿骨代谢指标中血清钙与胎龄、出生体重呈正相关(r=0.364、0.311,P＜0.05),血清ALP与胎龄、出生体重均呈负相关(r=-0.294、-0.261,P＜0.05),血清磷与出生体重呈正相关(r=0.186,P＜0.05)。在MBDP高危人群(胎龄＜32周)中,剖宫产组、胎儿宫内发育迟缓(IUGR)组、窒息/低Apgar评分组、妊娠期高血压疾病组血清磷分别低于顺产组、非IUGR组、非窒息/低Apgar评分组及非妊娠期高血压组(t=2.128、4.718、2.543、4.134,P＜0.05);IUGR组、妊娠期高血压疾病组ALP分别低于非IUGR组及非妊娠期高血压疾病组(Z=-1.846、-2.844,P＜0.05);妊娠期糖尿病组血清25(OH)D水平高于非妊娠期糖尿病组(Z=-2.410,P＜0.05)。多重线性回归分析提示IUGR与高危儿血清磷水平具有相关性(β=-0.231,P＜0.05),妊娠期高血压与ALP水平具有相关性(β=-60.360,P＜0.05)。结论早产儿骨代谢指标与其胎龄、出生体重存在明显相关性;针对MBDP高危人群(胎龄＜32周),IUGR是血清磷异常的危险因素,妊娠期高血压是ALP降低的影响因素,建议结合妊娠女性实际情况予以针对性干预,降低MBDP发生率。

关键词: 出生体重, 出生胎龄, 早产儿代谢性骨病

Abstract: Objective To analyze factors related to bone metabolism indicators in premature infants, so as to provide clinical evidence for early detection and prevention of neonatal metabolic bone disorders. Methods A total of 189 preterm infants who met the inclusion criteria from January 1st to December 1st, 2022, at the Northwest Women's and Children's Hospital were collected for retrospective analysis. The correlations of gestational age, birth weight with bone metabolism indicators at birth was analyzed, including serum calcium, phosphorus, 25(OH)D, alkaline phosphatase (ALP). For high-risk groups of metabolic bone disease of preterm (MBDP) infants (gestational age <32 weeks), the impact of different perinatal factors on the levels of serum calcium, phosphorus, 25(OH)D, and ALP at birth was analyzed. Results Serum calcium in preterm infants was positively correlated with gestational age and birth weight (r=0.364, 0.311, P<0.05), while serum ALP was negatively correlated with gestational age and birth weight (r=-0.294,-0.261, P<0.05), and serum phosphorus was positively correlated with birth weight (r=0.186, P<0.05). In the study of high-risk MBDP groups (gestational age <32 weeks), the serum phosphorus levels in the cesarean section group, IUGR group, asphyxia/low Apgar score group, and pregnancy-induced hypertension group were lower than those in the natural labor group, non-IUGR group, non-asphyxia/low Apgar score group, and non-pregnancy-induced hypertension group (t=2.128, 4.718, 2.543, 4.134, P<0.05). ALP in the IUGR group and pregnancy-induced hypertension group was lower than that in the non-IUGR group and non-pregnancy-induced hypertension group (Z=-1.846,-2.844, P<0.05); serum 25(OH)D level in the gestational diabetes group was higher than that in the non-gestational diabetes group (Z=-2.410, P<0.05). Multiple linear regression analysis suggested that IUGR wassignificantly associated with serum phosphorus level in high-risk infants (β=-0.231, P<0.05), and pregnancy-induced hypertension wassignificantly associated with ALP level(β=-60.360, P<0.05). Conclusions Bone metabolism markers in preterm infants are significantly correlated with gestational age and birth weight. For high-risk MBDP infants (gestational age < 32 weeks), IUGR is an risk factor for abnormal serum phosphorus levels, and hypertensive disorders of pregnancy are influencing factors for reduced ALP levels. Targeted interventions based on maternal conditions are recommended to reduce the incidence of MBDP.

Key words: birth weight, gestational age at birth, metabolic bone disease of prematurity

中图分类号:

R722.6

杨冬, 白瑞苗, 杨云帆. 早产儿骨代谢指标的影响因素分析[J]. 中国儿童保健杂志, 2025, 33(3): 335-339.

YANG Dong, BAI Ruimiao, YANG Yunfan. Influencing factors of bone metabolism indicators in premature infants[J]. Chinese Journal of Child Health Care, 2025, 33(3): 335-339.

参考文献

[1] 徐佳鑫, 李向红, 王小虎, 等. 早产儿代谢性骨病的临床高危因素分析[J]. 中华临床营养杂志, 2019, 27(6): 374-380.
Xu JX, Li XH, Wang XH, et al. Clinical high-risk factors of metabolic bone disease in very low birth weight infants[J]. Chin J Clin Nutr, 2019, 27(6): 374-380. (in Chinese)
[2] Yasmeen A, Jackson A. Bone health of extremely preterm infants: Screening, monitoring and management of metabolic bone disease of prematurity[J]. Infant, 2020, 16(5): 204-207.
[3] 贺晓日, 梁灿, 俞元强, 等. 极低/超低出生体重早产儿代谢性骨病危险因素的全国多中心调查[J]. 中国当代儿科杂志, 2021, 23(6): 555-562.
He XR, Liang C, Yu YQ, et al. Risk factors for metabolic bone disease of prematurity in very/extremely low birth weight infants: A multicenter investigation in China[J]. CJCP, 2021, 23(6): 555-562. (in Chinese)
[4] 郭佳林, 刘江勤, 花静. 早产儿代谢性骨病高危因素及诊断的研究进展[J]. 中国妇幼健康研究, 2022, 33(5): 126-130.
Guo JL, Liu JQ, Hua J. Research advances on high-risk factors and diagnosis of metabolic bone disease in preterm infants[J]. Chinese Journal of Woman Child Health Research, 2022, 33(5): 126-130. (in Chinese)
[5] 徐力平. 极低出生体重儿骨代谢指标的动态监测分析[J].宁夏医学杂志, 2018, 40(2): 117-119.
Xu LP. Dynamic study of bone metabolism index in preterm infants with very low birthweight[J]. Ningxia Med J, 2018, 40(2): 117-119. (in Chinese)
[6] Chin LK, Doan J, Teoh YSL, et al. Outcomes ofstandardised approach to metabolic bone disease of prematurity[J]. J Paediatr Child Health, 2018, 54(6): 665-670.
[7] Rayannavar A, Calabria AC. Screening for metabolic bone disease of prematurity[J]. Semin Fetal Neonatal Med, 2020, 25(1): 101086.
[8] Avila-Alvarez A,Urisarri A, Fuentes-Carballal J, et al. Metabolic bone disease of prematurity: Risk factors and associated short-term outcomes[J]. Nutrients, 2020, 12(12): 3786.
[9] 常艳美, 林新祝, 张蓉, 等. 早产儿代谢性骨病临床管理专家共识(2021年)[J]. 中国当代儿科杂志, 2021, 23(8): 761-772.
Chang YM, Lin XZ, Zhang R, et al. Expert consensus on clinical management of metabolic bone disease of prematurity (2021)[J]. CJCP, 2021, 23(8): 761-772. (in Chinese)
[10] Matejek T, Navratilova M, Zaloudkova L, et al. Vitamin D status of very low birth weight infants at birth and the effects of generally recommended supplementation on their vitamin D levels at discharge[J]. J Matern Fetal Neonatal Med, 2020, 33(22): 3784-3790.
[11] Schulz EV, Wagner CL. History, epidemiology and prevalence of neonatal bone mineral metabolicdisorders[J]. Semin Fetal Neonatal Med, 2020, 25(1): 101069.
[12] Mihatsch W, Fewtrell M, Goulet O, et al. ESPGHAN/ESPEN/ESPR/CSPEN guidelines on pediatric parenteral nutrition: Calcium, phosphorus and magnesium[J]. Clin Nutr, 2018, 37(6): 2360-2365.
[13] Wang J, Zhao Q, Chen B, et al. Risk factors for metabolic bone disease of prematurity: A Meta-analysis[J].PLoS One, 2022, 17(6): e0269180.
[14] Hagag AA, El Frargy MS, Abd El-Latif AE. Vitamin D as an adjuvant therapy in neonatal hypoxia: Is it beneficial?[J]. Endocr Metab Immune Disord Drug Targets, 2019, 19(3): 341-348.
[15] Oliver C, Watson C, Crowley E, et al. Vitamin and mineral supplementation practices in preterm infants: A survey of Australian and New Zealand neonatal intensive and special careunits[J]. Nutrients, 2020, 12(1): 51.
[16] Fogacci S, Fogacci F, Banach M, et al. Vitamin D supplementation and incident preeclampsia: A systematic review and meta-analysis of randomized clinical trials[J].Clin Nutr, 2020, 39(6): 1742-1752.
[17] Chinoy A, Mughal MZ, Padidela R. Metabolic bone disease of prematurity: Causes, recognition, prevention, treatment and long-term consequences[J]. Arch Dis Child Fetal Neonatal Ed, 2019, 104(5): F560-F566.