Abstract: Objective To investigate the correlation of serum 25-hydroxyvitamin D [25-(OH)D] level with calf skeletal muscle development and gross motor function measure (GMFM) score in children with cerebral palsy(CP), in order to further provide reliable medical evidence to confirm the importance of adequate vitamin D level on the normal development of skeletal muscle system in CP children. Methods From December 2019 to January 2022, a total of 48 CP children with hemiplegia (n=24) and diplegia (n=24) who received rehabilitation treatment in Qinhuangdao Maternal and Child Health Hospital were enrolled in this study, and 24 typically developed children with the same age were selected as the control group. Calf muscle structure was measured by ultrasound at rest. GMFM scores were used to assess the standing and walking ability of children with CP. Serum 25-(OH)D level was determined by enzyme-linked immunosorbent assay. Results Serum 25-(OH)D level in hemiplegia group [(21.62±5.89)ng/ml] and diplegia group [(20.85±4.73)ng/ml] was significantly lower than that in control group [(27.93±5.20)ng/ml, P＜0.05]. For children with CP, the lateral gastrocnemius muscle fascicle length (FL) and soleus muscle thickness (MT) were correlated with GMFM score(r=0.414, 0.402, P＜0.05). Serum 25-(OH)D level of CP children was positively correlated with MT of tibialis anterior muscle (r=0.511, P＜0.001), MT of medial gastrocnemius muscle (r=0.394, P=0.006), MT of lateral gastrocnemius muscle (r=0.483, P=0.001), MT of soleus muscle (r=0.287, P=0.048) and GMFM (r=0.436, P=0.002). Further multivariate linear regression analysis showed that serum 25-(OH)D level was positively correlated with MT of tibialis anterior muscle (β=0.556, 95%CI:0.610 - 2.641, P=0.002), MT of lateral gastrocnemius muscle (β=0.492,95%CI:0.007 - 2.795,P=0.049) and GMFM (β=0.056, 95%CI:0.000 - 0.112, P=0.049). Conclusions The decrease of serum 25-(OH)D level in CP children is related to the dysplasia of calf muscle structure and the impairment of standing/walking ability. Therefore, vitamin D should be supplemented appropriately for CP children and targeted activities should be carried out in the early stage to optimize the adaptive changes of muscle structure and function.

Key words: cerebral palsy children, 25-(OH)D, calf skeletal muscle development, gross motor function

摘要： 目的 探讨脑瘫(CP)患儿血清25-羟维生素D[25-(OH)D]水平与小腿骨骼肌发育及粗大运动功能量表(GMFM)评分的关系,为进一步证实充足的维生素D水平对CP患儿骨骼肌系统正常发育的重要性提供可靠的医学证据。方法 选择2019年12月—2022年1月在秦皇岛市妇幼保健院接受康复治疗的偏瘫和双瘫CP儿童各24例以及24例典型发育期同龄儿童作为正常组。在静息状态下用超声波测量小腿肌肉结构。利用GMFM评分评估站立和行走能力。采用酶联免疫吸附法检测血清25-(OH)D水平。结果 偏瘫组[(21.62±5.89)ng/ml]和双瘫组[(20.85±4.73)ng/ml]患儿血清25(OH)D水平均显著低于正常组[(27.93±5.20)ng/ml],(P＜0.05)。外侧腓肠肌肌束长度(FL)和比目鱼肌肌肉厚度(MT)与GMFM评分相关(r=0.414、0.402,P<0.05),而且CP患儿血清25-(OH)D水平与胫前肌MT(r=0.511,P＜0.001)、内侧腓肠肌MT(r=0.394,P=0.006)、外侧腓肠肌MT(r=0.483,P=0.001)、比目鱼肌MT(r=0.287,P=0.048)、GMFM(r=0.436,P=0.002)呈正相关。进一步经多元线性回归分析,血清25-(OH)D水平与胫前肌MT(β=0.556,95%CI:0.610~2.641,P=0.002)、外侧腓肠肌MT(β=0.492,95%CI:0.007~2.795,P=0.049)、GMFM(β=0.056,95%CI:0.000~0.112,P=0.049)仍呈正相关。结论 CP患儿血清25-(OH)D水平降低与小腿肌肉结构发育不良和站立/行走能力受损有关,应适当补充维生素D,并进行早期有针对性的活动以优化肌肉结构和功能的适应性变化。

关键词: 脑瘫患儿, 25-羟维生素D, 小腿骨骼肌发育, 粗大运动能力