Abstract: Objective To investigate the correlation of serum 25-hydroxyvitamin D₃ [25-(OH)D₃], albumin (ALB) and ferritin (SF) withScreening Tool for the Assessment of Malnutrition in Pediatrics (STAMP) score in preschool children with malnutrition, and to analyze the predictive value of these factors on clinical outcomes, so as to provide reference for improving clinical outcomes. Methods Totally 90 preschoolers with malnutrition in Fuzhou Children's Hospital from August 2021 to August 2022 were selected as the observation group, and 60 healthy preschool children during the same period were selected as the control group. Nutritional guidance was provided to the preschoolers for a consecutive 3-month period, followed by monitoring and recording the incidence of malnutrition and iron deficiency anemia within 3 months after treatment. Results The levels of serum 25-(OH)D₃, ALB and SF were lower in the observation group compared to the control group, while the STAMP score was higher in the observation group (t=9.700, 6.047, 4.771, 26.976, P<0.05). The levels of serum 25-(OH)D₃, ALB and SF in preschool children with malnutrition showed a negative correlation with the STAMP score (r=-0.813, -0.792, -0.829, P < 0.05). After 3 months of treatment, the levels of serum 25-(OH)D₃, ALB and SF, as well as the difference between pre- and post-treatment levels, were lower in children with adverse clinical outcomes compared to those with good clinical outcomes (t=3.622, 2.189, 2.163, 8.704, 4.354, 5.296, P< 0.05). When the difference in serum 25-(OH)D₃, ALB and SF before and after treatment was small, preschool children with malnutrition had a higher risk of adverse clinical outcomes [25-(OH)D₃ : OR=7.250, 95%CI: 3.008 - 17.476; ALB: OR=9.167, 95%CI: 2.954 - 28.444; SF: OR=5.730,95%CI: 2.364 - 13.890]. The combined predictive value of serum 25-(OH)D₃, ALB and SF before and after treatment had an AUC value of 0.927, higher than that of any single index. The decision curve analysis (DCA) showed that the combined prediction scheme of these factors had a clinical net benefit in predicting the clinical outcome of preschool children with malnutrition. Conclusions Low serum levels of 25-(OH)D₃, ALB and SF are indicative of a higher risk of adverse clinical outcomes. Utilizing the combined prediction of these factors before and after treatment shows high accuracy in predicting clinical outcomes.

Key words: malnutrition, ferritin, 25-(OH)D₃, albumin, Screening Tool for the Assessment of Malnutrition in Pediatrics, preschoolers

摘要： 目的 探讨学龄前营养不良儿童血清25-(OH)D₃、白蛋白(ALB)、铁蛋白(SF)与儿科营养不良评估筛查工具(STAMP)评分的相关性,并分析对临床结局的预测价值,为改善营养不良的预后提供参考。方法 选取2021年8月—2022年8月福州儿童医院90例学龄前营养不良患儿作为观察组,另选取同期学龄前健康体检儿童60例作为对照组。学龄前儿童予以营养指导,连续3个月,随访统计治疗后3个月内营养不良及缺铁性贫血发生情况。使用STAMP对所有研究对象进行评估,分析血清25-(OH)D₃,ALB、SF与学龄前营养不良患儿STAMP评分的关联性,并评价三者联合检测对营养不良临床结局的预测价值。结果 观察组血清25-(OH)D₃、ALB、SF水平均低于对照组,STAMP评分高于对照组(t=9.700、6.047、4.771、26.976,P＜0.05);学龄前营养不良患儿血清25-(OH)D₃、ALB、SF水平与STAMP评分均呈负相关(r=-0.813、-0.792、-0.829,P＜0.05);治疗3个月后,临床结局不良患儿血清25-(OH)D₃、ALB、SF及其治疗前后差值均低于临床结局良好患儿(t=3.622、2.189、2.163、8.704、4.354、5.296,P＜0.05);学龄前营养不良患儿血清25-(OH)D₃、ALB、SF治疗前后差值处于低水平时,其临床结局不良风险分别是高水平的7.250倍(95%CI:3.008～17.476)、9.167倍(95%CI:2.954～28.444)、5.730倍(95%CI:2.364～13.890);血清25-(OH)D₃、ALB、SF治疗前后差值联合预测的AUC值高于单一指标,为0.927;DCA曲线结果显示血清25-(OH)D₃、ALB、SF治疗前后差值联合预测方案预测学龄前营养不良患儿临床结局具有临床净获益。结论 低水平血清25-(OH)D₃、ALB、SF可增加学龄前营养不良患儿临床结局不良风险,联合检测对临床结局具有较高预测价值。

关键词: 营养不良, 铁蛋白, 25-(OH)D₃, 白蛋白, 儿科营养不良评估筛查工具, 学龄前儿童