目的 分析出生28~42 d出现佝偻病临床表现的纯母乳喂养儿的血清维生素D水平及与其母亲血维生素D水平的相关性,为预防婴儿早期营养性佝偻病的发生提供理论依据。方法 对2016年4月-2017年10月来西北妇女儿童医院儿童保健科正常体检的年龄为28~42 d、并且表现有佝偻病早期症状和(或)体征的119例纯母乳喂养儿及其母亲静脉血25-羟维生素D[25-(OH)D]进行相关性分析。结果 119例母亲血25-(OH)D＞30 ng/ml者15例(12.61%),≤30 ng/ml者104例(87.39%);孕期平均每日补充维生素D≥400 U的母亲19例,血25-(OH)D中位数为28.8 ng/ml,每日补充维生素D＜400 U母亲100例,血25-(OH)D中位数为16.1 ng/ml,两组血25-(OH)D差异有统计学意义(P<0.05);在119例婴儿中补充和未补充维生素D组的婴儿血25-(OH)D中位数分别为20.0 ng/ml和9.5 ng/ml,两者差异有统计学意义(P<0.05);婴儿血25-(OH)D与其母亲血清25-(OH)D水平呈正相关(r=0.349,P<0.01)。婴儿血25-(OH)D水平(＞20 ng/ml和≤20 ng/ml)与其出现佝偻病的症状、体征之间无统计学意义。结论 婴儿及其母亲维生素D整体处于不足水平,两者之间维生素D水平存在相关性。婴儿血25-(OH)D＞20 ng/ml并没有降低其发生营养性佝偻病的风险。建议母亲孕期应积极补充维生素D,同时提倡从新生儿一出生即开始补充维生素D,预防婴儿早期营养性佝偻病的发生。

Objective Toanalyze the correlation of serum vitamin D level between exclusively breast-fed infants aged 28~42 days with clinical manifestation of rickets and their mothers,in order to provide theoretical foundation for prevention of infant nutritional rickets. Methods A total of 119 exclusively breast-fed infants in Northwest Women and Children Hospital,diagnosed with nutritional rickets at age of 28~42 days,were enrolled in this study from April 2016 to October 2017. Serum 25-hydroxylvitamin D [25-(OH)D] level of both infants and their mothers were tested and the correlation was analyzed. Results Among the 119 mothers,15(12.61%) mothers had serum 25-(OH)D level higher than 30 ng/ml,104(87.39%) mothers were no more than 30 ng/ml. Totally 19 mothers took vitamin D supplementation ≥400 U per day during pregnancy,and the median serum level of 25-(OH)D was 28.8 ng/ml. And 100 mothers took vitamin D supplementation less than 400 U per day during pregnancy,and the median serum level of 25-(OH)D was 16.1 ng/ml. The difference on the median serum level of 25-(OH)D between the two groups was significant(P＜0.05). Also,there was significant difference on the median serum level of 25-(OH)D between infants with and without vitamin D supplementation(20.0 ng/ml vs.9.5 ng/ml,P＜0.05). The serum 25-(OH)D level of infants was positively correlated with theirs mothers' level. No correlation was found between serum 25-(OH)D level(20ng/ml as cutting edge) and the possibility of rickets symptoms and signs. Conclusions The overall vitamin D level of both infants and their mothers is insufficient,and the serum 25-(OH)D level between the infants and their mothers are significantly related. It is suggested to take vitamin D supplementation during pregnancy and to give infants vitamin D supplementation immediately after birth,so as to prevent nutritional rickets in infants.