目的 分析新生儿脐血25-羟基维生素D[25-(OH)D]水平与婴儿特应性皮炎(AD)的关系,为婴儿AD的一级预防及早期干预提供依据。方法 2016年12月-2017年12月前瞻性连续选取孕期妇女及其所生婴儿202对,出生时留取脐血,跟踪至婴儿6月龄,采用标准问卷调查获取父母及婴儿资料,酶联免疫吸附试验检测脐血血清25-(OH)D水平。 通过客观的SCORAD评分评估AD患儿病情的严重程度。用巢式病例对照及Logistic回归的方法分析影响婴儿AD发生的危险因素。结果 脐血25-(OH)D水平在AD患儿及健康对照组中的差异无统计学意义,家族过敏史阳性(OR=1.963)、非纯母乳喂养(OR=2.089)、夏季出生(OR=2.265)是影响AD发生的危险因素(P<0.05)。脐血25-(OH)D水平与婴儿AD的严重程度负相关(r =-0.325,P=0.023)。结论 脐血25-(OH)D不是预测婴儿AD发生的危险因素,但与AD发生的严重程度负相关,孕期合理地补充维生素D可能会减轻婴儿AD的严重程度。
Abstract
Objective To analyze the relationship between cord blood 25-hydroxyvitamin D [25-(OH)D] and infant atopic dermatitis(AD),in order to provide reference for the primary prevention and early intervention for AD in infants. Methods Totally 202 mothers and their infants were enrolled in this study from December 2016 to December 2017.Cord blood was collected at birth,and the children were followed up to 6 months old.A standard questionnaire was used to obtain the information of parents and infants,serum level of cord blood 25-(OH)D was detected by enzyme-linked immunosorbent assay.Objective Scoring of Atopic Dermatitis(SCORAD) was used to assess the severity of AD in infants.And the risk factors for AD in infants were analyzed by nested case-control study and Logistic regression analyzed. Results There was no statistically significant difference on cord blood level of 25-(OH)D between AD group and the healthy control group .Positive family history of allergy (OR=1.963),non-exclusive breastfeeding (OR=2.089),and birth in summer (OR=2.265) were risk factors for the occurrence of AD(P＜0.05).Cord blood levels of 25-(OH)D was negatively correlated with the severity of AD in infants (r=-0.325,P=0.023). Conclusions Cord blood 25-(OH)D can not predict the occurrence of AD in infants,but it is negatively correlated with the severity of AD.Reasonable vitamin D supplementation during pregnancy may reduce the severity of AD in infants.
关键词
脐血 /
25-羟基维生素D /
特应性皮炎 /
婴儿
Key words
cord blood /
25-hydroxyvitamin D /
atopic dermatitis /
infant
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
[1] 中华医学会皮肤性病学分会免疫学组、特应性皮炎协作研究中心.中国特应性皮炎诊疗指南(2014版)[J].全科医学临床与教育,2014,12(6):603-606,615.
[2] Weidinger S,Beck LA,Bieber T,et al.Atopic dermatitis[J].Nat Rev Dis Primers,2018,4(1):1.
[3] Rechavi E,Somech R.Maturation of the immune system in the fetus and the implications for congenital CMV[J].Best Pract Res Clin Obstet Gynaecol, 2019,pii:S1521-6934(19)30024-0.
[4] Akhtar E,Mily A,Haq A,et al.Prenatal high-dose vitamin D3 supplementation has balanced effects on cord blood Th1 and Th2 responses.[J].Nutr J,2016,15(1):75.
[5] Akan A,Azkur D,Ginis T,et al. Vitamin D level in children is correlated with severity of atopic dermatitis but only in patients with allergic sensitizations[J].Pediatr Dermatol,2013,30(3):359-363.
[6] Litonjua AA.Vitamin D deficiency as a risk factor for childhood allergic disease and asthma[J].Curr Opin Allergy ClinImmunol,2012,12(2):179-185.
[7] Mutgi K,Koo J.Update on the role of systemic vitamin D in atopic dermatitis[J].Pediatr Dermatol,2013,30(3):303-307.
[8] Robl R,Uber M,Abagge KT,et al. Serum vitamin D levels not associated with atopic dermatitis severity[J].Pediatr Dermatol,2016,33(3):283-288.
[9] Chiu YE,Havens PL,Siegel DH,et al.Serum 25-hydroxyvitamin D concentration does notcorrelate with atopic dermatitis severity[J].J Am Acad Dermatol,2013,69(1):40-46.
[10] Kunz B,Oranje AP,Labrèze L,et al.Clinical validation and guidelines for the SCORAD index:consensus report of the European Task Force on Atopic Dermatitis[J].Dermatology,1997,195(1):10-19.
[11] Hartmann B,Riedel R,Jörss K,et al. Vitamin D receptor activationimproves allergen-triggered eczema in mice [J].J Invest Dermatol,2012,132(2):330-336.
[12] Muehleisen B,Bikle DD,Aguilera C,et al.PTH/PTHrP and vitamin D control antimicrobial peptide expression and susceptibility to bacterial skin infection[J].Sci Transl Med,2012,4(135):135ra66.
[13] Jones AP,Palmer D,Zhang G,et al.Cord blood 25-hydro xyvitamin D3 and allergic disease during infancy[J]. Pediatrics,2012,130(5):e1128-1135.
[14] Baïz N,Dargent-Molina P,Wark JD,et al.EDEN Mother-Child Cohort Study Group.Cord serum 25-hydroxyvitamin D and risk of early childhood transient wheezing and atopic dermatitis[J].J Allergy Clin Immunol,2014,133(1):147-153.
[15] Boyle VT,Thorstensen EB,Thompson JMD,et al.The relationship between maternal 25-hydroxyvitamin D status in pregnancy and childhood adiposity and allergy:an observational study[J].Int J Obes,2017,41(12):1755-1760.
[16] Wills AK,Shaheen SO,Granell R,et al.Maternal 25-hyd roxyvitamin D and its association with childhood atopic outcomes and lung function[J].Clin Exp Allergy,2013,43(10):1180-1188.
[17] Fleischer AB Jr. Atopic dermatitis:the relationship to temperature and seasonality in the United States[J].Int J Dermatol,2019,58(4):465-471.
[18] Weisse K,Winkler S,Hirche F,et al.Maternal and newborn vitamin D status and its impact on food allergy development in the German LINA cohort study[J].Allerg,2013,68(2):220-228.
[19] Munns CF,Shaw N,Kiely M,et al.Global Consensus Recommendations on Prevention and Management of Nutritional Rickets[J].J Clin Endocrinol Metab,2016,101(2):394-415.
基金
广州市卫生和计划生育科技项目(20181A011029);广州市妇女儿童医疗中心儿科研究所内部基金(YIP-2016-002);广东省医学科学技术研究基金项目(A2018239)
PDF(696 KB)
