目的 探讨早产儿脐血血清25羟维生素D[25(OH)D] 水平与呼吸窘迫综合征(RDS)的关系,为RDS的临床预防提供新思路。方法 将2018年3月—2020年5月收治入复旦大学附属妇产科医院NICU的179例早产儿纳入分析,于出生时采集脐血,使用化学发光微粒子免疫检测法分析测定脐血血清25(OH)D水平。根据是否诊断RDS分为RDS组和对照组,将血清25(OH)D水平是否低于20 ng/ml分为维生素D减少组和充足组,并分别分析和比较两组各影响因素的差异。结果 25.1%早产儿脐血25(OH)D水平缺乏(<10 ng/ml)、42.5%不足(10~<20 ng/ml),32.4%正常(≥20 ng/ml)。RDS组脐血血清25(OH)D水平[(11.3±7.2) ng/ml]显著低于对照组[(15.88±8.4)nmol/L], t=3.469,P<0.01);RDS组脐血血清25(OH)D减少发生率为89.0%(121/136),显著高于对照组 [46.5%(20/43), χ2=35.221, P<0.01)]。通过单因素和多因素分析,新生儿胎龄≤32周和脐血血清25(OH)D<20 ng/ml是早产儿发生RDS的独立危险因素(OR=39.694, 5.696, P＜0.05)。结论 早产儿维生素D缺乏发生率高,低维生素D水平可能增加RDS发生率。
Abstract
Objective To investigate the relationship between serum 25 hydroxy vitamin D [25(OH) D] level and respiratory distress syndrome (RDS) in preterm infants,in order to provide new ideas for clinical prevention of RDS. Methods A total of 179 preterm infants admitted to NICU, Obstetrics and Gynecology Hospital Affiliated to Fudan University from March 2018 to May 2020 were included in the analysis.Cord blood was collected at birth, and the serum 25(OH)D level in cord blood was determined by chemiluminescent microparticle immunoassay.The infants were divided into RDS group and control group according to the diagnosis of RDS.According to whether serum 25(OH)D level was lower than 20 ng/ml, the infants were divided into vitamin D reduction group and normal group.The differences on the influencing factors between the two groups were analyzed and compared. Results Among all preterm infants, 25.1% were deficient in 25(OH)D level (<10 ng /ml), 42.5% were deficient (10—<20 ng/ml), and 32.4% were normal (≥20 ng/ml).The level of 25(OH)D in cord blood of RDS group [(11.3±7.2) ng/ml] was significantly lower than that of the control group [(15.88±8.4) nmol/L, t=3.469, P<0.01)].The prevalence of 25(OH)D decrease in RDS group was 89.0% (121/136), which was significantly higher than that in control group [46.5% (20/43), χ2= 35.221, P <0.01)].Multivariate analysis result indicated that gestational age and decreasing serum 25(OH)D level in cord blood were independent risk factors for RDS in preterm infants(OR=39.694, 5.696, P＜0.05). Conclusion The prevalence of vitamin D deficiency in preterm infants is high, and it may increase the incidences of RDS.
关键词
25羟维生素D /
呼吸窘迫综合征 /
危险因素 /
早产儿
Key words
25 hydroxy vitamin D /
respiratory distress syndrome /
risk factors /
infant, preterm infants
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参考文献
[1] Rodriguez RJ.Management of respiratory distress syndrome:an update[J].Respiratory Care, 2003, 48(3):279-286.
[2] Sakurai R, Shin E, Fonseca S, et al.1alpha, 25(OH)2D3 and its 3-epimer promote rat lung alveolar epithelial-mesenchymal interactions and inhibit lipofibroblast apoptosis[J].Am J Physiol Lung Cell Mol Physiol,2009,297(3):L496-L505.
[3] Mandell E, Seedorf GJ, Ryan S, et al.Antenatal endotoxin disrupts lung vitamin D receptor and 25-hydroxyvitamin D 1α-hydroxylase expression in the developing rat[J].Am J Physiol Lung Cell Mol Physiol, 2015, 309(9):L1018.
[4] Monangi N, Slaughter JL, Dawodu A, et al.Vitamin D status of early preterm infants and the effects of vitamin D intake during hospital stay[J].Arch Dis Child-Fetal,2014, 99(2):F166-F168.
[5] 陈超.新生儿呼吸窘迫综合征 [M]// 邵肖梅,叶洪瑁,丘小汕 .实用新生儿学.5版.北京:人民卫生出版社, 2019:575-578.
[6] Grossman Z, Hadjipanayis A, Stiris T, et al.Vitamin D in European children-statement from the European Academy of Paediatrics (EAP)[J].Eur J Pediatr,2017,176(6):829-831.
[7] 常立文.新生儿窒息[M]//王卫平.儿科学.8版.北京:人民卫生出版社, 2013:102-107.
[8] Nguyen M, Trubert CL, Rizk-Rabin M, et al.1,25-Dihydroxyvitamin D3 and fetal lung maturation:immunogold detection of VDR expression in pneumocytes type II cells and effect on fructose 1,6 bisphosphatase[J].J Steroid Biochem,2004, 89:93-97.
[9] Lykkedegn S, Sorensen GL, Beck-Nielsen SS, et al.The impact of vitamin D on fetal and neonatal lung maturation.A systematic review[J].Am J Physiol Lung Cell Mol Physiol, 2015, 308(7):587-602.
[10] Mohamed Hegazy A, Mohamed Shinkar D, Refaat Mohamed N, et al.Association between serum 25 (OH) vitamin D level at birth and respiratory morbidities among preterm neonates[J].J Matern Fetal Neonatal Med,2018,31(20):2649-2655.
[11] Fettah ND, Zenciroĝlu A, Dilli D, et al.Is higher 25-hydroxyvitamin D level preventive for respiratory distress syndrome in preterm infants?[J].Am J Perinatol,2015,32(3):247-250.
[12] Matejek T, Zemankova J, Malakova J, et al.Severe vitamin D deficiency in preterm infants:possibly no association with clinical outcomes?[J].J Matern Fetal Neonatal Med, 2020,6(1):1-9.
[13] Saggese G, Vierucci F, Prodam F, et al.Vitamin D in pediatric age:consensus of the Italian Pediatric Society and the Italian Society of Preventive and Social Pediatrics, jointly with the Italian Federation of Pediatricians[J].Ital J Pediatr, 2018,44(1):51.
[14] Burris HH, Van Marter LJ, McElrath TF, et al.Vitamin D status among preterm and full-term infants at birth[J].Pediatr Res,2014,75:75-80.
[15] Jobe AH.Vitamin D for extremely preterm infants[J].J Pediatr, 2016,174:1-3.
[16] Yorifuji J, Yorifuji T, Tachibana K, et al.Craniotabes in normal newborns:the earliest sign of subclinical vitamin D deficiency[J].J Clin Endocrinol Metab 2008,93(5):1784-1788.
[17] Principi N, Bianchini S, Baggi E, et al.Implication of maternal vitamin D deficiency for the fetus,the neonate and the young infant[J].Eur J Nutr, 2013,52(3):859-867.
[18] Dawodu A, Akinbi H.Vitamin D nutrition in pregnancy:current opinion[J].Int J Womens Health, 2013, 5:333-343.
[19] Hollis BW, Johnson D, Hulsey TC, et al.Vitamin D supplementation during pregnancy:double-blind, randomized clinical trial of safety and effectiveness[J].J Bone Miner Res, 2011,26(10):2341-2357.
[20] Aghajafari F, Nagulesapillai T, Ronksley PE, et al.Association between maternal serum 25-hydroxyvitamin D level and pregnancy and neonatal outcomes:systematic review and meta-analysis of observational studies[J].BMJ, 2013, 346:f1169.
[21] Wagner CL, McNeil RB, Johnson DD, et al.Health characteristics and outcomes of two randomized vitamin D supplementation trials during pregnancy:a combined analysis[J].J Steroid Biochem Mol Biol, 2013, 136:313-320.
[22] 余仁强,赵馨,陈道桢,等.早产儿出生时维生素D水平及影响因素分析[J].中国当代儿科杂志,2017,19(7):800-805.
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