动态监测极早产儿血25(OH)D水平及其对肺部疾病的影响

doi:10.3969/j.issn.1004-583X.2022.08.008

摘要/Abstract

摘要：

目的动态监测极早产儿维生素D水平并探讨其对极早产儿肺部疾病的影响。方法选取2019年6月-2020年12月期间于青岛大学附属医院新生儿重症监护室(neonatal intensive care unite, NICU)住院、并经得家长知情同意的胎龄<32周的极早产儿共126例,于生后24 h、1月、2月(或出院时)检测血清25-(OH)D水平。根据生后血清25-(OH)D水平,将极早产儿分为3组,维生素D缺乏组(n=71),25(OH)D<12 ng/ml;维生素D不足组(n=46),25(OH)D 12~<20 ng/ml;维生素D充足组(n =9),25(OH)D>20~≤100 ng/ml。所有早产儿在喂养耐受后给予维生素AD(其中维生素D 500 IU,维生素A 1500 IU)每日1粒,及维生素D3 400 IU;收集早产儿一般临床资料,比较各组间呼吸窘迫综合征(respiratory distress syndrome, RDS)、呼吸机使用时间、住院时间、早期肺高压、动脉导管未闭(patent ductus arteriosus, PDA)、支气管肺发育不良(bronchopulmonary dysplasia, BPD)发生情况。结果 (1)共纳入极早产儿126例,胎龄为26~31⁺⁶周,平均胎龄(29.75±1.52)周,其中男65例(51.59%),女61例(48.41%)。出生时维生素D缺乏组、不足组、充足组3组间的胎龄、出生体重、头围、身长等一般资料比较,差异均无统计学意义(P>0.05)。(2)出生时维生素D平均水平为(10.57±4.79) ng/ml,维生素D缺乏率达92.86%。每日口服维生素D900 IU,1月龄时(18.14±2.88) ng/ml,维生素缺乏率为72.3%,2月龄时(21.13±7.48) ng/ml,维生素D缺乏率为53.17%,无维生素D过量。(3)出生时维生素D缺乏组的RDS、BPD发生率明显升高,差异有统计学意义(P<0.05)。但出生时维生素D水平与BPD的严重程度无明显相关性(P=0.984)。不同维生素D水平组间Apgar评分、咖啡因使用时间、机械通气比率、无创通气时间、总用氧时间、PDA、住院时间及早期肺高压差异无统计学意义(P>0.05)。结论 (1)极早产儿普遍存在维生素D缺乏,补充维生素D 900 IU后,2月龄维生素D缺乏率仍然占53.17%,建议对早产儿进行个体化补充维生素D。(2)极早产儿出生时维生素D缺乏增加RDS、BPD的风险。

关键词: 婴儿, 早产, 维生素D, 肺部疾病

Abstract:

Objective To monitor the vitamin D level dynamically and to explore its effect on lung diseases of very preterm infants. Methods A total of 126 very premature infants <32 weeks were enrolled, who were admitted to the NICU of Affiliated Hospital of Qingdao University from June 2019 to December 2020 with informed consent of their parents. Serum 25-(OH)D levels were measured at postnatal 24h and postnatal month 1 and 2. All preterm infants were given vitamin AD (vitamin D 500 IU, vitamin A 1500 IU) daily and vitamin D3 400 IU after feeding tolerance. General clinical data were collected from the three groups which comprised Vitamin D deficiency group(n=71, 25-[OH] D <12 ng/ml), insufficient group(n=46, 25-[OH]D≥12~<20 ng/ml), and sufficient group(n=9, 25-OH]D≥20~≤100 ng/ml).The incidence of respiratory distress syndrome(RDS), duration of mechanical ventilation, hospital stay, early pulmonary hypertension(PH), patent ductus arteriosus(PDA), and bronchopulmonary dysplasia(BPD) were included as comparator, and statistical analysis was conducted. Results A total of 126 premature infants were included, ranging from 26 to 31⁺⁶ weeks with an average gestational age of (29.75±1.52) weeks, including 65 males (51.59%) and 61 females (48.41%). There were no significant differences in gestational age, birth weight, head circumference and body length among the three groups(P>0.05). The average level of vitamin D at birth was (10.57±4.79) ng/ml, and the rate of vitamin D deficiency reached 92.86%. Vitamin D900IU was taken orally daily. The mean level of vitamin D was (18.14±2.88) ng/ml and (21.13±7.48) ng/ml at month 1 and month 2 with deficiency rate 73.8% and 53.17%, no vitamin D overdose. The incidence of RDS or BPD was significantly higher in the vitamin D deficiency group at birth (P<0.05). However, there was no significant correlation between different vitamin D levels and the severity of BPD (P=0.984). There was no significant differences in postnatal Apgar score, duration of caffeine use, rate of mechanical ventilation, duration of non-invasive ventilation, duration of total oxygen use, patent ductus arteriosus (PDA), total length of hospital stay, and early pulmonary hypertension (P>0.05). Conclusion Vitamin D deficiency is common in very premature infants. After vitamin D900IU supplementation, the rate of vitamin D deficiency still accounted for 53.17% at aged 2 months. Therefore, it is recommended to provide individual vitamin D supplementation for premature infants.Vitamin D deficiency at birth in very premature infants increases the risk of RDS and BPD.

Key words: infant, premature, vitamin D, lung disease

中图分类号:

R722

锡洪敏, 杨丽娟, 尹向云, 杨萍, 马丽丽, 李向红. 动态监测极早产儿血25(OH)D水平及其对肺部疾病的影响[J]. 临床荟萃, 2022, 37(8): 717-722.

Xi Hongmin, Yang Lijuan, Yin Xiangyun, Yang Ping, Ma Lili, Li Xianghong. Dynamic monitoring of blood 25 (OH) D level and its effect on pulmonary disease in very premature infants[J]. Clinical Focus, 2022, 37(8): 717-722.

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链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2022.08.008

https://huicui.hebmu.edu.cn/CN/Y2022/V37/I8/717

图/表 5

表1 极早产儿一般资料比较

维生素D营养状况	缺乏组( $n$ =71)	不足组( $n$ =46)	充足组( $n$ =9)	$F$ /χ²值	$P$ 值
性别[例(%)]
男女	36(55.38) 35(57.37)	24(36.92) 22(33.85)	5(7.69) 4(6.56)		1.000^*
胎龄(周)	29.64±1.48	29.78±1.53	29.66±1.31	0.458	0.634
<28周	12(63.16)	6(31.56)	1(5.26)
28~29⁺⁶周	20(54.06)	12(32.43)	5(13.51)		0.410^*
30~31⁺⁶周	39(55.71)	28(40)	3(4.29)
出生体重(g)	1150.58±252.28	1310.19±339.520	1343.33±252.438	0.420	0.055
<1 000 g[例(%)]	28(71.79)	11(28.21)	0
1 000 g~1 499 g[例(%)]	37(56.92)	22(33.85)	6(9.23)		0.270^*
1 500 g~1 999 g[例(%)]	6(30.00)	11(55.00)	3(15.00)
>2 000 g[例(%)]	0	2(100.00)	0
头围(cm)	26.56±2.24	27.42±2.25	27.56±2.01	1.809	0.154
身长(cm)	37.12±3.01	36.57±3.01	37.78±1.99	1.223	0.168
分娩方式[例(%)]
顺产剖宫产	10(40.00) 62(61.38)	13(52.00) 33(32.67)	2(8.00) 7(6.93)		0.128^*

表1 极早产儿一般资料比较

维生素D营养状况	缺乏组( $n$ =71)	不足组( $n$ =46)	充足组( $n$ =9)	$F$ /χ²值	$P$ 值
性别[例(%)]
男女	36(55.38) 35(57.37)	24(36.92) 22(33.85)	5(7.69) 4(6.56)		1.000^*
胎龄(周)	29.64±1.48	29.78±1.53	29.66±1.31	0.458	0.634
<28周	12(63.16)	6(31.56)	1(5.26)
28~29⁺⁶周	20(54.06)	12(32.43)	5(13.51)		0.410^*
30~31⁺⁶周	39(55.71)	28(40)	3(4.29)
出生体重(g)	1150.58±252.28	1310.19±339.520	1343.33±252.438	0.420	0.055
<1 000 g[例(%)]	28(71.79)	11(28.21)	0
1 000 g~1 499 g[例(%)]	37(56.92)	22(33.85)	6(9.23)		0.270^*
1 500 g~1 999 g[例(%)]	6(30.00)	11(55.00)	3(15.00)
>2 000 g[例(%)]	0	2(100.00)	0
头围(cm)	26.56±2.24	27.42±2.25	27.56±2.01	1.809	0.154
身长(cm)	37.12±3.01	36.57±3.01	37.78±1.99	1.223	0.168
分娩方式[例(%)]
顺产剖宫产	10(40.00) 62(61.38)	13(52.00) 33(32.67)	2(8.00) 7(6.93)		0.128^*

图1 不同月龄维生素D水平

表2 极早产儿喂养情况

项目	缺乏组( $n$ =71)	不足组( $n$ =46)	充足组( $n$ =9)	$F$ /χ²值	$P$ 值
肠外喂养时间(d)	27.40±11.80	23.90±11.56	19.33±5.79	2.870	0.109
喂养方式
母乳[例(%)]	22(61.11)	12(33.33)	2(5.56)
母乳+强化剂[例(%)]	34(60.71)	19(33.92)	3(5.36)		0.408^*
早产儿配方奶[例(%)]	15(44.11)	15(44.11)	4(11.76)
添加维生素D3时间(d)	14.40±6.60	13.62±6.88	12.33±3.93	0.497	0.609
添加维生素AD时间(d)	10.95±5.76	11.14±6.37	8.44±3.28	0.826	0.440
生后2月龄ALP(U/L)	405.62±194.21	356.53±124.71	363.53±156.68	1.272	0.284
生后2月龄血Ca(mmol/L)	2.35±0.11	2.36±0.14	2.37±0.09	0.313	0.732
生后2月龄血P(mmol/L)	1.98±0.40	2.05±0.27	2.14±0.12	1.114	0.331

表2 极早产儿喂养情况

项目	缺乏组( $n$ =71)	不足组( $n$ =46)	充足组( $n$ =9)	$F$ /χ²值	$P$ 值
肠外喂养时间(d)	27.40±11.80	23.90±11.56	19.33±5.79	2.870	0.109
喂养方式
母乳[例(%)]	22(61.11)	12(33.33)	2(5.56)
母乳+强化剂[例(%)]	34(60.71)	19(33.92)	3(5.36)		0.408^*
早产儿配方奶[例(%)]	15(44.11)	15(44.11)	4(11.76)
添加维生素D3时间(d)	14.40±6.60	13.62±6.88	12.33±3.93	0.497	0.609
添加维生素AD时间(d)	10.95±5.76	11.14±6.37	8.44±3.28	0.826	0.440
生后2月龄ALP(U/L)	405.62±194.21	356.53±124.71	363.53±156.68	1.272	0.284
生后2月龄血Ca(mmol/L)	2.35±0.11	2.36±0.14	2.37±0.09	0.313	0.732
生后2月龄血P(mmol/L)	1.98±0.40	2.05±0.27	2.14±0.12	1.114	0.331

表3 出生时极早产儿不同维生素D水平与肺部疾病关系

项目	缺乏组( $n$ =71)	不足组( $n$ =46)	充足组( $n$ =9)	$F$ /χ²值	$P$ 值
RDS[例(%)]	69(97.18)	44(95.65)	7(77.78)		0.032^*
BPD[例(%)]	40(56.34)	17(37.00)	2(22.22)		0.039^*
机械通气[例(%)]	12(16.90)	7(15.21)	1(11.11)	0.322	0.820
无创通气时间(d)	23.12±19.28	19.71±19.68	12.33±14.21	1.451	0.238
总用氧时间(d)	38.83±29.45	35.90±34.10	24.56±22.88	0.872	0.421
早期肺动脉高压[例(%)]	13(18.30)	5(10.86)	1(11.11)	1.430	0.496
咖啡因使用时间	34.74±15.59	31.35±18.51	28.00±12.37	1.024	0.362
1 min Apger评分	6.91±2.17	7.10±2.42	7.88±1.05	0.787	0.458
5 min Apger评分	8.21±1.81	8.39±1.79	9.56±0.53	2.326	0.102
PDA[例(%)]	35(49.29)	16(34.78)	3(33.33)		0.172^*
住院时间(d)	65.99±21.46	60.08±24.35	49.33±13.15	2.720	0.070
新生儿败血症	6(75.00)	1(12.50)	1(12.50)		0.139^*

表3 出生时极早产儿不同维生素D水平与肺部疾病关系

项目	缺乏组( $n$ =71)	不足组( $n$ =46)	充足组( $n$ =9)	$F$ /χ²值	$P$ 值
RDS[例(%)]	69(97.18)	44(95.65)	7(77.78)		0.032^*
BPD[例(%)]	40(56.34)	17(37.00)	2(22.22)		0.039^*
机械通气[例(%)]	12(16.90)	7(15.21)	1(11.11)	0.322	0.820
无创通气时间(d)	23.12±19.28	19.71±19.68	12.33±14.21	1.451	0.238
总用氧时间(d)	38.83±29.45	35.90±34.10	24.56±22.88	0.872	0.421
早期肺动脉高压[例(%)]	13(18.30)	5(10.86)	1(11.11)	1.430	0.496
咖啡因使用时间	34.74±15.59	31.35±18.51	28.00±12.37	1.024	0.362
1 min Apger评分	6.91±2.17	7.10±2.42	7.88±1.05	0.787	0.458
5 min Apger评分	8.21±1.81	8.39±1.79	9.56±0.53	2.326	0.102
PDA[例(%)]	35(49.29)	16(34.78)	3(33.33)		0.172^*
住院时间(d)	65.99±21.46	60.08±24.35	49.33±13.15	2.720	0.070
新生儿败血症	6(75.00)	1(12.50)	1(12.50)		0.139^*

表4 3组BPD严重程度比较

BPD分度	缺乏组( $n$ =71)	不足组( $n$ =46)	充足组( $n$ =9)
轻度	22(66.67)	10(30.30)	1(3.03)
中度	17(68.00)	7(28.00)	1(4.00)
重度	1(100.00)	0	0

表4 3组BPD严重程度比较

BPD分度	缺乏组( $n$ =71)	不足组( $n$ =46)	充足组( $n$ =9)
轻度	22(66.67)	10(30.30)	1(3.03)
中度	17(68.00)	7(28.00)	1(4.00)
重度	1(100.00)	0	0

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