| Objective: To investigate the nutritional status and distribution of vitamin D in serum of children with different gender,different age groups and different types of short stature in the Department of Pediatrics of Yan’an University Affiliated Hospital for the first time,and to study the value of vitamin D in the diagnosis of growth hormone deficiency.Methods: From january2019 to february2022,101 short stature children who were first diagnosed in pediatrics of Yan’an University Affiliated Hospital and met the Naxi criteria were selected.The groups were as follows: 1.According to gender,they were divided into male group（63 cases）and female group（38 cases）;2.They were divided into pre-school age group（29 cases）and non school age group（72 cases）;3.They were divided into idiopathic dwarfism group（55 cases）and growth hormone deficiency group（46 cases）.The general status and serum 25 hydroxyvitamin D（25-（OH）d）levels in each group were retrospectively investigated,analyzed and compared to further explore the nutritional distribution of vitamin D in children with dwarfism among each group.Single factor binary logistic regression was used to analyze whether growth parameters and clinical indicators（such as serum vitamin D）were independent influencing factors of growth hormone deficiency,Then the independent influencing factors were further analyzed by the receiver operating curve（ROC curve）to evaluate its value in the diagnosis of growth hormone deficiency.Results: According to the inclusion criteria and exclusion criteria,101 children and adolescents with an average age of 8.8±2.7 years were included,ranging from 3 to 14 years old;The average vitamin D level of children with dwarfism was 15.0±6.7ng/ml,which was in the insufficient stage,the lowest was 4.2ng/ml,the highest was 37.85ng/ml;There were 42 vitamin D deficiency patients,accounting for 41.6%,and the content was 9.1±1.9ng/ml;There were 39 patients with deficiency,accounting for 38.6%,and the content was 16.3±2.2ng/ml;There were 19 sufficient patients,accounting for 18.8%,and the content was 25.5±5.1ng/ml;1.Grouped by gender: 63 males and 38 females.There was no significant difference in age between the two groups（Z=-1.946,P=0.052,>0.05）,which were comparable.Comparison of vitamin D nutritional status between male and female children with short stature: according to the one-way ordinal data nonparametric test,male children with short stature did not differ from female children in the distribution of vitamin D nutritional status（z =-0.094,P = 0.925,> 0.05）,and there was also no difference in serum vitamin D levels between male and female children（z =-0.547,P = 0.585,> 0.05）,suggesting that in children with short stature,the,No differences were found in vitamin D levels and distribution between male and female children.2.Grouped by age: 29 in the preschool group and 72 in the non preschool group,there was no significant difference in the gender ratio between the two groups according to the chi square test（P = 0.343,> 0.05）and they were comparable.The difference in vitamin D levels between the two groups was significant（z =-2.988,P = 0.003,< 0.05）,with the preschool group having higher serum vitamin D levels（18.0（12.3-23.5mg / ml））than the non preschool group(12.4（9.5-17.8）mg / ml;There were also significant differences in the rank distribution of vitamin D nutritional status among children with short stature at different age stages（z =-2.671,P = 0.008,< 0.05）,and the percentage of children with short stature in the preschool age group with vitamin D deficiency（24.1%）was less than that in the non preschool group（48.6%）and with sufficiency（34.5%）was greater than that in the non-school age group（13.9%）.Overall,the vitamin D nutritional status of children with short stature in the preschool age group was better than that in the non preschool group;3.Grouped by etiology: 46 in the growth hormone deficiency group and 55 in the idiopathic short stature group,there were no significant differences in gender composition or age between the two groups（χ2= 0.488,P = 0.485,z =-1.946,P =0.052,> 0.05）,and they were comparable.According to nonparametric tests,there was a significant difference in the rank distribution of vitamin D nutritional status between children with different types of short stature（z =-2.933,P = 0.003,< 0.05）,with a higher percentage of children with vitamin D lack in the GHD group（56.5%）compared with the ISS Group（29.1%）and a significant difference in the serum vitamin D levels between the two groups（z =-2.653,P = 0.008,< 0.01）,The vitamin D level of the GHD group（10.8（9.5-17.1）mg/ml）was significantly smaller than that of the ISS Group（16.7（10.8-20.8）mg / ml）,and overall,the vitamin D nutritional status of the ISS Group was better than that of the GHD group.4.Univariate binary logistic regression analysis:Taking GH excitation peak <10μg/L as the diagnostic criteria for GHD,the occurrence of GHD was assigned as 1,and the absence of GHD（ie ISS）was assigned as 0.With GHD as the dependent variable,various growth parameters and clinical indicators including gender,age,height,weight,BMI,bone age,BAD,and vitamin D content were used as independent variables,respectively,and a univariate binary logistic regression analysis was performed,the results showed that vitamin D level was significantly associated with GHD（P=0.015,<0.05）,and vitamin D level was a protective factor for GHD（β=-0.084,<0;OR=0.920,<1）.5.ROC curves assessing the predictive power of vitamin D levels for GHD:The level of vitamin D,an independent influencing factor derived from binary logistic regression analysis,was used as the testing variable for ROC curve analysis,the results showed that the area under the curve of the predictive model for vitamin D levels was 0.700,P = 0.008,< 0.05;When the serum vitamin D level was less than 15.665mg/ml,the sensitivity was 0.739,the specificity was 0.6,and it was a good predictor of GHD.Conclusions:1.In this study,the average content of serum vitamin D in 101 children with dwarfism was 15.0±6.7ng/ml,of which 80.2% were in the stage of deficiency and deficiency.Therefore,clinicians and parents should pay attention to the monitoring and supplementation of serum vitamin D in children with dwarfism.2.In this study,the serum vitamin D nutritional status of children with dwarfism was not related to gender.3.In this study,the vitamin D deficiency and deficiency rate of children with short stature increased with age.4.In this study,the nutritional status of vitamin D in GHD group was worse than that in ISS Group.Binary logistic regression showed that vitamin D level was the protective factor of GHD.ROC curve analysis of vitamin D was of certain value in the diagnosis of GHD when it was less than 15.665ng/ml. |
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