| Objective Metabolic bone disease of prematurity(MBDP)is a serious problem faced by premature infants,especially those with ultra-low birth weight.It not only affects the normal growth of children,but also affects the bone health of adults.It is also an important factor in increasing the probability of osteoporosis in later years.In recent years,the relationship between 25(OH)D and MBDP,which are closely related to calcium and phosphorus metabolism,has attracted the attention of scholars at home and abroad.The purpose of this study was to explore the correlation between 25(OH)D and MBDP,and to provide guidance for its early prevention and treatment.Methods From September 2018 to September 2019,preterm infants eligible for hospitalization in our department were selected as the study objects(gestational weeks 26 + ～ 36 + weeks,birth weight 601 ～ 2500g).According to the condition,enteral or parenteral nutrition channels were established.The former was given VitD 800 IU orally,while the latter was given intravenous nutrition with 10% calcium gluconate injection of 2-3ml / kg and sodium glycerophosphate of 1-2ml / kg.Enteral nutrition and VitD 800 IU were started at the right time.Then 85 preterm infants were divided into three groups according to the diagnosis of MBDP based on the results of long bone radiographs taken at 6 weeks or(and)9 weeks after birth: early MBDP group(6 weeks radiographs showed MBDP,9 weeks radiographs did not show MBDP after vitamin D and calcium phosphorus supplementation),confirmed group(6 weeks radiographs showed MBDP,9 weeks radiographs still showed MBDP after vitamin D and calcium phosphorus supplementation)and control group(6 weeks and 9 weeks radiographs MBDP)was not shown,and the contents of the comparison included serum 25(OH)d,AKP,calcium and phosphorus levels at the 2nd,4th,6th and 8th week of birth.SPSS 20.0 statistical software was used to analyze the data,the mean ± standard deviation(x ± s)was used to express the measurement data,and the repeated measurement ANOVA was used to analyze the multiple group comparison;the rank sum test of independent sample comparison was used between the two groups,P < 0.05 was statistically significant.Result There were 85 cases in this study.According to the results of long bone radiograph,they were divided into three groups: early MBDP group(6-week radiograph showed MBDP,9-week radiograph did not show MBDP after vitamin D,calcium and phosphorus treatment),diagnosis group(6-week radiograph showed MBDP,9-week radiograph still showed MBDP after vitamin D,calcium and phosphorus treatment)and control group(6-week and 9-week radiograph did not show MBDP).30 cases in early MBDP group The gestational age was 31.88 ± 1.62 weeks,the establishment of enteral feeding was delayed due to various reasons,and vitamin D was continuously supplemented 2-3 weeks after birth.There were 15 cases in MBDP group,the gestational age was less than 32 weeks,the gestational age was 28.80 ± 1.32 weeks.In the control group,the gestational age was less than 37 weeks,the mean gestational age was 34.65 ± 1.26 weeks,enteral feeding was established successfully,and vitamin D was continuously supplemented after 2 weeks of birth.In the above three groups,the serum calcium and phosphorus concentrations were maintained in the normal range,and there was no significant difference between the groups(P > 0.05),so the serum calcium and phosphorus concentration could not be used as the diagnosis index of MBDP.The average value of serum AKP in the early MBDP group was 480.21 ± 79.84u/l in the second week after birth,550.75 ± 150.93u/l in the fourth week,355.22 ± 161.54 in the sixth week,252.30 ± 151.17u/l in the eighth week,485.50 ± 78.89u/l in the second week after birth,and 355.22 ± 161.54 in the fourth week After 8 weeks,the average value was 510.32 ± 135.89u/l,but the p value of the three groups was 0.081 in 2 weeks,0.065 in 4 weeks,0.073 in 6 weeks,0.061 in 8 weeks,no significant difference and no statistical significance,so the serum AKP could not be used as the sensitivity of MBDP diagnosis Sense index.The serum 25(OH)d in MBDP,early MBDP and control group was measured by multiple rank sum test,P value was 0.001 in 2 weeks,0.001 in 4 weeks,0.000 in 6 weeks,and 0.001 in 8 weeks,all of which were less than 0.05,with statistical significance.Therefore,serum 25(OH)d can be used as the diagnostic standard of MBDP.In addition,compared with the serum 25(OH)d of the control group and the early MBDP group,P = 0.002 < 0.05 in the second week,P = 0.000 < 0.05 in the fourth week,indicating that there is a significant difference between the control group and the early group,with statistical significance;P = 0.464 > 0.05 in the next six weeks,P = 0.571 > 0.05 in the eighth week,indicating that there is no significant difference between the control group and the early group after six or eight weeks.Therefore,25(OH)d has the function of early warning MBDP.However,the serum 25(OH)d in MBDP group was significantly different from that in control group,P = 0.000 < 0.05 in the second week,P = 0.000 < 0.05 in the fourth week,P = 0.000 < 0.05 in the sixth week,P = 0.000 < 0.05 in the eighth week.Therefore,we can draw the conclusion that 25(OH)d can be used as the early diagnosis basis of MBDP and early warning of MBDP.At the same time,according to the guidance of 2016 edition of "global consensus on the prevention and treatment of nutritional rickets",when serum 25(OH)d > 250 nmol / L(12-20 ng / ml),it is VitD poisoning.Therefore,we can guide clinical practice according to this standard,so as to avoid VitD poisoning.Conclusion Serum calcium and phosphorus concentration have no obvious specificity in MBDP,while 25(OH)d can be used as the early diagnosis basis of MBDP,and can early warn the occurrence of MBDP,at the same time,it can guide the adjustment of clinical treatment dose according to serum 25(OH)d value to avoid VitD poisoning. |
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