脐血25羟基维生素D水平与早产儿呼吸窘迫综合征关系的临床研究

Clinical Study on the Relationship between Cord Blood 25 Hydroxyvitamin D Levels and Respiratory Distress Syndrome in Preterm Infants

摘要: 目的：探讨脐血25羟基维生素D [25 hydroxyvitamin D, 25(OH)D]水平与早产儿呼吸窘迫综合征(Respiratory distress syndrome, RDS)的关系，为RDS的预防提供新思路。方法：选择2024年1月至2024年12月日照市人民医院新生儿重症监护室(Neonatal intensive care unit, NICU)收治的243例早产儿纳入研究。早产儿出生时采集脐血测定25(OH)D水平，并根据其水平分为充足组[25(OH)D > 20 ng/mL)]、不足组[25(OH)D 12~20 ng/mL]、缺乏组[25(OH)D < 12 ng/mL]。比较三组早产儿临床特征差异，采用单因素及多因素logistic回归分析脐血25(OH)D水平对早产儿RDS的影响。结果：共有243例早产儿纳入研究，其中充足组70例(28.8%)，不足组74例(30.5%)，缺乏组99例(40.7%)。3组间PS的应用、PS应用 ≥ 2次、BPD、有创通气天数、无创通气天数、氧疗天数及住院天数的比较，差异均有统计学意义(P < 0.05)。组间两两比较显示，缺乏组的PS应用、应用PS ≥ 2次的发生率，均高于充足组、不足组(P < 0.05)。缺乏组有创通气天数、无创通气天数、氧疗天数及住院天数，均高于充足组(P < 0.05)。单因素及多因素logistic回归分析显示25(OH)D < 12 ng/mL是早产儿发生RDS的独立危险因素。结论：早产儿脐血维生素D缺乏发生率较高，维生素D缺乏可能会增加早产儿RDS的发生。

Abstract: Objective: To investigate the relationship between 25-hydroxyvitamin D [25(OH)D] levels in umbilical cord blood and respiratory distress syndrome (RDS) in preterm infants, and to provide new insights for the prevention of RDS. Methods: A total of 243 preterm infants admitted to the neonatal intensive care unit (NICU) of Rizhao People’s Hospital from January 2024 to December 2024 were included in the study. 25(OH)D levels in umbilical cord blood were measured at birth. The infants were divided into sufficient group [25(OH)D > 20 ng/mL], insufficient group [25(OH)D 12~20 ng/mL] and deficient group [25(OH)D < 12 ng/mL] based on 25(OH)D levels. The clinical characteristics of the preterm infants in three groups were compared. Univariate and multivariate logistic regression analyses were used to analyze the effect of 25(OH)D levels in umbilical cord blood on RDS in preterm infants. Results: A total of 243 preterm infants were included in the study, including 70 cases (28.8%) in the sufficient group, 74 cases (30.5%) in the insufficient group and 99 cases (40.7%) in the deficient group. There were statistically significant differences in the application of pulmonary surfactant (PS), the application of PS ≥ 2 times, bronchopulmonary dysplasia (BPD), days of invasive ventilation, days of non-invasive ventilation, days of oxygen therapy and length of hospital stay among the three groups (P < 0.05). Pairwise comparisons between groups showed that the incidence of PS application and PS application ≥ 2 times in the deficient group was higher than that in the sufficient group and the insufficient group (P < 0.05). The days of invasive ventilation, non-invasive ventilation, oxygen therapy and length of hospital stay in the deficient group were longer than those in the sufficient group (P < 0.05). Univariate and multivariate logistic regression analysis showed that 25(OH)D < 12 ng/mL was an independent risk factor for RDS in preterm infants. Conclusion: The incidence of vitamin D deficiency in umbilical cord blood of preterm infants is relatively high. Vitamin D deficiency may increase the risk of RDS in preterm infants.