极低出生体重儿出生时骨代谢指标对代谢性骨病预测意义

Predictive Significance of Bone Metabolism Indexes at Birth in Very Low Birth Weight Infants for Metabolic Bone Disease

摘要: 目的：探讨极低出生体重儿发生代谢性骨病的预测指标。方法：选取确诊代谢性骨病的129例极低出生体重儿设为病例组；同期47例非代谢性骨病极低出生体重儿为对照组。分析比较两组新生儿出生时血清钙、血磷、血钙磷乘积、血碱性磷酸酶等。结果：出院后确诊代谢性骨病的极低出生体重儿出生时平均血清钙、血磷、血钙磷乘积与对照组无统计学差异(P值分别为0.574、0.360、0.325)；血碱性磷酸酶水平低于对照组，差异有统计学意义(P = 0.017)；使用ROC曲线分析，血碱性磷酸酶曲线下面积为0.519；血碱性磷酸酶(241.5 U/L)对代谢性骨病的预测敏感性为84.5%，特异性为31.9%，95%CI：0.413~0.624。结论：MBDP极低出生体重儿出生时血碱性磷酸酶可能存在差异，但无助于预测代谢性骨病的发生。

Abstract: Objective: To investigate the predictors of metabolic bone disease in very low birth weight infants. Methods: 129 very low birth weight infants diagnosed with metabolic bone disease were selected as the case group; 47 very low birth weight infants with non-metabolic bone disease during the same period were selected as the control group. The serum calcium, serum phosphorus, serum calcium and phosphorus product, and serum alkaline phosphatase at birth were analyzed and compared between the two groups of infants. Results: The mean serum calcium, serum phosphorus, and se-rum calcium and phosphorus product of very low birth weight infants diagnosed with metabolic bone disease after discharge were not significantly different from those in the control group (P values were 0.574, 0.360, and 0.325, respectively); The enzyme level of serum alkaline phosphate was lower than the control group, and the difference was statistically significant (P = 0.017). Using ROC curve analysis, the area under the curve of serum alkaline phosphatase was 0.519; The sensitivity of serum alkaline phosphatase (241.5 U/L) for the prediction of metabolic bone disease was 84.5%, the specificity was 31.9%, 95%CI: 0.413~0.624. Conclusions: There may be differences in serum alkaline phosphatase at birth in very low birth weight infants with MBDP, but they are not helpful in predicting the occurrence of metabolic bone disease.