山东省某医院0~18岁就诊者维生素D水平及影响因素分析

Analysis of Vitamin D Levels and Influencing Factors in Patients Aged 0 to 18 Years in a Hospital in Shandong Province

摘要: 目的：调查某医院0~18岁就诊者血清25-羟基维生素D [25(OH)D]水平，分析维生素D缺乏/不足状况及其影响因素，为临床诊疗提供科学依据。方法：选取2016.1~2021.12就诊于青岛大学附属医院儿科门诊并检验血清25(OH)D的0~18岁儿童作为对象，共获得资料完整有效数据3165人，男2028人，女1137人。新生儿组107人，婴儿组207人，幼儿组416人，学龄前组1010人，学龄组640人，青春期组785人。以电化学发光法检测血清25(OH)D。SPSS 21.0对数据进行统计学处理：血清25(OH)D水平呈非正态分布，采用M(P25, P75)表示，采用Mann-Whitney检验、kruskal-wallis H检验、卡方检验、logistic回归等检验方法，P < 0.05为差异具有统计学意义。结果：3165名就诊儿童血清25(OH)D水平为54.00 (39.75, 70.75) nmol/L，其中维生素D缺乏(<30 nmol/L)占12.23%，不足(30~50 nmol/L)占31.03%，充足(>50~250 nmol/L)占56.65%。各年龄组维生素D不足/缺乏检出率分别为：新生儿组96.3% (103/107)，婴儿组34.8% (72/207)，幼儿组8.7% (36/416)，学龄前组35.6% (360/1010)，学龄组49.7% (318/640)，青春期组61.1% (480/785)。各年龄组儿童血清25(OH)D水平比较差异有统计学意义(H = 769.295, P < 0.05)，除新生儿组及婴儿组外，就诊者血清25(OH)D水平随年龄增长呈现下降趋势。男童血清25(OH)D水平55.50 (41.75, 71.25) nmol/L，女童为51.50 (37.50, 69.50) nmol/L，差异有统计学意义(Z = −3.484, P < 0.05)。血清25(OH)D水平以夏秋季较高，冬春季较低，除婴儿组外，各年龄组不同季节组间差异有统计学意义。logistic回归分析显示：女性、冬季、早产、抽动障碍、哮喘及过敏性鼻炎、身材矮小均为维生素D缺乏/不足的危险因素。结论：本区域就诊儿童维生素D缺乏/不足率较高，患病儿童维生素D缺乏/不足的风险高于健康体检儿童。

Abstract: Objective: To investigate the serum 25-hydroxyvitamin D [25(OH)D] levels in patients aged 0~18 years in a hospital and analyze the vitamin D deficiency/insufficiency status and its influencing fac-tors to provide a scientific basis for clinical diagnosis and treatment. Methods: Children aged 0~18 years attending the pediatric outpatient clinic of the Affiliated Hospital of Qingdao University and tested for serum 25(OH)D from 2016.1 to 2021.12 were selected as subjects, and a total of 3165 children, 2028 males and 1137 females, with complete and valid data were obtained. There were 107 in the neonatal group, 207 in the infant group, 416 in the toddler group, 1010 in the preschool group, 640 in the school-age group, and 785 in the adolescent group. Serum 25(OH)D was detected by electrochemiluminescence method. SPSS 21.0 was used for statistical processing of the data: se-rum 25(OH)D levels were non-normally distributed and expressed by M(P25, P75), and Mann-Whitney test, kruskal-wallis H test, Chi-square test, logistic regression were used. P < 0.05 was considered a statistically significant difference. Results: Serum 25(OH)D levels in 3165 children attending the hospital were 54.00 (39.75, 70.75) nmol/L, of which 12.23% were vitamin D deficient (<30 nmol/L), 31.03% were insufficient (30~50 nmol/L), and sufficient (>50~250 nmol/L) ac-counted for 56.65%. The detection rates of vitamin D insufficiency/deficiency in each age group were 96.3% (103/107) in the neonatal group, 34.8% (72/207) in the infant group, 8.7% (36/416) in the toddler group, 35.6% (360/1010) in the preschool group, 49.7% (318/640) in the school-age group, and 61.1% (480/785) in the adolescent group. There was a statistically significant difference in the comparison of serum 25(OH)D levels among the children attending the clinic in each age group (H = 769.295, P < 0.05), and except for the neonatal and infant groups, the serum 25(OH)D levels of those attending the clinic showed a decreasing trend with age. Serum 25(OH)D levels were 55.50 (41.75, 71.25) nmol/L in boys and 51.50 (37.50, 69.50) nmol/L in girls, with a statistically significant difference (Z = −3.484, P < 0.05). Serum 25(OH)D levels were higher in summer and au-tumn and lower in winter and spring, with statistically significant differences between different seasonal groups in all age groups except the infant group. Logistic regression analysis showed that female, winter, prematurity, tic disorder, asthma and allergic rhinitis, and short stature were risk factors for vitamin D deficiency/insufficiency. Conclusion: The rate of vitamin D deficien-cy/insufficiency in children attending a hospital in the region was high, and the risk of vitamin D deficiency/insufficiency was higher in sick children than in healthy children on physical examina-tion.