ACM Advances in Clinical Medicine 2161-8712 Scientific Research Publishing 10.12677/ACM.2023.1351227 ACM-66263 ACM20230500000_89564035.pdf 医药卫生 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 聂 梦姝 2 1 衣 明纪 3 1 杨 召川 3 1 单 延春 3 1 王 艳霞 3 1 马 良 3 1 刘 伟 3 1 刘 小梅 3 1 冉 霓 3 1 青岛大学医学部，山东 青岛 青岛大学附属医院儿童保健科，山东 青岛 null 06 05 2023 13 05 8782 8789 © Copyright 2014 by authors and Scientific Research Publishing Inc. 2014 This work is licensed under the Creative Commons Attribution International License (CC BY). http://creativecommons.org/licenses/by/4.0/

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。 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.

维生素D，25-羟基维生素D，儿童, Vitamin D 25-Hydroxy Vitamin D Children 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。

 关键词

维生素D，25-羟基维生素D，儿童

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

Mengshu Nie1, Mingji Yi2, Zhaochuan Yang2, Yanchun Shan2, Yanxia Wang2, Liang Ma2, Wei Liu2, Xiaomei Liu2, Ni Ran2*

1Medical College, Qingdao University, Qingdao Shandong

2Child Health Care Department, Affiliated Hospital of Qingdao University, Qingdao Shandong

Received: Apr. 28th, 2023; accepted: May 21st, 2023; published: May 31st, 2023

 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 factors 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: serum 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) accounted 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 autumn 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 deficiency/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 examination.

Keywords:Vitamin D, 25-Hydroxy Vitamin D, Children

Copyright © 2023 by author(s) and beplay安卓登录

This work is licensed under the Creative Commons Attribution International License (CC BY 4.0).

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 1. 引言

维生素D是一种脂溶性开环甾类化合物，是人体必需的微量营养素，对维持人体钙平衡、促进骨骼、肌肉健康不可或缺，其在心血管疾病、糖尿病、癌症、自身免疫和炎性反应等中的作用也逐渐被关注。血清25-羟基维生素D [(25(OH)D)]是维生素D经肝脏转化的代谢物，是反应人体内维生素D状态最可靠的生物标志物之一 [ 1 ] 。维生素D缺乏在世界范围内仍是一个较为普遍存在的问题，国内研究也显示中国儿童尤其是青少年维生素D水平不容乐观，安娜等 [ 2 ] 的研究显示国内儿童维生素D严重缺乏率2.46%、缺乏率21.57%，且缺乏率随年龄增加逐渐升高。本研究通过分析近6年在山东省青岛大学附属医院就诊儿童的血清25(OH)D水平，评估其维生素D营养情况，为更好的防治维生素D缺乏提供科学的依据。

 2. 对象与方法 2.1. 研究对象

搜素青岛大学附属医院云数据，选取2016.1~2021.12就诊于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，其中男2028人，女1137人，按照年龄划分为6组：新生儿组(0~28天) 107人；婴儿组(29天~<1岁) 207人；幼儿组(1~<3岁) 416人；学龄前组(3~<7岁) 1010人；学龄组(7~<10岁) 640人；青春期组(10~18岁) 785人。根据来院检查的月份按季节划分为：春季组(3、4、5月) 738名；夏季组(6、7、8月) 1063名；秋季组(9、10、11月) 712名；冬季组(12、1、2月) 652名。根据来院检查的诊断类别分为：健康查体313例，抽动障碍707例，身材矮小425例，早产儿236例，过敏性鼻炎及哮喘232例，其他疾病合并为1252例(包含糖尿病79例、肥胖42例、甲状旁腺功能减退28例、急性淋巴细胞白血病27例、癫痫19例等每类不足100例者)。本研究已通过青岛大学附属医院伦理委员会审查，家属知情同意，伦理号：QYFY WZLL 27282。

 2.2. 检测方法

电化学发光法。

 2.3. 诊断标准

血清25(OH)D < 30 nmol/L为维生素D缺乏，30~50 nmol/L为维生素D不足，>50~250 nmol/L为维生素D充足 [ 3 ] 。

 2.4. 统计学方法

选用SPSS 21.0对数据进行处理。结果血清25(OH)D水平呈非正态分布，采用M(P25, P75)表示，两样本组间比较采用Mann-Whitney检验，多样本组间比较采用kruskal-wallis H检验，分类资料采用例和百分比(%)表示，组间比较采用卡方检验，影响因素分析采用二元logistic回归(仅保留初诊数据)。以P < 0.05为差异具有统计学意义。

 3. 结果 3.1. 0~18岁就诊者血清25(OH)D总体水平

3165名儿童血清25(OH)D水平为54.0 (39.8, 70.8) nmol/L，其中维生素D缺乏占12.2% (387/3165)，不足占31.0% (982/3165)，充足占56.7% (1796/3165)。

 3.2. 不同年龄及性别儿童血清25(OH)D水平

各年龄组儿童血清25(OH)D水平比较结果示年龄组间差异有统计学意义(H = 769.295, P < 0.05)，除新生儿组及婴儿组外，儿童血清25(OH)D水平随年龄增长出现下降趋势。各年龄组维生素D不足/缺乏检出率：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)。结果见表1。男童血清25(OH)D水平55.5 (41.8, 71.3) nmol/L，女童为51.5 (37.5, 69.5) nmol/L，差异有统计学意义(Z = −3.484, P < 0.05)。

 3.3. 不同季节儿童血清25(OH)D水平

除婴儿期外，不同季节、各年龄组儿童血清25(OH)D水平有显著差异(具体见表2)，夏秋季水平高于冬春季。

 3.4. 0~18岁就诊儿童维生素D缺乏/不足影响因素的多因素分析

以维生素D缺乏/不足作为因变量(是 = 1，否 = 0)，以年龄、性别、季节、早产、抽动障碍、身材矮小、哮喘及过敏性鼻炎作为自变量(疾病组仅纳入初诊数据)，进行二元logistic回归分析。结果示女性、冬季、早产、抽动障碍、哮喘、身材矮小均为维生素D缺乏/不足的危险因素，具体见表3。

Serum 25(OH)D levels in children of different age
年龄分组 人数 水平[nmol/L, M(P25, P75)] 缺乏n(%) 不足n (%) 充足n (%)
新生儿组 107 28.3 (19.5, 36.5) 65 (60.8) 38 (35.5) 4 (3.7)
婴儿组 207 73.5 (34.8, 100.3) 42 (20.3) 30 (14.5) 135 (65.2)
幼儿组 416 80.5 (64.3, 99.9) 4 (1.0) 32 (7.7) 380 (91.3)
学龄前组 1010 56.8 (45.4, 71.8) 52 (5.2) 308 (30.5) 650 (64.3)
学龄组 640 50.5 (38.8, 61.7) 74 (11.6) 244 (38.1) 322 (50.3)
青春期组 785 45.3 (33.1, 57.0) 150 (19.1) 330 (42.0) 305 (38.9)
H/c2值 769.295 468.457
P值 <0.05 <0.05

表1. 不同年龄儿童血清25(OH)D水平

Serum 25(OH)D levels in children of different seasons and age groups [nmol/L, M(P25, P75)
新生儿期组 婴儿期组 幼儿期组 学龄前期组 学龄期组 青春期组
冬春季 26.0 (15.5, 36.3) 71.5 (32.2, 100.1) 76.0 (60.3, 91.3) 51.8 (39.8, 66.8) 42.8 (31.3, 55.3) 38.1 (28.0, 49.9)
夏秋季 30.3 (23.6, 38.8) 75.5 (35.1, 102.6) 87.8 (68.0, 106.3) 61.5 (49.5, 74.8) 55.5 (45.3, 64.5) 49.3 (39.0, 61.1)
H值 4.723 0.452 20.406 58.455 74.966 71.249
P值 <0.05 0.50 <0.05 <0.05 <0.05 <0.05

表2. 不同季节、各年龄组儿童血清25(OH)D水平[nmol/L, M(P25, P75)]

Logistic regression analysis of factors influencing vitamin D deficiency/insufficiency in children aged 0 to 18 year
变量 人数 β SE P OR (95%CI)
性别
男 2028 0 1
女 1137 0.385 0.085 <0.05 1.470 (1.245~1.736)
年龄
新生儿期 107 0 <0.05 1
婴儿期 207 −4.028 0.536 <0.05 0.018 (0.006~0.051)
幼儿期 416 −5.717 0.544 <0.05 0.003 (0.001~0.010)
学龄前期 1010 −3.851 0.519 <0.05 0.021 (0.008~0.059)
学龄期 640 −3.187 0.521 <0.05 0.041 (0.015~0.115)
青春期 785 −2.703 0.520 <0.05 0.067 (0.024~0.185)
季节
春 738 0 1
夏 1063 −1.046 0.111 <0.05 0.351 (0.283~0.437)
秋 712 −0.488 0.117 <0.05 0.614 (0.488~0.771)
冬 652 0.360 0.121 <0.05 1.433 (1.131~1.817)
诊断类别
健康查体 300 0 <0.05 1
早产儿 217 1.927 0.202 <0.05 6.869 (4.620~10.214)
抽动障碍 665 1.287 0.166 <0.05 3.622 (2.618~5.010)
身材矮小 286 1.316 0.188 <0.05 3.730 (2.580~5.394)
哮喘及过敏性鼻炎 232 1.689 0.197 <0.05 5.412 (3.677~7.966)
其他疾病 1235 1.087 0.157 <0.05 2.965 (2.179~4.034)

表3. 0~18岁儿童维生素D缺乏/不足影响因素的logistic回归分析

 4. 讨论

维生素Ｄ对儿童青少年健康意义重大，随着对维生素D生理作用的深入研究，维生素D缺乏与疾病的相关性不断被发现，国内外学者对维生素D缺乏，特别是特殊人群的维生素D缺乏关注度增高。目前，国内儿童血清25(OH)D水平和维生素D缺乏数据多以医院健康体检儿童为主 [ 2 ] [ 4 ] [ 5 ] 。本研究为综合性医院儿科6年3000多例较大样本的维生素D数据分析，年龄范围涵盖了婴儿期~青春期，数据包含较多患病儿童。文中分析了样本数较多的几种疾病(抽动障碍、早产、矮小、哮喘等)的维生素D缺乏风险，同时分析了年龄、性别、季节等对儿童维生素D水平的影响。

结果显示：维生素D水平和缺乏情况呈现明显年龄差异，>1岁组儿童血清25(OH)D水平呈现随年龄增长下降趋势，年龄越大缺乏/不足率越高，青春期组维生素D充足率仅有38.85%。国内2010~2020健康儿童维生素D水平Meta分析数据也表明：缺乏率随着年龄增加逐渐增高，婴幼儿组最低，青春期最高(56.14%) [ 2 ] 。可能与我国3岁以下儿童维生素D补充剂应用率较高有关，婴幼儿期维生素D维持在一个较好的水平 [ 6 ] 。随着儿童年龄增长，维生素D补充剂的应用减少，户外活动不足，维生素D缺乏率反而升高。Giudici等 [ 7 ] 指出青春期儿童的维生素D状态可能会受到青春期发育、短暂的青春期胰岛素抵抗、体育活动不足和饮食习惯变化等因素的影响而恶化。本研究中新生儿组血清25(OH)D水平最低，缺乏/不足率为96.3%。Yang等报道0~18岁健康儿童维生素D水平新生儿组最低，缺乏/不足率为88.1%，与本结果基本相符 [ 8 ] 。新生儿期25(OH)D水平受出生体质量、日龄、孕母年龄、孕母25-羟维生素D水平、孕中晚期补充维生素D剂量等多种因素影响 [ 9 ] 。母亲孕期维生素D缺乏仍然较常见，脐血25(OH)D与母体孕晚期维生素D水平明显相关，但低于母体水平，平均比母亲低9.2 ng/mL (约减少50%)，同时维生素D结合蛋白也约为母体水平一半，游离25(OH)D有可能增高，对于新生儿25(OH)D参考值和阈值水平仍存在争议 [ 10 ] 。

本研究中女童维生素D水平低于男童，两者有统计学差异(Z = −3.484, P < 0.05)，出现维生素D缺乏/不足的风险为男童的1.47倍，与既往多个研究 [ 5 ] [ 11 ] [ 12 ] 相一致，女童的25(OH)D水平更低，缺乏的风险更大，这可能是与女童的户外活动时间相对较少，使用防晒产品意识较强，皮肤直接接受阳光照射时长偏短有关，使用防晒霜和衣物遮挡等物理防晒措施会导致维生素D的自身合成减少 [ 13 ] ，而李贤见等 [ 14 ] 的研究结果未显示性别间的差异。Young等 [ 15 ] 建议户外活动时使用高UVA-PF (Ultraviolet A protection factor，紫外线A保护系数)值的防晒霜，以减少对UVB的防护，从而促进维生素D的产生。

影响维生素D水平的因素有很多，季节、地理纬度、海拔、日照时间、着装习惯、防晒措施等均可影响人体维生素D水平 [ 16 ] [ 17 ] 。本研究结果显示，除婴儿期外，儿童血清25(OH)D水平以夏秋季较高，冬春季较低，与国内多数研究结果一致 [ 4 ] [ 18 ] [ 19 ] ，婴儿期维生素D水平季节差异不显著，可能与此年龄组户外活动较少但规律服用维生素D补充剂比例较高有关 [ 20 ] ，而新生儿期维生素D水平受母体影响较大，季节差异有统计学意义。2010~2012年中国营养与健康调查结果显示，儿童维生素D水平存在地区和季节差异 [ 2 ] ：6~17岁儿童25(OH)D < 50 nmol/L比例在春、夏、秋、冬季分别为59.6%、37.4%、50.85%、58.8%，冬春季缺乏比例高。人体维生素D水平季节差异主要和阳光照射，皮肤阳光暴露程度，自身经皮肤合成维生素D有关。

本研究对象为综合性医院儿科就诊人群，其中部分为儿科疾病人群，样本中“早产儿、抽动障碍、哮喘、身材矮小”等病例数占比相对较多，logistic回归分析显示与健康查体儿童相比疾病儿童维生素D不足/缺乏可能性更大。Li等 [ 21 ] 的病例对照研究结果显示，患有抽动障碍儿童的血清25(OH)D水平低于正常儿童，且其降低水平与疾病的严重程度相关，并在该团队随后的随机对照研究中证实了补充维生素D可能会有效改善抽动症状 [ 22 ] ，这与本研究结果相符。但Bond等 [ 23 ] 的一项大型多中心研究显示较低的血清25(OH)D水平与抽动障碍及疾病的严重程度无关，而与抽动障碍合并出现注意缺陷多动障碍及其严重程度有关，作者强调有关“抽动障碍与维生素D”的相关研究应记录维生素D补充剂的使用和日晒的数据等资料，并在未来的研究中进行控制。

身材生长受遗传因素和环境因素的共同调节，身材矮小与各种潜在的环境因素，包括膳食摄入不足、必需营养或微量元素缺乏、环境污染物暴露等相关。维生素D的缺乏会降低骨骼矿化和骨骼生长速度 [ 24 ] ，从而可能会影响身高。本研究中初诊身材矮小儿童出现维生素D缺乏/不足的风险为健康查体儿童的3.73倍，Xu等 [ 25 ] 的研究亦指出身材矮小儿童的维生素D水平低于正常身材对照儿童。

本研究结果显示哮喘和过敏性鼻炎儿童出现维生素D缺乏/不足的风险较高。维生素D已被证明可以调节免疫系统中促炎和抗炎反应的平衡，它对免疫系统各个方面的调节使人们逐渐认识到其在哮喘中的潜在作用。荟萃分析结果表明母亲孕期补充维生素D有助于预防哮喘的发展和生命早期的反复喘息，von Mutius等 [ 26 ] 认为虽然补充维生素D对预防学龄期儿童哮喘方面的效果并不明显，但对于父母有哮喘或过敏史的儿童来说，母亲孕期补充维生素D仍具有重要意义。对于哮喘儿童应及时矫正维生素D缺乏状态，以利于免疫功能恢复和哮喘发作的控制。早产儿出现维生素D缺乏/不足的可能性为健康查体儿童的6.869倍，这一结果与Burris等 [ 27 ] 的研究一致，维生素D缺乏的风险随胎龄减小而增加 [ 28 ] 。本研究的局限性在于：样本来自综合性医院儿科就诊人群，为健康体检人群混杂儿科疾病人群，虽有助于影响因素的分析，但可能无法准确得到健康群体的维生素D水平。

维生素D的受体分布在全身各个系统，其活性形式1,25-(OH)控制着负责调节细胞增殖、分化、凋亡在内的上百个基因，维生素D的缺乏/不足与多种疾病风险相关 [ 29 ] 。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。在2022年“中国儿童维生素D营养相关临床问题实践指南”中明确指出，从新生儿出生数天后直至青春期，儿童每日均需补充维生素D 400 IU，因此应做好科普宣传工作，合理应用维生素D补充剂，监测易患病群体血清25(OH)D水平，降低维生素D的缺乏/不足患病率。

 文章引用

聂梦姝,衣明纪,杨召川,单延春,王艳霞,马 良,刘 伟,刘小梅,冉 霓. 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[J]. 临床医学进展, 2023, 13(05): 8782-8789. https://doi.org/10.12677/ACM.2023.1351227

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