昆明市幼儿骨密度影响因素分析

【目的】探讨昆明市1~3岁幼儿骨密度及相关的影响因素,为了解此年龄段儿童肾发育状况提供参考。【方法】利用超声骨密度仪测定昆明市133名汉族幼儿胫骨骨密度,同时通过问卷调查的形式对其出生情况、喂养方式、是否补充钙剂及VitD制剂,父母文化程度等相关因素进行调查。【结果】高龄幼儿组骨密度明显高于低龄幼儿组;不同性别幼儿骨密度值差异无统计学意义;幼儿身长、体重和骨密度值呈正相关;补充钙剂和骨密度值有关;父母文化程度与幼儿骨密度值的有显著相关性。【结论】影响昆明市幼儿骨量水平的重要因素是:年龄、身长、体重和补钙情况以及父母文化程度。     

产后妇女骨密度影响因素分析

目的了解产后妇女骨密度变化及相关影响因素,为预防妊娠哺乳期妇女骨量降低提供依据。方法对2010年1-3月及2010年6-7月在株洲市妇幼保健院产后42 d检查的单胎足月分娩产妇,随机抽取222例测量骨密度、查血AB18、尿常规、测血压、量身高体重,并进行问卷调查,准确记录年龄、孕期是否补钙、孕期及产后缺钙症状、婴儿喂养方法等。结果 222例产妇骨质疏松发生率为9.91%。经统计学处理骨密度与身高、体重呈正相关;与孕期缺钙症状、怀孕季节、是否产后贫血差异无统计学意义（P〉0.05）;与喂养方式、孕期是否补钙差异有统计学意义（P〈0.01）,与有无产后缺钙症状差异有统计学意义（P〈0.05）。结论妊娠哺乳妇女应常规补充钙剂,增加食物钙含量,减少骨量丢失,尤其是身高体重较小、纯母乳喂养、产后有缺钙症状的孕产妇要注意监测骨密度的变化。     

286例产妇产褥期骨密度降低的影响因素研究

目的研究286例产妇产褥期骨密度降低的影响因素。方法选择2015年4月—2016年4月期间在广州市海珠区妇幼保健院住院分娩的产妇(孕38~40周时骨密质检测正常)286例作为研究对象,于产后6~7周对其进行随访调查,并采用FURUNO CM200B超骨密度检测仪检测产妇骨密度。比较产妇产褥期和孕38~40周时的骨密度,并分析喂养方式、产褥期补钙、不良生活行为、产后户外运动及孕期体重增加对骨量减少的影响。结果产褥期产妇骨密度与孕期对比,差异有统计学意义(P<0.05);产褥期产妇骨量减少为20例,发生率为6.99%(20/286);分析得出产后喂养方式、产褥期补钙情况、生活行为、产后户外运动及孕期体重增加情况对骨量减少均存在显著影响。结论产褥期产妇哺乳方式、生活方式及饮食习惯均为骨密度降低的影响因素,故应有效提升钙的摄入量,并纠正不良生活习惯及饮食行为。     

孕期补钙与小儿骨密度关系调查

目的探讨小儿骨密度与孕期补钙的关系,为临床预防小儿低骨密度提供依据。方法随机选择3个月～1岁的小儿732名,用超声骨密度仪测量胫骨中段骨密度,同时,询问母亲孕期补钙情况、腓肠肌痉挛次数、孕后期所处季节等。结果母亲在孕期补钙的婴幼儿骨密度异常率为23.3%,母亲在孕期未补钙的婴幼儿骨密度异常率为40.6%,比较差异有统计学意义(P0.05)。在孕期出现腓肠肌痉挛次数越多骨密度异常率越高,差异有统计学意义(P0.05)。母亲孕后期在冬春季的婴幼儿骨密度异常率为44.4%,母亲孕后期在夏秋季的婴幼儿骨密度异常率为26.5%,比较差异有统计学意义(P0.05)。结论小儿低骨密度的发生与孕期是否补钙、腓肠肌痉挛的次数及怀孕后期所处的季节有关。     

婴幼儿骨密度及其影响因素分析

目的:观察10个月～3岁的婴幼儿骨密度测量值,分析相关影响因素。方法:应用超声骨强度测量仪测量110例婴幼儿骨密度,并对所有婴幼儿家长进行问卷调查。结果:婴幼儿SOS值与月龄呈明显正相关。89例(80.91%)婴幼儿骨密度在正常范围。男女婴幼儿间骨量减少差异不具有统计学意义(P>0.05)。母孕期未补钙、产后小儿未予补钙、低龄、单纯母乳喂养等与婴幼儿骨量减少有关。结论:多数婴幼儿骨密度在正常范围,临床应注意母孕期及产后给予小儿补钙,并注意混合喂养。     

新生儿脐带血促肾上腺皮质激素、皮质醇水平的影响因素研究

目的 分析健康足月儿促肾上腺皮质激素(ACTH)、皮质醇(COR)的水平及其影响因素,为新生儿的预防保健提供理论支持。方法 选取2018年10月-2019年2月空军医学特色中心妇产科出生的88例新生儿为研究对象,检测脐带血ACTH、COR水平,用最优尺度回归分析的方法探讨分娩方式、胎龄、性别、出生体重、母亲孕期情况对新生儿脐带血ACTH、COR水平的影响。结果 88例新生儿脐带血ACTH水平为(172.11±93.93)pg/ml,COR水平为(310.05±125.33)ng/ml。单因素分析结果显示,不同分娩方式、胎龄的新生儿脐带血COR水平的差异具有统计学意义(P＜0.01),而不同性别、出生体重、母亲孕期健康情况的新生儿COR水平差异无统计学意义,不同分娩方式、胎龄、性别、出生体重、母亲孕期情况的新生儿的ACTH水平差异无统计学意义(P>0.05)。最优尺度回归分析显示,分娩方式、性别、胎龄和体重对脐带血COR的水平有显著影响(β=-0.522,-0.221,0.284,-0.260,P＜0.05)。结论 分娩方式、胎龄是健康足月儿脐带血COR水平的主要影响因素,而本研究所涉及的胎龄、性别、出生体重、母亲孕期情况等均不影响ACTH水平。     

产后骨密度影响因素研究

目的了解产后42-60 d妇女骨密度影响因素。方法利用双能X线吸收仪检测髋关节骨密度、L1-4腰椎骨密度,利用MES-运动功能分析仪进行双下肢肌肉功能分析,自制调查表调查孕期小腿抽筋情况、分娩方式、母乳喂养情况、产后钙摄入情况。结果产后骨密度存在不同程度下降,骨密度值与孕期小腿有无抽筋、分娩方式、喂养方式、产后钙摄入情况密切相关。结论孕期和产后补钙有助于预防产后骨密度下降。     

围产期妇女骨量及骨代谢生化指标的临床研究

目的:探讨整个孕期影响骨代谢的相关因素。方法:孕妇入院待产后取空腹血和晨尿测定尿钙(Ca)、肌酐(Cr)、血碱性磷酸酶(ALP),产后3天内测骨密度。根据孕期补钙及喝牛奶情况分为两组:孕20周以后补钙(元素钙500 mg/天以上)及喝牛奶(250 ml/天以上)持续16周以上的59例产妇为A组,未有效补钙及喝牛奶的58例产妇为B组。结果:初产年龄与左侧股骨颈骨密度值的高低有正相关性,A组左侧股骨颈骨密度高于B组,差异有统计学意义;B组产妇血ALP、尿Ca/Cr高于A组,差异有统计学意义。结论:孕期容易发生骨量减少,有效补钙可以防治孕期骨质疏松,降低骨转换率。     

新生儿骨密度与孕期保健

目前国内外尚缺乏新生儿及婴幼儿的骨密度正常值,更缺乏用骨密度的方法来观察新生儿及婴幼儿骨骼发育及疾病的报道.本文采用单光子骨密度仪测定了110例正常孕母尺桡骨及其新生儿的胫腓骨骨密度,同时还测定了部分早产儿的骨密度,对母孕期营养供给、补钙、日晒、运动等多种因素对其所生新生儿骨密度的影响也进行了多因素分析,结果表明早产双胎儿骨密度值明显低于足月正常新生儿,母孕期适当补充钙剂对母婴的骨密度均有明显影响,母孕期未加服钙剂者母亲的尺桡骨骨密度值明显低于服用钙剂者,她们所生新生儿的骨密度亦明显降低,多因素进步回归分析也发现母孕期的营养供给对新生儿有正性影响,所以提倡孕期保健、适当服用一些钙剂与鱼肝油,加强孕期营养是促进新生儿生长发育的有力保障.     

孕产妇骨密度及其相关因素分析

目的:研究孕产妇及哺乳期妇女骨密度的变化及相关因素的影响。方法:采用双能X线骨密度仪对3 103例产后42天的健康妇女进行手指骨密度测定。结果:年龄大、学历高的哺乳期妇女骨密度低;孕期及产后未补钙、未补充牛奶及未进行户外活动的产妇比补钙、补充牛奶、进行户外活动的产妇骨密度低,差异有统计学意义(P<0.05)。结论:孕产妇及哺乳期妇女极易发生骨密度下降、骨质疏松,骨密度受内分泌、代谢、膳食、哺乳、运动及补充钙剂的影响,应对孕产妇骨密度降低进行防治。     

珠海市6月龄婴儿超声骨密度与身长发育关系的调查分析

[目的]了解婴儿生长发育期间身高的增长速度与超声骨密度之间的关系,为探讨婴儿生长发育期间骨矿物质缺乏及预防早期佝偻病的发生提供依据.[方法]取2009年1月-2010年2月份门诊体检随机监测的6月龄婴儿531名.采用美国奥诺BMD-1000C型超声骨质分析仪进行婴儿胫骨SOS值测量,并采用Z值进行比较[Z值=(测值-均...     

胎婴儿骨代谢研究进展

本文介绍了早产儿代谢性骨病发病基础及现状,主要论述了早产儿出生前后矿物质代谢特点,指出早产儿代谢性骨病发生的原因与宫内及宫外环境因素密切相关。     

幼儿摄食影响因素Logistic回归分析

目的了解幼儿的摄食情况及其影响因素。方法采用整群抽样方法在福州市区抽取5所幼儿园,并对778名幼儿家庭进行问卷调查。结果儿童经常吃的食物是米饭、面包、肉、鱼、鸡蛋、青菜、牛奶;母亲的文化程度、母亲从事职业、以及父母是否关注儿童喂养方面的电视或书刊,均与儿童摄食情况有关(P<0．05)。结论要使儿童养成良好的饮食习惯,家长要积极引导,学校要加强健康教育。     

西安市0～3岁婴幼儿超声骨密度7207例分析

目的 了解西安市0~3岁婴幼儿骨密度现状,探讨年龄、性别及季节对婴幼儿骨密度的影响,为婴幼儿骨强度不足早期防治提供依据。方法采用定量超声技术,测定7 207例0~3岁婴幼儿左侧胫骨的超声速度(speed of sound,SOS)和Z值,并对不同性别、不同年龄、不同季节的骨密度不足检出率进行比较分析。结果 女童骨密度Z值低于男童(P0.001);不同月龄婴幼儿骨密度SOS和Z值间差异有统计学意义(P0.001),0~3月龄组的SOS值最低,0~3月和3~6月龄组Z值差异无统计学意义(P0.05)。骨强度不足总检出率为74.29%,其中女童检出率(81.10%)高于男童(68.02%)。0~3月和3~6月龄组骨强度不足检出率达90%以上;骨强度不足检出率随年龄增长呈下降趋势(P0.001)。冬季男童骨的SOS值最低。结论 本地区婴幼儿需常年补充钙剂及维生素D制剂;生后0~6个月是防治骨强度不足的关键时期。女童易发生骨强度不足。     

1431名婴儿超声骨强度测定结果分析

目的：了解婴儿骨强度现状,探讨影响婴儿骨强度的相关因素。方法：用定量超声仪对1431名婴儿进行骨强度测定并进行相关因素问卷调查,调查资料运用SPSS统计软件进行分析。结果：婴儿骨强度减低占44.2%,以轻度为主,经单因素和多因素分析,性别、年龄、有佝偻病症状和体征、喂养方式与婴儿骨强度相关。结论：婴儿骨强度总体水平偏低,临床应重点关注小年龄女婴,定期监测骨强度,对防治婴儿佝偻病有积极意义。     

不同喂养方式对早产小于胎龄儿骨密度的影响

目的 研究不同喂养方式对早产小于胎龄儿（ SGA）骨密度的影响。方法 将215例小于胎龄儿按照喂养方式分为5组：早产儿出院后配方奶喂养组、母乳喂养组、足月儿配方奶喂养组、母乳＋早产儿出院后配方奶喂养组、母乳＋足月儿配方奶喂养组,比较各组在生后第6月、12月骨密度值。结果 5组小于胎龄儿的骨密度数值从高到低依次为：母乳＋早产儿出院后配方奶喂养组、母乳喂养组、早产儿出院后配方奶喂养组、母乳＋足月儿配方奶组、足月儿配方奶喂养组,差异具有统计学意义（6月龄时：F男＝2．845,F女＝2．570;12月龄时：F男＝2．737,F女＝7．461,均P＜0．05）。结论 对早产小于胎龄儿童进行母乳喂养或强化母乳喂养能改善其骨密度情况,适用于早产儿。     

Bone Mineral Density,Body Composition,and Metabolic Health of Very Low Birth Weight Infants Fed in Hospital Following Current Macronutrient Recommendations during the First 3 Years of Life

The present study longitudinally evaluated growth, bone mineral density, body composition, and metabolic health outcome in very low birth weight (VLBW) infants whose in-hospital target nutrient intake was within recent recommendations. From six months to three years, bone mineral density (dual-energy X-ray absorptiometry, DXA), body composition, and metabolic health outcome were compared with a reference group of term infants. The aim was to test whether in-hospital achieved weight gain until 36 weeks of gestation (light or appropriate for term equivalent age; LTEA or ATEA) predicts later growth, bone mineral density (BMD), abdominal obesity, or metabolic health outcomes such as insulin resistance, relative to term infants, during the first three years of life. Target in-hospital energy and protein intake was not achieved. Growth in weight, length and head circumference, mid arm circumference, adiposity, fat free mass (FFM), and bone mineralization in VLBW infants was less than those in term infants and influenced by nutritional status at discharge. Preterm infants had poorer motor and cognitive outcomes. Post-discharge body composition patterns indicate FFM proportional to height but lower fat mass index in LTEA preterm infants than term infants, with no evidence of increased truncal fat in preterm infants. The hypothesis of early BMD catch-up in VLBW infants after discharge was not supported by the present data. The clinical significance of these findings is unclear. The data may suggest a reduced obesity risk but an increased osteoporosis risk. Since postnatal growth restriction may have permanent negative health effects, LTEA VLBW infants would especially appear to benefit from targeted preventive interventions. Further follow-up of the infants is required.     

无锡地区健康婴儿与数据库中亚洲婴儿骨骼超声测量结果的比较

目的:了解无锡地区0~12个月的婴儿骨骼强度的状况。方法:共检测7 727例0~12个月的无锡地区健康婴儿,采用标准方法测定婴儿胫骨中段的SOS值;以Sunlight系统内提供的同月龄、同性别亚洲婴儿的SOS值为参照标准。结果:①得出无锡地区0~12个月健康婴儿骨骼SOS值;②得出无锡地区婴儿与亚洲婴儿比较后的Z值。结论:无锡地区0~12个月健康婴儿骨骼SOS值与数据库提供的亚洲婴儿SOS值比较,Z值早期低,随月龄增加逐渐接近。     

Factors affecting newborn bone mineral content: in utero effects on newborn bone mineralization

Several factors have been found recently to have a significant impact on newborn bone mineral content (BMC) and developing fetal bone. Recently we showed that maternal vitamin D deficiency may affect fetal bone mineralization. Korean winter-born newborn infants had extremely low serum 25-hydroxyvitamin D (25-OHD), high serum cross-linked carboxy-terminal telopeptide of type I collagen (ICTP; a bone resorption marker), and markedly lower (8 %) total body BMC than summer-born newborn infants. Infant total body BMC was positively correlated with cord serum 25-OHD and inversely correlated with ICTP, which was also negatively correlated with vitamin D status. In three separate studies on North American neonates we found markedly lower (8-12 %) BMC in summer newborn infants compared with winter newborn infants, the opposite of the findings for Korean neonates. The major reason for the conflicting BMC results might be the markedly different maternal vitamin D status of the North American and Korean subjects. Recently, we found evidence of decreased bone formation rates in infants who were small-for-gestational age (SGA) compared with infants who were appropriate-for-gestational age; we reported reduced BMC, cord serum osteocalcin (a marker of bone formation) and 1,25-dihydroxyvitamin D (the active metabolite of vitamin D), but no alterations in indices of fetal bone collagen metabolism. In theory, reduced utero-placental blood flow in SGA infants may result in reduced transplacental mineral supply and reduced fetal bone formation. Infants of diabetic mothers (IDM) have low BMC at birth, and infant BMC correlated inversely with poor control of diabetes in the mother, specifically first trimester maternal mean capillary blood glucose concentration, implying that factors early in pregnancy might have an effect on fetal BMC. The low BMC in IDM may be related to the decreased transplacental mineral transfer. Cord serum ICTP concentrations were higher in IDM than in control subjects, implying increased intrauterine bone resorption. BMC is consistently increased with increasing body weight and length in infants. Race and gender differences in BMC appear in early life, but not at birth. Ethanol consumption and smoking by the mother during pregnancy affect fetal skeletal development.     

In utero physiology: role in nutrient delivery and fetal development for calcium, phosphorus, and vitamin D

Only limited aspects of the transfer of calcium across the placenta to the fetus are known. Clinical outcome studies suggest that bone mineral mass in newborn infants is related to maternal size and dairy intake. Available data indicate that vitamin D deficiency may also limit in utero fetal bone mineral accumulation. Recent data suggest that maternal vitamin D status affects long-term childhood bone status. At present, no strong evidence exists showing that improving maternal calcium or vitamin D status has a long-term positive effect on childhood bone mass. In premature infants, clinical rickets and fractures are common. In utero rates of calcium accretion during the third trimester cannot be readily achieved. The use of fortifiers designed for human-milk-fed infants or specially designed high-mineral-containing formulas allows for bone mineral accretion at or near in utero rates. Recent data have shown that physical therapy programs, judiciously used, in combination with adequate mineral content, can enhance bone mineral mass in preterm infants. There is little evidence for the use of high doses of vitamin D in the management of premature infants. After hospital discharge, continuation of a relatively high mineral intake has been shown to enhance bone mineral acquisition. Future research should include evaluations of the role of maternal vitamin D supplementation on fetal and infant bone mass, the mineral needs of infants weighing <800 g or <25 wk gestation, and the optimal discharge management of premature infants who are at risk of low bone mass.