泰兴镇0～3岁儿童维生素D缺乏性佝偻病发病因素分析

目的了解泰兴镇0～3岁儿童佝偻病发病情况及其影响因素,为社区防治提供科学依据。方法检测680名门诊体检儿童外周骨源性碱性磷酸酶(bone alkaline phosphatase,BALP)活性,并对其母亲作佝偻病发病相关因素调查。结果 680名儿童中佝偻病发生率22.1%,其发病与孕期缺钙、早产、低体重、双胎、喂养及辅食添加不当等因素有关,P<0.05为差异有统计学意义。居住地区、男女发病率差异无统计学意义(P>0.05)。结论佝偻病的发生是多因素综合作用的结果,对母亲给予营养及健康教育,有助于改善儿童喂养方式,促进正常发育。     

包头地区晚发性佝偻病的相关因素分析

本文探讨包头地区晚发性佝偻病发病的相关因素。方法采用BALP试剂盒检测骨碱性磷酸酶,根据诸福棠实用儿科学晚发性佝偻病的诊断标准,选择40例患儿并与60名健康儿童作以对照,就性别、母亲文化程度,喂养情况,发病季节,幼时患佝偻病以及症状体征等可能的相关因素予以分析。结果表明,母亲文化程度低、有偏食、出现症状、体征是晚发性佝偻病的发病危险因素,而幼时患佝偻病为其抵抗因素。     

幼儿乳牙龋病影响因素调查

目的:了解幼儿乳牙龋病患病情况的影响因素。方法:对北京市154名幼儿龋齿进行检查并对母亲口腔健康状况及相关因素进行调查。结果:154名幼儿中,患龋齿66名,患龋率为42.85%,龋均为2.20;母亲患龋齿的幼儿患龋率为49.35%,明显高于母亲未患龋齿患龋率35.67%(P<0.05);中学、小学及以下的幼儿患龋率为50.64%,明显高于母亲的文化程度在中专、大学以上的幼儿患龋率35.06%(P<0.05);母亲口腔健康知识丰富的幼儿患龋率为31.81%明显低于知识贫乏的幼儿患龋率46.10%(P<0.05)。幼儿开始刷牙年龄在>3岁的幼儿患龋率为47.40%明显高于刷牙年龄在≤3岁的患龋率30.51%(P<0.05);每天用含氟牙膏并能早晚各1次刷牙的幼儿患龋率为31.16%与每天不刷牙的幼儿患龋率52.59%比较差异有统计学意义(P<0.05)。幼儿无佝偻病组患龋率为23.86%,明显低于有佝偻病组的56.06%,差异有统计学意义(P<0.01)。结论:母亲的口腔健康状况、文化程度及幼儿开始刷牙时间、频率、每天坚持用含氟牙膏刷牙、幼儿患佝偻病与幼儿乳牙龋病有直接影响。     

学龄前儿童佝偻病危险因素分析

目的探讨学龄前儿童佝偻病发病状况及危险因素,为制定预防措施提供依据。方法采用随机抽样方法,抽取义乌市学龄前儿童共850人,对其监护人进行问卷调查,内容包括社会经济状况、抚育因素、生活环境因素等。采用卡方检验及多因素logistic回归分析佝偻病危险因素。结果义乌学龄前儿童佝偻病患病率为27.1%,其影响因素主要有年龄(OR=1.02,95%CI:1.01～1.03,P<0.01),性别(OR=1.54,95%CI:1.12～2.14,P<0.01),哮喘(OR=2.18,95%CI:1.25～3.77,P<0.01),儿童在婴儿期的喂养方式(OR=0.80,95%CI:0.67～0.97,P<0.05)。结论义乌学龄前儿童佝偻病形势仍较严峻,因根据危险因素,开展针对性的健康教育,建立良好卫生习惯,预防佝偻病的发生。     

2005-2012年我国27省市3岁以内儿童佝偻病流行病学特征分析

【目的】 分析2005-2012年我国3岁以内儿童佝偻病的流行病学特征。 【方法】 从中国知网、重庆维普和万方数据库检索佝偻病流行病学研究的相关文献,根据设立的筛选标准进一步筛选出具有代表性的研究文献。提取性别、年龄、喂养方式、佝偻病检出率等相关数据,并与1977-1983年普查资料进行比较,采用描述流行病学方法分析2005-2012年我国27省市3岁以内儿童佝偻病的流行病学特征。 【结果】 共纳入27篇文献,我国佝偻病的平均检出率由1977-1983年的40.3%下降为本次分析的20.3%。佝偻病的检出率在东北、华北和西北地区明显下降,但江西、河南和新疆3省则明显上升。佝偻病的发病与年龄和婴幼儿喂养方式有关,1岁以内婴幼儿佝偻病的检出率最高,各种喂养方式检出率母乳喂养<混合喂养<人工喂养。 【结论】 我国佝偻病的发病整体呈下降趋势,但在幼儿特别是低龄幼儿中仍广泛流行。佝偻病是多因素综合作用的结果,需加强防治工作。     

西昌市城区0~4岁儿童佝偻病现况调查

【目的】 通过流行病学调查研究西昌市0~4岁汉族和彝族儿童营养性维生素D缺乏佝偻病患病情况及影响因素。 【方法】 于西昌市区随机选取来自5个幼儿园及凉山彝族自治州第一人民医院儿保科常规保健就诊的1 235名儿童进行常规体检及实验室检查,包括25-(OH)-D₃骨密度,骨钙素、左手腕骨X拍片。并对其家长进行问卷调查。 【结果】 西昌市区0~4岁儿童佝偻病患病率为38.1%,婴儿佝偻病患病以早期、活动期为主,幼儿以恢复期、后遗症期为主。彝族儿童佝偻病患病率较高,血25-(OH)-D₃水平明显低于汉族儿童。影响西昌城区儿童患病的因素主要有民族差异,彝族儿童患病因素有喂养及维生素AD添加方式。 【结论】 应加强婴幼儿营养性维生素D佝偻病的早期预防,尤其需加强彝族儿童健康管理。     

甘肃省定西地区佝偻病调查及相关因素分析

目的研究定西地区O~7岁儿童佝偻病患病率及相关因素。方法以随机抽样法选取定西地区O~7岁儿童480例,设计调查表进行佝偻病及其相关因素调查。结果定西地区O~7岁儿童佝偻病的患病率为29.58%,其中男童28.63%,女童30.73%,男女童患病率无明显差异(P0.05)。不同年龄段儿童佝偻病患病率存在统计学差异,以O~1岁婴儿患病率最高,3~7岁儿童最低(PO.05)。与该地区佝偻病的发生率相关的因素包括:家庭年人均收入、住房阳光朝向、父亲受教育水平、母亲孕期营养状况、户外活动时间、早期补充维生素D干预、喂养方式、富钙食品摄入情况等因素。结论定西地区儿童佝偻病是由于多种因素综合作用的结果,应采取早期筛查、早期干预、综合防治的措施,进一步控制佝偻病的发病率。     

湖南省5岁以下儿童营养不良的多因素研究

目的 了解影响湖南省5岁以下儿童营养不良的因素,为进一步降低营养不良的发病率,改善儿童营养提供依据.方法 利用Logistic回归方法分析影响湖南省5岁以下儿童生长发育的主要因素.结果 经单因素分析,2004年影响湖南省5岁以下儿童生长发育的主要因素为民族、居住地、父母亲的文化程度、人均收入、母亲职业、早产、窒息、肺炎、贫血、佝偻病、母乳喂养和剖宫产(经X2检验P值均小于0.05).Logistic回归分析发现父亲和母亲文化程度高(β分别为-1.503、-2.071)、剖宫产(β=-0.352)是避免低体重发生的保护因素,民族(β=0.255)、早产(β=0.981)、窒息(β=0.586)、肺炎(β=0.922)、喂养方式(β=0.181)、佝偻病(β=0.423)和贫血(β=0.709)是导致消瘦的危险因素;父亲和母亲文化程度高(β分别为-1.018及-2.509)、母亲职业(β=-0.478)、人均收入(β=-0.624)和剖宫产(β=-0.352)是避免低体重发生的保护因素,民族(β=0.507)、早产(β=0.948)、喂养方式(β=0.251)、贫血(β=1.008)和佝偻病(β=0.487)是导致低体重的危险因素;父亲文化(β=-0.977)、母亲文化(β=-2.712)、剖宫产(β=-0.259)和人均收入(β=-0.389)是避免发育迟缓发生的保护因素,民族(β=0.468)、居住地(β=0.564)、早产(β=0.640)、喂养方式(β=0.178)、贫血(β=0.706)和佝偻病(β=0.355)是导致发育迟缓的危险因素.结论 社会经济发展、科学喂养及降低儿童常见病发生有助于改善湖南省5岁以下儿童营养状况.     

通化地区3161例学龄前儿童维生素D缺乏普查分析

目的 :为掌握通化地区学龄前儿童佝偻病发病、治疗情况 ,分析相关影响因素。方法 :我们于 2 0 0 2年对通化地区 3 161名儿童进行筛查、骨碱性磷酸酶 (BALP)技术检测及家长问卷调查。结果 :各年龄组儿童按BALP值诊断佝偻病的发病率 18 0 %～ 68 0 % ,可疑患病 5 0 0 %～ 80 1% ,按临床症状及体征诊断佝偻病发病率 1 0 %～ 18 9%。母亲养育技术、文化水平等与发病率正相关。结论 :儿童佝偻病发病率很高 ,依靠临床表现诊断率有很高的漏诊 ;农村发病率较高 ,3岁后佝偻病发病率目前有增高的趋势 ;母亲养育技术的水平、职业及文化程度等与儿童佝偻病有很大的相关性。     

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。     

25(OH)Vitamin D Deficiency and Calcifediol Treatment in Pediatrics

Vitamin D is essential for the normal mineralization of bones during childhood. Although diet and adequate sun exposure should provide enough of this nutrient, there is a high prevalence of vitamin D deficiency rickets worldwide. Children with certain conditions that lead to decreased vitamin D production and/or absorption are at the greatest risk of nutritional rickets. In addition, several rare genetic alterations are also associated with severe forms of vitamin-D-resistant or -dependent rickets. Although vitamin D3 is the threshold nutrient for the vitamin D endocrine system (VDES), direct measurement of circulating vitamin D3 itself is not a good marker of the nutritional status of the system. Calcifediol (or 25(OH)D) serum levels are used to assess VDES status. While there is no clear consensus among the different scientific associations on calcifediol status, many clinical trials have demonstrated the benefit of ensuring normal 25(OH)D serum levels and calcium intake for the prevention or treatment of nutritional rickets in childhood. Therefore, during the first year of life, infants should receive vitamin D treatment with at least 400 IU/day. In addition, a diet should ensure a normal calcium intake. Healthy lifestyle habits to prevent vitamin D deficiency should be encouraged during childhood. In children who develop clinical signs of rickets, adequate treatment with vitamin D and calcium should be guaranteed. Children with additional risk factors for 25(OH)D deficiency and nutritional rickets should be assessed periodically and treated promptly to prevent further bone damage.     

维生素D缺乏性佝偻病影响因素的研究

目的 探讨佳木斯地区0～2岁婴幼儿佝偻病的影响因素,为佝偻病的干预提供依据.方法 整群抽取0～2岁临床上有活动期维生素D缺乏性佝偻病症状和体征的婴幼儿159例,同时随机抽取78例0～2岁正常婴幼儿作为对照组.在填写家庭、社会和营养因素调查表的同时进行相应的体格及实验室检查.结果 单因素分析:佝偻病的发生与母孕期每天日照时间、婴幼儿年龄、每天乳制品的摄入量、每天日照时间、是否患有慢性腹泻等疾病、体重、身高等7个变量显著相关.多因素逐步回归分析:母孕期每天日照时间、婴幼儿出生体重、出生身长、出生后至调查时是否补充维生素D、每天乳制品摄入量及每天日照时间,与佝偻病的发生显著相关.结论 母孕期每天日照时间短、婴幼儿年龄小、出生体重重、出生身长短、出生后未及时补充维生素D、每天乳制品摄入量过少及每天日照时间短,是佝偻病发生的危险因素.     

Vitamin D and bone health in early life

Prolonged vitamin D deficiency resulting in rickets is seen mainly during rapid growth. A distinct age distribution has been observed in the Copenhagen area where all registered hospital cases of rickets were either infants and toddlers or adolescents from immigrant families. Growth retardation was only present in the infant and toddler group. A state of deficiency occurs months before rickets is obvious on physical examination. Growth failure, lethargy and irritability may be early signs of vitamin D deficiency. Mothers with low vitamin D status give birth to children with low vitamin D status and increased risk of rickets. Reports showing increasing rates of rickets due to insufficient sunlight exposure and inadequate vitamin D intake are cause for serious concern. Many countries (including the USA from 2003) recommend vitamin D supplementation during infancy to avoid rickets resulting from the low vitamin D content of human milk. Without fortification only certain foods such as fatty fish contain more than low amounts of vitamin D, and many children will depend entirely on sun exposure to obtain sufficient vitamin D. The skin has a high capacity to synthesize vitamin D, but if sun exposure is low vitamin D production is insufficient, especially in dark-skinned infants. The use of serum 25-hydroxyvitamin D to evaluate vitamin D status before development of rickets would be helpful; however, there is no agreement on cut-off levels for deficiency and insufficiency. Furthermore, it is not known how marginal vitamin D insufficiency affects children's bones in the long term.     

纯母乳喂养小婴儿及其母亲维生素D水平相关性研究

目的 分析出生28~42 d出现佝偻病临床表现的纯母乳喂养儿的血清维生素D水平及与其母亲血维生素D水平的相关性,为预防婴儿早期营养性佝偻病的发生提供理论依据。方法 对2016年4月-2017年10月来西北妇女儿童医院儿童保健科正常体检的年龄为28~42 d、并且表现有佝偻病早期症状和(或)体征的119例纯母乳喂养儿及其母亲静脉血25-羟维生素D[25-(OH)D]进行相关性分析。结果 119例母亲血25-(OH)D＞30 ng/ml者15例(12.61%),≤30 ng/ml者104例(87.39%);孕期平均每日补充维生素D≥400 U的母亲19例,血25-(OH)D中位数为28.8 ng/ml,每日补充维生素D＜400 U母亲100例,血25-(OH)D中位数为16.1 ng/ml,两组血25-(OH)D差异有统计学意义(P<0.05);在119例婴儿中补充和未补充维生素D组的婴儿血25-(OH)D中位数分别为20.0 ng/ml和9.5 ng/ml,两者差异有统计学意义(P<0.05);婴儿血25-(OH)D与其母亲血清25-(OH)D水平呈正相关(r=0.349,P<0.01)。婴儿血25-(OH)D水平(＞20 ng/ml和≤20 ng/ml)与其出现佝偻病的症状、体征之间无统计学意义。结论 婴儿及其母亲维生素D整体处于不足水平,两者之间维生素D水平存在相关性。婴儿血25-(OH)D＞20 ng/ml并没有降低其发生营养性佝偻病的风险。建议母亲孕期应积极补充维生素D,同时提倡从新生儿一出生即开始补充维生素D,预防婴儿早期营养性佝偻病的发生。     

社区卫生服务防控维生素D缺乏性佝偻病效果初探

目的 探讨用社区卫生服务的方法防控婴儿维生素D缺乏性佝偻病的效果。方法 把开展社区卫生服务前后的293例婴儿及其母亲分为观察组178例和对照组115例，统计并对比两组婴儿佝偻病发病率和两组母亲对佝偻病相关知识知晓率，用X^2检验统计组问差异。结果 X^2值分别为13．45、28．31，P均〈0．01，两组在发病率和相关知识知晓率方面均有显著性差异，观察组的发病率低于对照组，观察组佝偻病相关知识知晓率高于对照组。结论 扎实持续的社区卫生服务可以在较短的时问内降低社区婴儿维生素D缺乏性佝偻病的发病率，显示出明显的防控效果，较传统医学模式更有优势。     

25-Hydroxyvitamin D: functional outcomes in infants and young children

Vitamin D deficiency occurs in the United States in exclusively breastfed infants who have high levels of skin pigmentation, inadequate vitamin D supplementation, and insufficient sunlight exposure. I review serum 25-hydroxyvitamin D [25(OH)D] concentrations and functional outcomes of vitamin deficiency in young children and breastfed and nonbreastfed infants. These outcomes include the presence or absence of vitamin D deficiency rickets, bone mineral content, and serum parathyroid hormone concentration. Daily vitamin D supplements of 400 IU/L keep serum 25(OH)D concentrations higher than 50 nmol/L and prevent rickets in infants and young children. The available evidence is not sufficient to support the use of bone mineral content or parathyroid hormone concentrations in infants and young children as functional outcomes to define deficient or sufficient levels of 25(OH)D. I therefore propose a research agenda to establish the functional definitions of vitamin D sufficiency or deficiency in infants and young children.     

337例婴儿维生素D水平与超声骨密度的分析

目的 通过探讨婴儿维生素D水平与超声骨密度及身长发育等因素的关系,旨在及早的发现婴儿维生素D缺乏性佝偻病的高危因素,为确定维生素D缺乏性佝偻病的诊断标准提供依据。方法 选取2010年3月-2011年4月在本院出生,并在儿保科常规建册系统管理的9个月婴儿337例,根据生长发育指标测量方法进行体重、身长的体格测量并记录,同时进行喂养方式等相关问卷调查。9个月体检时采集婴儿静脉血5 mL,采用酶联免疫法(ELISA)检测血清25-(OH)D浓度;进行婴儿胫骨SOS测量,并采用Z值进行比较,了解骨矿化状况。并采用单因素方差分析及独立样本t检验等进行婴儿维生素D水平与超声骨密度及身长发育等的关系分析;结果 不同喂养方式、母乳喂养持续时间、户外活动时间比较,其不同组间的维生素D水平及超声骨密度Z值均有差异(P均＜0.05)。婴儿不同组间的25-(OH)D,其骨密度Z值及身长差异有统计学意义(P＜0.05)。结论 婴儿的维生素D营养状况与婴儿的骨矿物质含量密切相关,合理适量的补充维生素D是今后儿保工作的重点。证实了25-(OH)D是诊断维生素D缺乏性佝偻病的金标准。     

Do health visitors advise mothers about vitamin supplementation for their infants in line with government recommendations to help prevent rickets?

BACKGROUND: Increasing numbers of children are presenting with nutritional rickets. Rickets affects mainly dark-skinned infants being breastfed for prolonged periods without vitamin supplementation. The main aim of this study was to assess health visitors' (HV) knowledge of the government guidelines for vitamin supplementation for infants and children and the advice given to mothers. METHODS: Questionnaires were sent to all HV in Brent, Harrow and Westminster Primary Care Trusts (PCT). Information received was collated and used to assess HV knowledge. RESULTS: A total of 98 (69%) questionnaires were returned from HV. Seventy-nine HV (81%) recommend vitamins for the breastfed infant at 6 months or younger, 18 of which would recommend at 1 month of age. Fifty-six HV (57%) recommend vitamins until 5 years of age. Seventy-nine HV correctly identified Asians to be at risk of developing rickets. However, only 28 and 16 HV, respectively, identified Black Africans and Black Caribbeans to be at risk. CONCLUSION: Rickets has become a national public health issue. The majority of HVs is advising vitamin supplements according to government guidelines for breastfeeding infants and the age to which children should continue vitamin supplements. However, ethnic minority groups are at increased risk of vitamin D deficiency. Consequently, greater awareness needs to be raised about the government guidelines for vitamin D supplementation for ethnic minorities to ensure all HVs are imparting consistent, correct advice to these families.     

HPLC-MS/MS法检测吉林省427例儿童血浆25(OH)D的水平

目的:了解吉林省保健体检儿童血浆25(OH)D的水平,探讨高效液相色谱-串联质谱法(HPLC-MS/MS法)诊断维生素D缺乏性佝偻病的临床意义。方法:采用HPLC-MS/MS法检测并分析了427例体检儿童血浆25(OH)D的水平。结果:①血浆25(OH)D属于正常参考值范围的检出率为41.69%(178/427);低于正常参考值范围的检出率为58.31%(249/427),其中血浆25(OH)D处于缺乏水平的检出率为28.34%(121/427),处于不足水平的检出率为29.98%(128/427);高于正常参考值的检出率为0.00%(0/427)。②255例0～3岁研究对象中,1岁以内婴儿25(OH)D缺乏的发病率为39.34%(24/61),13个月～3岁幼儿25(OH)D缺乏的发病率为15.46%(30/194),二者相比有统计学差异(χ2=15.854 9,P=6.84E-5)。③临床诊断为佝偻病的121例儿童血浆25(OH)D检测结果占全部低于正常参考值儿童的48.59%(121/249),而血浆25(OH)D检测值低于正常参考值但临床尚未诊断佝偻病的儿童占全部低于正常参考值儿童的51.41%(128/249)。结论:①维生素D不足在吉林省的发病率高(58.31%),尤其1岁内婴儿更容易罹患维生素D缺乏,必须进一步加强和规范吉林省佝偻病的防治工作。②目前临床诊断佝偻病与经HPLC-MS/MS法检测25(OH)D诊断佝偻病符合率约50%,应尽快广泛普及此法,提高诊断的敏感性和特异性。     

A genetic study of vitamin D deficiency rickets: 2-sex differences and ABO typing.

In a further attempt to study the role of genetics in vitamin D deficiency rickets, 400 rachitic infants randomly chosen and aged from 6 months to 2 years (14.3 +/- 3.5 months) were investigated for sex differences and ABO typing. A significant (P < 0.001) predominance of the male sex was found, sex ratio being 1.43. Blood group A was significantly (P < 0.001) associated with rachitic patients whether males or females. Alkaline phosphatase values were significantly (P < 0.01) higher in male infants 91% of them had levels above 30 K.A. units, while the corresponding percentage of girls was 72%. This indicates that the disease is more severe among males. The study gives added support for the belief that there is a genetic factor in nutritional rickets.