重庆市开州地区 0~6岁儿童 25-羟基维生素 D水平调查及相关危险因素分析

目的　分析重庆市开州地区0~6 岁儿童25- 羟基维生素D25-（OH）D] 水平及相关危险因素，为防治因25-（OH） D 缺乏或不足引起的相关疾病提供依据。方法　选取1 486 例0~6 岁儿童为研究对象，采用磁微粒化学发光免疫分析法 进行25-（OH）D 检测，从性别、年龄、季节方面分析25-（OH）D 水平，并对可能引起其缺乏或不足的相关危险因素 进行单因素及多因素分析。结果　1 486 例0~6 岁儿童血清25- （OH）D缺乏率为21.6%（321/1 486），不足率为29.54%（439/1 486），充足率为48.86%（726/1 486），男女儿童间25-（OH）D 缺乏、不足和充足率差异无统计学意义（χ2=0.472， P >0.05）；3~6 岁儿童25-（OH）D 水平显著低于<1 岁、1~2 岁和2~3 岁儿童（26.18±7.52 ng/ml vs 29.66±8.88 ng/ ml，31.36±9.83 ng/ml and 30.84±8.24 ng/ml），差异具有统计学意义（F =19.529，P <0.01），不同年龄段的儿童25- （OH）D 缺乏率、不足率和充足率差异具有统计学意义（χ2=23.730，P <0.01）；夏、秋季儿童25-（OH）D 水平高于春、 冬季（33.11±9.29 ng/ml，32.73±9.46 ng/ml vs 27.28±8.82 ng/ml，26.51±7.23 ng/ml），不同季节的25-（OH）D 缺乏 率、不足率和充足率差异具有统计学意义（χ2=89.795，P <0.01 ）。单因素分析显示:单独母乳喂养、未规律服用维生 素D 制剂、挑食或厌食、户外活动时间< 2h/ 天、父母文化程度低、反复腹泻是引起受检儿童25-（OH）D 缺乏或 不足的影响因素（χ2=5.823，25.758，10.531，5.666，6.973，4.707，均P <0.05）；多因素分析显示:挑食或厌食、反 复腹泻是引起0~6 岁受检儿童25-（OH）D 缺乏或不足的独立危险因素（χ2=85.690，6.392，均P <0.05）。结论　开州 地区0~6 岁儿童25-（OH）D 缺乏或不足的情况较为严重，应在春、冬季和儿童在3~6 岁阶段进行维生素D 制剂补充； 加强儿保教育，纠正引起儿童25-（OH）D 缺乏或不足的相关危险因素。

Investigation of 25-Hydroxyvitamin D Level and Analysis of Related Risk Factors in Children Aged 0~6 Years in Kaizhou District of Chongqing

Objective　To analyze the level of 25-hydroxyvitamin D25-（OH）D] and its related risk factors in children aged 0~6 years in Kaizhou of Chongqing in order to provide evidence for the prevention and treatment of related diseases caused by 25-（OH）D deficiency or insufficiency. Methods　A total of 1 486 children aged 0~6 years were selected as subjects. 25-（OH） D was detected by magnetic particle chemiluminescence immunoassay. The levels of 25-（OH）D were analyzed in terms of sex, age and season, and the related risk factors that might cause their deficiency or deficiency were analyzed by single factor and multi-factor analysis. Results　The serum 25-（OH） D deficiency rate was 21.6% （321/1 486）, deficiency rate was 29.54% （439/1 486） and adequacy rate was 48.86% （726/1 486） in 1 486 children aged 0~6 years. There was no significant difference in 25-（OH） D deficiency, insufficiency and adequacy rate between boys and girls （χ2=0.472, P >0.05）. The level of 25-（OH）D in children aged 3~6 years was significantly lower than that in children aged < 1,1~2 and 2~3 years （26.18±7.52 ng/ml vs 29.66±8.88 ng/ml, 31.36±9.83 ng/ml and 30.84±8.24 ng/ml），respectively, the difference was statistically singnificant（F =19.529，P <0.01） . There were significant differences in the rate of 25-（OH）D deficiency, insufficiency and adequacy among children of different ages （χ2=23.730，P <0.01）. The levels of 25-（OH）D in summer and autumn was higher than that in spring and winter （33.11±9.29 ng/ml，32.73±9.46 ng/ml vs 27.28±8.82 ng/ml，26.51±7.23 ng/ml）. There were significant differences in the rate of 25-（OH）D deficiency, insufficiency and adequacy in different seasons （χ2=89.795，P <0.01）. Univariate analysis showed that breastfeeding alone, irregular use of vitamin D preparations, picky or anorexia, outdoor activities less than 2 hours/day, low educational level of parents and recurrent diarrhea were risk factors for 25-（OH） D deficiency or insufficiency （χ2=5.823, 25.758, 10.531, 5.666, 6.973, 4.707, all P <0.05）. Analysis showed that picky eating, anorexia and recurrent diarrhea were independent risk factors for 25-（OH） D deficiency or deficiency in children aged 0~6 years （χ2= 85.690, 6.392, all P <0.05）.Conclusion　The situation of 25-（OH） D deficiency and insufficiency in children aged 0~6 years in Kaizhou is serious.Vitamin D supplementation should be carried out in spring, winter and children aged 3~6 years, and the education of child care should be strengthened to correct the related risk factors of 25-（OH）D deficiency and insufficiency in children.