北京城北地区0~14岁儿童维生素 K 营养状况的观察研究

An observational study on the nutritional status of vitamin K in children aged 0-14 years in the northern of Beijing

摘要

目的 观察北京城北地区0~14岁儿童维生素K营养状况,为儿童的合理补充维生素K提供理论依据。方法 选取2020年11月至2023年3月在北京积水潭医院儿童保健和生长发育门诊就诊的北京城北地区(昌平区、海淀北部地区)儿童274例,采用高效液相色谱串联质谱法(HPLC-MS/MS)测定维生素K₁、维生素K₂(MK-4、MK-7)水平;采用超声骨密度仪测定骨密度;按照纳入儿童的不同性别、年龄、季节、身高、体重、体质量指数(BMI)等临床资料,比较分析维生素K水平。结果 在274例儿童中,0~14岁儿童维生素K₁中位水平为0.39(0.25,0.72)ng/mL,维生素K₁缺乏率较低,占2.2%(6/274).维生素MK-4中位水平为0.06(0.05,0.09)ng/mL,维生素MK-4缺乏率占81.4%(223/274);维生素MK-7中位水平为0.55(0.42,0.74)ng/mL,未检测到MK-7缺乏者,维生素K₂缺乏主要以MK-4缺乏为主.不同年龄段儿童血清维生素MK-4缺乏率、血清维生素MK-4水平比较差异均无统计学意义(P>0.05).不同季节的儿童血清维生素K₁水平比较差异无统计学意义(P>0.05);夏季的血清维生素MK-4、MK-7水平均最高[0.07(0.05,0.09)ng/mL、0.76(0.55,1.07)ng/mL],冬季均最低[0.05(0.05,0.06)ng/mL、0.50(0.40,0.67)ng/mL],不同季节的儿童血清维生素MK-4、MK-7水平比较差异均有统计学意义(H值分别为11.538、24.424,P<0.05).体重>P₁₀与体重≤P₁₀的儿童血清维生素K₁、MK-7水平比较差异均无统计学意义(P>0.05);体重>P₁₀的儿童血清维生素MK-4水平[0.06(0.06,0.09)ng/mL]高于体重≤P₁₀者[0.05(0.05,0.07)ng/mL],经比较差异有统计学意义(Z=-3.026,P<0.05).不同BMI的儿童血清维生素MK-7水平比较差异无统计学意义(P>0.05);不同BMI的儿童血清维生素K₁、MK-4水平比较差异均有统计学意义(H值分别为6.627、9.582,P<0.05).在不同性别、年龄、身高、骨密度因素中,儿童血清维生素K₁、MK-4、MK-7水平比较差异均无统计学意义(P>0.05)。结论 在北京城北地区0~14岁儿童中,维生素K₂缺乏率较高,以MK-4缺乏为主,维生素K₂水平有季节性差异,肥胖儿童维生素K水平低于正常儿童.

Abstract

Objective To observe the vitamin K nutritional status of children aged 0-14 years in the northern urban area of Beijing, providing a theoretical basis for the rational supplementation of vitamin K in children. Methods From November 2020 to March 2023, 274 children from the northern urban area of Beijing (Changping District and northern Haidian District) who visited the children's health and growth development clinics at Beijing Jishuitan Hospital were selected. The levels of vitamin K₁ and vitamin K₂ (MK-4, MK-7) were measured by high performance liquid chromatography-tandem mass spectrometry (LC-MS/MS); Bone density was measured using an ultrasonic bone densitometer; Vitamin K levels were analyzed and compared based on clinical data such as gender, age, season, height, weight, and body mass index (BMI). Results Among the 274 children, the median level of vitamin K₁ was 0.39 (0.25, 0.72) ng/mL, with a low deficiency rate of 2.2% (6/274); The median level of vitamin MK-4 was 0.06 (0.05, 0.09) ng/mL, with a deficiency rate of 81.4% (223/274); The median level of MK-7 was 0.55 (0.42, 0.74) ng/mL, with no detected MK-7 deficiency. Vitamin K₂ deficiency was mainly due to MK-4 deficiency. There was no statistically significant difference in serum vitamin MK-4 deficiency rate and serum MK-4 levels among different age groups (P>0.05). There was no statistically significant difference in serum vitamin K₁ levels among children in different seasons (P>0.05); In summer, the average levels of serum vitamin MK-4 and MK-7 in children were the highest [0.07 (0.05, 0.09) ng/mL, 0.76 (0.55, 1.07) ng/mL], while in winter they were the lowest [0.05 (0.05, 0.06) ng/mL, 0.50 (0.40, 0.67) ng/mL]. There was a statistically significant difference in serum vitamin MK-4 and MK-7 levels between different seasons (H=11.538 and 24.424, P<0.05). There were no statistically significant differences in serum vitamin K₁ and MK-7 levels between children with weight>P₁₀ and those with weight≤P₁₀ (P>0.05); The serum vitamin MK-4 levels in children with a weight>P₁₀ [0.06 (0.06, 0.09) ng/mL] were higher than those with a weight≤P₁₀ [0.05 (0.05, 0.07) ng/mL], with a statistically significant difference (Z=-3.026, P<0.05). No statistically significant differences were found in serum vitamin MK-7 levels among children with different BMIs (P>0.05); There were statistically significant differences in serum vitamin K₁ and MK-4 levels among children with different BMI (H=6.627 and 9.582, P<0.05). There were no statistically significant difference in serum vitamin K₁, MK-4, and MK-7 levels among children of different genders, ages, heights, and bone densities (P>0.05). Conclusion In children aged 0-14 years in the northern urban area of Beijing, the deficiency rate of vitamin K₂ is high, mainly due to MK-4 deficiency. Vitamin K₂ levels show seasonal variation, and obese children have lower vitamin K levels than normal-weight children.

关键词

维生素 K₁ / 维生素 K₂ / 肥胖 / 儿童

Key words

vitamin K₁ / vitamin K₂ / obesity / children

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基金资助

北京市医院管理中心儿科学科协同发展中心专项经费资助(XTZD20180401)