维生素 D、K₂ 联合干预对早产儿童骨代谢的影响

Effects of combined intervention of vitamin D and vitamin K ₂ on bone metabolism in premature infants

摘要

目的 探讨维生素 D(VD)、维生素 K₂(VK₂)联合干预对早产儿童骨代谢的影响。方法 选取于我院2022年9月至2023年6月出生的120例早产儿作为研究对象。根据孕周及出生体重分为低危早产儿及高危早产儿,进一步根据治疗方法的不同分为 VD 常规组(n=60)及 VD、VK₂ 联合干预组(n=60)。采用t检验对比两组干预前及干预后6月龄、12月龄时骨代谢指标[25-羟维生素 D₃ [25-(OH)-D₃]、VK₂、骨碱性磷酸酶(BALP)和胰岛素样生长因子-1(IGF-1)]、骨密度[Z 值、超声波声速度(SOS)]、营养指标(身长和头围)变化。采用Pearson相关分析25-(OH)-D₃、VK₂ 与骨代谢指标的相关性。结果 干预后6月龄及12月龄时,低危早产儿干预组血清25-(OH)-D₃、VK₂、IGF-1水平、骨密度Z 值、SOS、及身长、体重均较常规组显著升高(6月龄时: t值分别为5.039、4.623、2.450、3.368、6.913、4.995、2.106,均P <0.05;12 月龄时:t 值分别为8.437、2.969、3.004、4.106、4.523、3.395、3.410,均P<0.05)。干预后6月龄及12月龄时,高危早产儿干预组血清25-(OH)-D₃、VK₂、IGF-1水平、骨密度Z 值、SOS、及身长、体重均较常规组显著升高(6月龄时: t值分别为5.240、7.703、4.584、3.171、5.559、5.349、7.434,均P<0.05;12月龄时: t值分别为4.861、6.961、7.928、6.463、5.056、4.795、4.482,均P<0.05)。干预后6月龄及12月龄时,低危早产儿和高危早产儿血清BALP水平均较常规组显著降低(低危组:t 值分别为7.791、5.116,均P <0.05;高危组:t 值分别为3.516、4.568,均P <0.05)。经 Pearson相关性分析,25-(OH)-D₃、VK₂ 与 BALP 呈明显负相关(r= -0.479、-0.624,P <0.05),与IGF-1呈明显正相关(r=0.570、0.672,P<0.05)。结论 维生素 D、K₂ 联合干预有利于提高早产儿童25-羟维生素 D₃、K₂ 水平,改善骨代谢,提高骨密度,促进机体生长发育。

Abstract

Objective To investigate effect and mechanism of combined intervention of vitamin D (VD) and vitamin K₂ (VK₂) on bone metabolism in preterm infants. Methods One hundred and twenty preterm infants who were born in our hospital from September 2022 to June 2023 were selected as study subjects.They were categorized into low-risk preterm infant group and high-risk preterm infant group according to gestational week and birth weight of the infant,then they were divided into VD conventional treatment group (conventional treatment group) and VD and VK₂ combined intervention group (intervention group) according to treatment method (in each group,n=60).Bone metabolism markers {25-hydroxyvitamin D₃ [25-(OH)-D₃],VK₂,bone alkaline phosphatase (BALP) and insulin-like growth factor-1(IGF-1)},ultrasonic bone mineral density indexes [Z-score and speed of sound (SOS)],and nutritional indexes (height and head circumference)]were compared between the two groups before intervention and at 6 months and 12 months of corrected ages after intervention in t-test.Pearson correlation analysis was used to analyze correlations between 25-(OH)-D₃,VK₂ and bone metabolic markers. Results At 6 months and 12 months of corrected ages after intervention,the serum levels of 25-(OH)-D₃,VK₂,IGF-1,bone density Z-score and SOS,and height and weight of the low-risk premature infants in the intervention group were significantly higher than those low-risk premature infants in the conventional treatment group (at 6 months of corrected age: t=5.039,4.623,2.450,3.368,6.913,4.995 and 2.106 respectively,all P<0.05;at 12 months of corrected age: t=8.437,2.969,3.004,4.106,4.523,3.395 and 3.410 respectively,all P<0.05).Also,at 6 months and 12 months of corrected age after intervention,the serum levels of 25-(OH)-D₃,VK₂,IGF-1,bone density Z-score and SOS,and height and weight of the high-risk premature infants in the intervention group were significantly higher than those high-risk premature infants in the conventional treatment group (at 6 months of corrected age: t=5.240,7.703,4.584,3.171,5.559,5.349 and 7.434 respectively,all P <0.05;at 12 months of corrected age:t=4.861,6.961,7.928,6.463,5.056,4.795 and 4.482 respectively,all P<0.05).While at 6 months and 12 months of corrected age after intervention,the serum levels of BLAP of both low-risk premature infants and high-risk premature infants in the intervention group were significantly higher than those low-risk premature infants and high-risk premature infants in the conventional treatment group (for the low-risk group: t=7.791 and 5.116 respectively,both P<0.05;for the high-risk group: t=3.516 and 4.568 respectively,both P<0.05).Pearson correlation analysis shown that 25-(OH)-D ₃ and VK₂ were significantly negatively correlated with BALP (r=-0.479 and -0.624 respectively,both P<0.05),while they were positively correlated with IGF-1 (r=0.570 and 0.672 respectively,both P<0.05). Conclusion The combined intervention of VD and VK₂ is conducive to elevate serum levels of 25-(OH)-D₃ and VK₂,improve bone metabolism,enhance bone density,and promote growth and development of the premature infants.

关键词

早产儿 / 维生素 D / 维生素 K₂ / 骨代谢

Key words

premature infant / vitamin D / vitamin K₂ / bone metabolism

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基金资助

2022年佛山市自筹经费类科技创新项目入库(2220001004510)