江苏省0～5岁儿童骨密度水平现况研究
|
摘要
目的了解江苏省0～5岁儿童骨密度水平,分析不同年龄、不同性别、不同出生情况和不同地区季节的儿童骨密度状况,为制定防治干预措施提供依据。方法 2014年4月-2015年3月采用分层随机整群抽样的方法,抽取江苏省0～5岁儿童5 289名,其中男童2 786名,女童2 503名,采用自行设计的问卷调查儿童一般健康状况并对调查儿童胫骨中段的骨密度进行测定。计量资料采用■表示,调整年龄和性别混杂因素,计量资料的组间比较采用协方差分析,计数资料采用χ~2检验。结果江苏省0～5岁儿童骨密度不足检出率为14.6%;0～6月,6～11月,12～23月,24～35月,36～47月,48～59月,60～月骨密度不足检出率分别为44.9%、21.9%、14.3%、10.0%、9.0%、9.1%、11.6%,组间差异有统计学意义(P<0.001)。本次研究男童、女童骨密度不足检出率分别为14.8%、14.5%,组间差异无统计学意义(P=0.887)。早产儿骨密度不足检出率(20.9%)比足月儿(14.4%)高,差异有统计学意义(P=0.018)。调整年龄和性别混杂因素后,早产儿超声骨密度SOS值比足月儿低,差异有统计学意义(P=0.007);低出生体重儿的超声骨密度SOS值比正常体重儿低,差异有统计学意义(P=0.042)。调整年龄、性别、胎龄、分娩方式和出生体重,南京地区、苏南地区、苏中地区和苏北地区儿童的超声骨密度SOS值的组间差异有统计学意义(P=0.042);春季、夏季、秋季和冬季儿童的超声骨密度SOS值的组间差异有统计学意义(P<0.001)。结论江苏省0～5岁儿童普遍存在骨密度不足的情况,1岁以内尤其是0～6个月婴儿骨密度不足总检出率高达44.9%,是骨密度不足的高发人群。骨密度水平与年龄、早产、低出生体重、地区和季节相关,与性别、胎次、产次、分娩方式和城乡户籍无关。
Objective To explore the bone mineral density(BMD) of 0 to 5-year-old children in Jiangsu province monitored by quantitative ultrasound,and to analyze the association among sex,age,births,district,season and BMD,in order to provide reference for making intervention strategies. Methods A stratified cluster random sampling method was used to select children aged 0-5 years in Jiangsu province from April 2014 to March 2015. Totally 5 289 children were investigated,including 2 786 boys and 2 503 girls. A face to face investigation was conducted by the prepared doctors with self-designed questionnaires to collect related details and the bone mineral density was measured. Analysis of covariance variance(ANOVA) was used to describe mean differences of continuous variables after adjusting potential covariates such as age,gender and chi-square test was used to examine differences in categorical variables. Results The overall detection rate of low BMD in 0 to 5-year-old children was 14.6%. And the low BMD rates in children aged 0-6 months,7-12 months,13-24 months,25-36 months,37-48 months,49-60 months and ≥60 months were 44.9%,21.9%,14.3%,10.0%,9.0%,9.1% and 11.6%,respectively,and the difference was significant(P<0.001). No significant difference on detection rate of low BMD between boys and girls was found(14.8% vs. 14.5%,P=0.887). The detection rate of low BMD in preterm children was significantly higher than that of full-term children(20.9% vs. 14.4%,P=0.018). After adjusting the confounders of gender and age,the speed of sound(SOS) value in preterm infants was significantly lower than that in full-term infants,and SOS value in low birth weight infants was also lower than normal birth weight infants(P<0.05). After adjusting the confounders of age,gender,gestational age,parity and birth weight,differences on SOS value was significant among different areas and seasons(P<0.05). Conclusions The BMD level of children in Jiangsu province is generally low. And children under 1 year old are at high risk of low BMD,with the prevalence rate of 44.9% in 0 to 6-month-old infants. The BMD level of children is related to age,preterm,low birth weight,district and season,but is not influenced by gender,parity,delivery mode and dwelling district.
Objective To explore the bone mineral density(BMD) of 0 to 5-year-old children in Jiangsu province monitored by quantitative ultrasound,and to analyze the association among sex,age,births,district,season and BMD,in order to provide reference for making intervention strategies. Methods A stratified cluster random sampling method was used to select children aged 0-5 years in Jiangsu province from April 2014 to March 2015. Totally 5 289 children were investigated,including 2 786 boys and 2 503 girls. A face to face investigation was conducted by the prepared doctors with self-designed questionnaires to collect related details and the bone mineral density was measured. Analysis of covariance variance(ANOVA) was used to describe mean differences of continuous variables after adjusting potential covariates such as age,gender and chi-square test was used to examine differences in categorical variables. Results The overall detection rate of low BMD in 0 to 5-year-old children was 14.6%. And the low BMD rates in children aged 0-6 months,7-12 months,13-24 months,25-36 months,37-48 months,49-60 months and ≥60 months were 44.9%,21.9%,14.3%,10.0%,9.0%,9.1% and 11.6%,respectively,and the difference was significant(P<0.001). No significant difference on detection rate of low BMD between boys and girls was found(14.8% vs. 14.5%,P=0.887). The detection rate of low BMD in preterm children was significantly higher than that of full-term children(20.9% vs. 14.4%,P=0.018). After adjusting the confounders of gender and age,the speed of sound(SOS) value in preterm infants was significantly lower than that in full-term infants,and SOS value in low birth weight infants was also lower than normal birth weight infants(P<0.05). After adjusting the confounders of age,gender,gestational age,parity and birth weight,differences on SOS value was significant among different areas and seasons(P<0.05). Conclusions The BMD level of children in Jiangsu province is generally low. And children under 1 year old are at high risk of low BMD,with the prevalence rate of 44.9% in 0 to 6-month-old infants. The BMD level of children is related to age,preterm,low birth weight,district and season,but is not influenced by gender,parity,delivery mode and dwelling district.
引文
[1] 李冬松,林红,蔡波,等.儿童骨质密度低下相关研究概况[J].中国骨质疏松杂志,2012,18(10):953-959.
[2] 杨继英,凌昱,宋玉.2 519 例儿童超声骨密度结果分析[J].昆明医科大学学报,2016,37(2):133-135.
[3] 钟日英,吴晓兰,陈文娟,等.湛江市1 000例儿童骨密度检测结果分析[J].广东医学院学报,2016,34(2):204-206.
[4] 张桂香,李婧吴,胡幼芳,等.南京市2 岁以内儿童骨强度状况研究[J].中国儿童保健杂志,2010,18(12):985-987.
[5] 卢佳希,刘小兵,陈竞,等.2010-2012年中国城市育龄妇女维生素D营养状况[J].中华预防医学杂志,2017,51(2):112-116.
[6] 胡贻椿,陈竞,李敏,等.2010—2012年中国城市孕妇贫血及维生素A、维生素D营养状况[J].中华预防医学杂志,2017,51(2):125-131.
[7] Lee DH,Ryu HM,Han YJ,et al.Effects of serum 25-hydroxy-vitamin D and fetal bone growth during pregnancy[J].J Bone Metab,2015,22(3):127-133.
[8] Petersen SB,Olsen SF,Molgaard C,et al.Maternal vitamin D status and offspring bone fractures:prospective study over two decades in Aarhus City,Denmark[J].PLoS One,2014,9(12):e114334.
[9] Dror DK,King JC,Fung EB,et al.Evidence of associations between feto-maternal vitamin D status,cord parathyroid hormone and bone-specific alkaline phosphatase,and newborn whole body bone mineral content[J].Nutrients,2012,4(2):68-77.
[10] Hyde NK,Brennan-Olsen SL,Wark JD,et al.Maternal dietary nutrient intake during pregnancy and offspring linear growth and bone:the vitamin D in pregnancy cohort Study[J].Calcif Tissue Int,2017,100(1):47-54.
[11] 王志松,陈嘉辛.妊娠期合理膳食及适量补充微量营养素对新生儿骨密度影响研究[J].中国妇幼保健,2015,30:6504-6505.
[12] 郭齐雅,赵丽云,何宇纳,等.2010—2012年中国居民营养素摄入状况[J].中华预防医学杂志,2017,51(6):519-522.
[13] 连星烨,孟增东.不同地区光照量与人体维生素D 水平及骨密度之间的关系[J].中国骨质疏松杂志,2012,18(2):183-165.
[14] Fu Y,Hu Y,Qin Z,et al.Association of serum 25-hydroxyvitamin D status with bone mineral density in 0-7 year old children[J].Oncotarget,2016,7(49):80811-80819.
[15] Specker BL,Mulligan L,Ho M.Longitudinal study of calcium intake,physical activity,and bone mineral content in infants 6-18 months of age[J].J Bone Miner Res,1999,14(4):569-576.
[16] 吴田英,王丽珍,古桂雄,等.婴儿活动水平对骨密度的影响[J].中国儿童保健杂志,2008,16(2):179-184.
[17] Kalkwarf HJ,Zemel BS,Yolton K,et al.Bone mineral content and density of the lumbar spine of infants and toddlers:influence of age,sex,race,growth,and human milk feeding[J].J Bone Miner Res,2013,28(1):206-212.
[18] Maruyama H,Amari S,Fujinaga H,et al.Bone fracture in severe small-for-gestational-age,extremely low birth weight infants:A single-center analysis[J].Early Hum Dev,2017,106-107:75-78.
[19] 刘强,赵淑芸,王萍,等.骨定量超声技术在早产儿骨发育评价中应用和影响早产儿骨发育因素的研究[J].中国新生儿科杂志,2010,25(3):146-149.
[20] Wood CL,Wood AM,Harker C,et al.Bone mineral density and osteoporosis after preterm birth:the role of early life factors and nutrition[J].Int J Endocrinol,2013,2013:902513.
[21] Martinez-Mesa J,Restrepo-Mendez MC,Gonzalez DA,et al.Life-course evidence of birth weight effects on bone mass:systematic review and meta-analysis[J].Osteoporos Int,2013,24(1):7-18.
[2] 杨继英,凌昱,宋玉.2 519 例儿童超声骨密度结果分析[J].昆明医科大学学报,2016,37(2):133-135.
[3] 钟日英,吴晓兰,陈文娟,等.湛江市1 000例儿童骨密度检测结果分析[J].广东医学院学报,2016,34(2):204-206.
[4] 张桂香,李婧吴,胡幼芳,等.南京市2 岁以内儿童骨强度状况研究[J].中国儿童保健杂志,2010,18(12):985-987.
[5] 卢佳希,刘小兵,陈竞,等.2010-2012年中国城市育龄妇女维生素D营养状况[J].中华预防医学杂志,2017,51(2):112-116.
[6] 胡贻椿,陈竞,李敏,等.2010—2012年中国城市孕妇贫血及维生素A、维生素D营养状况[J].中华预防医学杂志,2017,51(2):125-131.
[7] Lee DH,Ryu HM,Han YJ,et al.Effects of serum 25-hydroxy-vitamin D and fetal bone growth during pregnancy[J].J Bone Metab,2015,22(3):127-133.
[8] Petersen SB,Olsen SF,Molgaard C,et al.Maternal vitamin D status and offspring bone fractures:prospective study over two decades in Aarhus City,Denmark[J].PLoS One,2014,9(12):e114334.
[9] Dror DK,King JC,Fung EB,et al.Evidence of associations between feto-maternal vitamin D status,cord parathyroid hormone and bone-specific alkaline phosphatase,and newborn whole body bone mineral content[J].Nutrients,2012,4(2):68-77.
[10] Hyde NK,Brennan-Olsen SL,Wark JD,et al.Maternal dietary nutrient intake during pregnancy and offspring linear growth and bone:the vitamin D in pregnancy cohort Study[J].Calcif Tissue Int,2017,100(1):47-54.
[11] 王志松,陈嘉辛.妊娠期合理膳食及适量补充微量营养素对新生儿骨密度影响研究[J].中国妇幼保健,2015,30:6504-6505.
[12] 郭齐雅,赵丽云,何宇纳,等.2010—2012年中国居民营养素摄入状况[J].中华预防医学杂志,2017,51(6):519-522.
[13] 连星烨,孟增东.不同地区光照量与人体维生素D 水平及骨密度之间的关系[J].中国骨质疏松杂志,2012,18(2):183-165.
[14] Fu Y,Hu Y,Qin Z,et al.Association of serum 25-hydroxyvitamin D status with bone mineral density in 0-7 year old children[J].Oncotarget,2016,7(49):80811-80819.
[15] Specker BL,Mulligan L,Ho M.Longitudinal study of calcium intake,physical activity,and bone mineral content in infants 6-18 months of age[J].J Bone Miner Res,1999,14(4):569-576.
[16] 吴田英,王丽珍,古桂雄,等.婴儿活动水平对骨密度的影响[J].中国儿童保健杂志,2008,16(2):179-184.
[17] Kalkwarf HJ,Zemel BS,Yolton K,et al.Bone mineral content and density of the lumbar spine of infants and toddlers:influence of age,sex,race,growth,and human milk feeding[J].J Bone Miner Res,2013,28(1):206-212.
[18] Maruyama H,Amari S,Fujinaga H,et al.Bone fracture in severe small-for-gestational-age,extremely low birth weight infants:A single-center analysis[J].Early Hum Dev,2017,106-107:75-78.
[19] 刘强,赵淑芸,王萍,等.骨定量超声技术在早产儿骨发育评价中应用和影响早产儿骨发育因素的研究[J].中国新生儿科杂志,2010,25(3):146-149.
[20] Wood CL,Wood AM,Harker C,et al.Bone mineral density and osteoporosis after preterm birth:the role of early life factors and nutrition[J].Int J Endocrinol,2013,2013:902513.
[21] Martinez-Mesa J,Restrepo-Mendez MC,Gonzalez DA,et al.Life-course evidence of birth weight effects on bone mass:systematic review and meta-analysis[J].Osteoporos Int,2013,24(1):7-18.