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目的探索骨碱性磷酸酶、血25-(OH)D联合其他实验室指标诊断小儿维生素D缺乏性佝偻病的价值。方法选取2015年2月-2016年5月在该中心保健门诊就诊的1 200例儿童作为研究对象,抽取这些儿童的末梢血测定血液内25-(OH)D、骨碱性磷酸酶、血钙水平,同时测骨密度,其中355例儿童拍左手腕骨的X线片。依据《中华儿科杂志》维生素D缺乏性佝偻病防治建议,确定佝偻病的诊断标准,判定相应实验室方法检测佝偻病的灵敏度和特异度。结果在743例25-(OH)D<50 nmol/L的儿童中,有179例为佝偻病患者,占24.09%;在457例25-(OH)D≥50 nmol/L的儿童中,有28例为佝偻病患者,占6.13%;佝偻病儿童血液中25-(OH)D浓度为(38.6±10.6)nmol/L,显著低于未患病儿童(60.6±11.3)nmol/L,差异有统计学意义(t=25.748,P<0.05);在690例骨碱性磷酸酶异常的儿童中,138例患有佝偻病;467例骨密度异常的儿童中,118例患有佝偻病;320例血钙异常的患儿中,57例患有佝偻病;355例X片检查的阳性患者87均患有佝偻病。结论血液中25-(OH)D的浓度为诊断佝偻病的较好指标。而血液中骨碱性磷酸酶的浓度测定的特异度和灵敏度也较别的指标灵敏,可以用于筛查佝偻病。在25-(OH)D和骨碱性磷酸酶浓度异常的条件下联合其他指标可以很大程度地提高对患者佝偻病的识别性。
Objective To explore the value of bone alkaline phosphatase and serum 25- (OH) D combined with other laboratory indexes in the diagnosis of vitamin D deficiency rickets in children. Methods From January 2015 to May 2016, 1,200 children attending health clinics in the center were selected as research objects. Peripheral blood of these children was collected for determination of 25- (OH) D, bone alkaline phosphatase, calcium Level, while measuring bone mineral density, of which 355 cases of children taking left wrist carotid X-ray film. According to “China Pediatrics” vitamin D deficiency rickets prevention and control recommendations to determine the diagnostic criteria for rickets, determine the appropriate laboratory method for the detection of rickets sensitivity and specificity. Results Of 743 children with rhesus, 74.09% of 743 children with 25- (OH) D <50 nmol / L were found to be 24.09%. Among 457 children with 25- (OH) D≥50 nmol / L, 28 The incidence of 25- (OH) D in children with rickets was (38.6 ± 10.6) nmol / L, which was significantly lower than that of non-sick children (60.6 ± 11.3) nmol / L, the difference was statistically significant (T = 25.748, P <0.05); Of the 690 children with abnormal bone alkaline phosphatase, 138 had rickets; Among 467 children with abnormal BMD, 118 had rickets; 320 had abnormal calcium Of 57 children with rickets, 355 were positive with rickets in 87 patients. Conclusion The concentration of 25- (OH) D in blood is a good indicator for the diagnosis of rickets. The specificity and sensitivity of the determination of bone alkaline phosphatase in blood are more sensitive than other indicators, which can be used to screen for rickets. In combination with other indicators of abnormal 25- (OH) D and bone alkaline phosphatase concentration can greatly improve the identification of patients with rickets.