Relationship between Levels of Serum 25-hydroxyvitamin D，Calcium，Zinc and Growth and Development of Children
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摘要:
目的 观察儿童血清25-羟基维生素D钙、锌水平，并探析3项指标与儿童生长发育的关系。 方法 将2021年1月至2022年12月于自贡市妇幼保健院接受治疗的98例生长发育迟缓患儿纳入生长发育迟缓组，另取同期于该院体检的80例生长发育正常的儿童为生长发育正常组，对比2组血清25-羟基维生素D钙、锌水平及其他临床资料，分析血清25-羟基维生素D钙、锌水平与生长发育的关系。 结果 生长发育迟缓组身长/身高、体重、钙、锌、25-羟基维生素D水平低于生长发育正常组（P < 0.05）；经点二列相关性分析结果显示，钙、锌、25-羟基维生素D水平与儿童生长发育迟缓呈负相关（r < 0，P < 0.05）；建立Logistic回归模型，结果显示，身长/身高（95%CI：0.673～0.824）、体重（95%CI：0.477～0.717）、钙（95%CI：0.127～0.467）、锌（95%CI：0.140～0.571）、25-羟基维生素D（95%CI：0.130～0.461）水平是儿童生长发育的保护因素（OR < 1，P < 0.05）；绘制ROC曲线，结果显示，钙、锌、25-羟基维生素D水平对儿童生长发育具有一定预测价值（AUC = 0.601、0.627、0.667），3项指标并联预测价值更高（AUC = 0.808）。 结论 儿童生长发育状况与血清25-羟基维生素D钙、锌水平密切相关，临床应动态监测血清25-羟基维生素D钙、锌水平变化，有助于早期预测儿童生长发育状况。 Abstract:Objective To observe the levels of serum 25-hydroxyvitamin D, calcium and zinc in children, and explore the relationship between the three indexes and the growth and development of children. Methods From January 2021 to December 2022, 98 children with growth retardation treated in Zigong Maternal and Child Health Hospital were included in the growth retardation group, and 80 children with normal growth and development were taken as the normal growth and development group. The serum 25-hydroxyvitamin D, calcium , zinc level and other clinical data of the two groups were compared, and the relationship between serum 25-hydroxyvitamin D, calcium , zinc level and growth and development was analyzed. Results The levels of body length/height, weight, calcium, zinc and 25- hydroxyvitamin D in the growth retardation group were lower than those in the normal growth development group （P < 0.05）. The results of point-and-column correlation analysis showed that the levels of calcium, zinc and 25- hydroxyvitamin D were negatively correlated with children's growth retardation （r < 0, P < 0.05）. Logistic regression model was established. The results showed that the levels of Size / height （95%CI:0.673～0.824）, weight （95%CI:0.477～0.717）, calcium （95%CI: 0.127～0.467）, zinc （95%CI: 0.140～0.571） and 25- hydroxyvitamin D （95%CI: 0.130～0.461） were the protective factors for children's growth and development （or < 1 The ROC curve was drawn. The results showed that the levels of calcium, zinc and 25-hydroxyvitamin D had certain predictive value for children's growth and development （AUC = 0.601, 0.627 and 0.667）, and the predictive value of The three indicators are parallel was higher （AUC = 0.808）. Conclusion The growth and development of children is closely related to the level of serum 25-hydroxyvitamin D, calcium and zinc. Clinical monitoring of the level of serum 25-hydroxyvitamin D, calcium and zinc is helpful for early prediction of children's growth and development. -
Key words:
- Children /
- 25-hydroxyvitamin D /
- Calcium /
- Zinc /
- Growth and development
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图 1 钙、锌、25-羟基维生素D水平预测儿童生长发育的ROC图
Figure 1. ROC diagram of predicting children's growth and development by calcium，zinc and 25- hydroxyvitamin D levels
1 生长发育迟缓组与生长发育正常组血清25-羟基维生素D水平及其他临床资料比较[（$ \bar x \pm s $）/n]（2）
1. Comparison of serum 25-hydroxyvitamin D level and other clinical data between growth retardation group and normal growth group[（$ \bar x \pm s$）/n]（2）
组别 血清钙（mmol/L） 血清铜（μmol/L） 血清铁（μmol/L） 血清镁（mmol/L） 血清锌（μg/g） 血清25-羟基维生素D（ng/mL） <2.25 ≥2.25 <5.0 ≥5.0 <9.0 ≥9.0 <0.75 ≥0.75 <110 ≥110 <20 ≥20 生长发育迟缓组（n=98） 55 43 29 69 22 76 18 80 42 56 61 37 生长发育正常组（n=80） 19 61 18 62 13 67 11 69 14 66 23 57 χ2 19.003 1.140 1.072 0.689 13.134 19.828 P <0.001* 0.286 0.301 0.407 <0.001* <0.001* *P < 0.05。 
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表 1 生长发育迟缓组与生长发育正常组血清25-羟基维生素D水平及其他临床资料比较[（$ \bar x \pm s $）/n]（1）
Table 1. Comparison of serum 25-hydroxyvitamin D level and other clinical data between growth retardation group and normal growth group[（$ \bar x \pm s$）/n]（1）
组别 性别 年龄（岁） 身长/身高（cm） 体重（kg） 出生情况 骨密度 男 女 自然分娩 剖宫产 正常 异常 生长发育迟缓组（n=98） 47 51 3.46±1.28 94.53±5.29 13.59±2.13 65 33 80 18 生长发育正常组（n=80） 42 38 3.51±1.34 101.39±5.04 16.08±2.24 48 32 71 9 χ2/t 0.363 0.254 8.790 7.580 0.761 1.734 P 0.547 0.800 <0.001* <0.001* 0.383 0.188 *P < 0.05。
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表 2 主要自变量赋值
Table 2. Assignment of main independent variables
自变量 变量说明 赋值情况 身长/身高 数值变量 − 体重 数值变量 − 钙 分类变量 0=<2.25 mmol/L，1=≥2.25 mmol/L 锌 分类变量 0=<110 μg/g，1=≥110 μg/g 血清25-羟基维生素D 分类变量 0=<20 ng/mL，1=≥20 ng/mL
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表 3 血清钙、锌、25-羟基维生素D水平对儿童生长发育的影响
Table 3. Effects of serum calcium，zinc and 25- hydroxyvitamin D levels on children's growth and development
自变量 β 标准误 Waldχ2 P OR 95%CI 身长/身高 −0.295 0.052 32.678 <0.001* 0.745 0.673～0.824 体重 −0.537 0.104 26.611 <0.001* 0.585 0.477～0.717 钙（≥2.25 mmol/L） −1.413 0.332 18.064 <0.001* 0.244 0.127～0.467 锌（≥110 μg/g） −1.263 0.358 12.437 <0.001* 0.283 0.140～0.571 血清25-羟基维生素D（≥20 ng/mL） −1.408 0.323 18.968 <0.001* 0.245 0.130～0.461 常量 1.840 0.488 14.210 <0.001* 6.294 − *P < 0.05。
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表 4 血清钙、锌、25-羟基维生素D水平对儿童生长发育的预测价值
Table 4. Predictive value of serum calcium，zinc and 25-hydroxyvitamin D levels on children’ s growth and development
检验变量 AUC 标准误 P 95%CI 敏感度 特异度 约登指数 钙 0.601 0.042 0.021* 0.517～0.684 0.639 0.638 0.277 锌 0.627 0.042 0.004* 0.545～0.709 0.629 0.675 0.304 血清25-羟基维生素D 0.667 0.041 <0.001* 0.587～0.748 0.722 0.688 0.410 联合 0.808 0.033 <0.001* 0.743～0.873 0.865 0.613 0.478 *P < 0.05。
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