Department of Neonates, Children's Hospital of Nanjing Medical University, Nanjing, China.
Department of Neonates, Children's Hospital of Nanjing Medical University, Nanjing, China.
J Chin Med Assoc. 2018 May;81(5):482-486. doi: 10.1016/j.jcma.2017.07.011. Epub 2017 Nov 9.
There hasn't been conclusive proof about the association between vitamin D and pulmonary morbidities of prematurity.
106 preterm infants were retrospectively included into this study. Clinical data and blood samples of all the patients were collected within 24 h of admission.
(1) Respiratory distress syndrome (RDS) patients were mainly concentrated in "≤30 weeks" stage when compared with other two gestational age groups. The only significant decrease of vitamin D concentration between RDS and non-RDS patients reflected in "≤30 weeks" stage (RDS vs. non-RDS: 29.48 ± 13.06 vs. 40.47 ± 20.52 nmol/l). (2) Bronchopulmonary dysplasia (BPD) patients were also concentrated in "≤30 weeks" stage. Vitamin D concentration showed significant difference both in "≤30 weeks" stage and "30-34 weeks" stage (≤30 weeks stage, BPD vs. non-BPD: 33.20 ± 16.51 vs. 39.21 ± 16.65 nmol/l; 30-34 weeks stage, BPD vs. non-BPD: 30.36 ± 15.50 vs. 41.21 ± 20.40 nmol/l). (3) Though vitamin D concentration in mechanical ventilation (MV) group was lower than non-MV group, there're no significant differences. (4) Vitamin D concentration in dead cases was significant lower than survival patients at discharge. (5) It showed a good correlation between vitamin D concentration and serum Ca, serum P, duration of MV and duration of oxygen support in "≤30 weeks" stage.
The significant decrease of vitamin D concentration between RDS and non-RDS patients only reflected in "≤30 weeks" stage. And significant decrease of vitamin D concentration in BPD patients was both showed in "≤30 weeks" stage and "30-34 weeks" stage, which is consistent with "duration of oxygen support". However, the overall effect did not show any difference in all preterm infants. It seems that the appropriate concentration of vitamin D is beneficial to lung maturation of human. Certainly, large sample, multi-center randomized controlled trials are necessary.
维生素 D 与早产儿肺部疾病的相关性尚未得到明确证实。
本研究回顾性纳入 106 例早产儿。所有患者入院后 24 小时内采集临床资料和血样。
(1)与其他两个胎龄组相比,呼吸窘迫综合征(RDS)患者主要集中在“≤30 周”阶段。RDS 患者与非 RDS 患者的维生素 D 浓度唯一显著下降仅反映在“≤30 周”阶段(RDS 与非 RDS:29.48±13.06 与 40.47±20.52 nmol/L)。(2)支气管肺发育不良(BPD)患者也集中在“≤30 周”阶段。维生素 D 浓度在“≤30 周”和“30-34 周”两个阶段均有显著差异(≤30 周阶段,BPD 与非 BPD:33.20±16.51 与 39.21±16.65 nmol/L;30-34 周阶段,BPD 与非 BPD:30.36±15.50 与 41.21±20.40 nmol/L)。(3)尽管机械通气(MV)组的维生素 D 浓度低于非 MV 组,但无显著差异。(4)死亡病例的维生素 D 浓度明显低于出院时存活的患者。(5)在“≤30 周”阶段,维生素 D 浓度与血清 Ca、血清 P、MV 持续时间和氧支持持续时间之间存在良好的相关性。
RDS 患者与非 RDS 患者之间维生素 D 浓度的显著下降仅反映在“≤30 周”阶段。BPD 患者维生素 D 浓度的显著下降在“≤30 周”和“30-34 周”两个阶段均有表现,与“氧支持时间”一致。然而,在所有早产儿中,总体效果没有差异。适当浓度的维生素 D 似乎有利于人类肺成熟。当然,需要进行大样本、多中心随机对照试验。