Relationship Between Serum 25-hydroxyvitamin D、Serum Calcium、Serum Phosphorus(P)、Alkalinephosphatase(ALP) And Speed Of Ultrasound In Children

Objective:To estimate the vitamin D nutritional status of children in the winter of Shijiazhuang area. To understand relationships among serum 25OHD、serum calcium、serum phosphorus、parathyroid hormone and alkalinephosphatase with ultrasonic bone conduction speed. Explore the clinical value in application of quantitative ultrasound instrument(QUS).Methods:120 cases normal physical examination children were selected as the research subjects, from October to December,2012 in the Growth of outpatient service, including boys in 62 cases,58 cases girls. There age ranged from 6 month to12 years old. In strict accordance with the inclusion criteria for selection, all children are no obvious abnormal in skeletal system, without kidney diseases and other special diseases; Recent unused sugar cortical hormone, growth hormone and therapeutic doses of vitamin D.A professional physical examination and detailed information recording. Grouping children by age of 0 ~ 1years old,1 ~ 3 years old,3 ~ 7 years old,7 ~ 12 years old. All subjects were from the local area, long residence in the local. The children were all on the examination day extraction of venous blood 4 ml, anticoagulation, placed at room temperature 20-40 min to make it fully coagulation. 25 OHD were assayed by ELSIA. Serum PTH was assayed by CLIA, serum Ca, P and serum ALP were assayed by auto-biochemistry analytical instrument. Bone density was tested by ultrasonic bone density apparatus. Data were analyzed by using SPSS17.0 for Windows software. All data were normally distributed analyzed by Normality Tests, so they were showed as Mean±SD or median(50%), Medians among groups were computed and compared by using sample T test or rank test, K-W Tests. The relevancies between variables were analyzed by Spearman correlation analysis. Differences were considered as significant at P<0.05.Results: 1 The average levels of markers in 120 cases:serum 25OHD: 23.16(14.47) nmol/L, SOS:1540(43.75) m/s, serum ALP 238.85(60.90) U/L, serum PTH 2.20(1.58)pmol/L, serum Ca: 2.50(0.18)mmol/L, serum P:(1.78±0.16)mmol/L. The average levels of markers in boys: serum 25 OHD(25.34±1.48) nmo/L, SOS: 1539.5(45) m/s, serum ALP: 241(52.02) U/L and serum PTH 1.90(1.83) pmol/L serum Ca:(2.49±0.13)mmol/L, serum P:(1.78±0.16)mmol/L.The average levels of markers in girls: serum 25OHD(25.15±1.27)nmo/L,SOS:1543(37.50)m/s, serum ALP: 229.5(68.62)U/L serum PTH:2.35(1.15)pmol/L,serum Ca : 2.48(0.14)mmol/L,serum P(25.15±1.27) mmol L. The above indicators were no statistical significance of differences between boys and girls. 2 120 cases of children vitamin D nutritional status: According to the seven classification of vitamin D nutritional status: Severe vitamin D deficiency:8 cases, 6.83%; Moderate vitamin D deficiency: 54 cases, 44.46%; Mild vitamin D deficiency: 47 cases, 39.31%; Insufficient: 5 cases, 4.27%; vitamin D adequate : 6 cases, 5.13%; vitamin D excess and poisoning:0 cases. Boy’s vitamin D nutritional status accounted for the proportion: severe vitamin D deficiency: 5 cases, 4.17%; Moderate vitamin D deficiency: 28 cases, 23.33%; Mild vitamin D deficiency: 24 cases, 20.00%; vitamin D insufficient : 3 cases, 2.50%; vitamin D adequate: 4 cases, 3.33%; vitamin D excessive and vitamin D poisoning: 0. Vitamin D nutritional status of the girls accounted for the proportion: severe vitamin D deficiency: 4 cases, 2.66%; Moderate vitamin D deficiency: 26 cases, 21.13%; Mild vitamin D deficiency: 23 cases, 19.31%; vitamin D insufficient : 2 cases, 1.77%; vitamin D adequate: 2 cases, 1.80%; No vitamin D excessive and poisoning. 3 Changes of serum 25 OHD, SOS, serum ALP, serum PTH, and serum Ca, serum P along with age. 3.1All the objects were divided into 4 subgroups according to their age: 0-1yr, 1-3yr, 3-7yr and 7-12 yr. The average levels of serum 25 OHD in the 4groups were32.22±4.18nmol/L,31.13±3.13nmol/L,21.98.±1.8 nmol/L and 23.12±0.15 nmol/L respectively. The average levels of SOS in the 4 groups were 1531(45)m/s, 1559(68)m/s, 1540(55)m/s, 1539(29)m/s respectively. The average levels of serum ALP in the 4 groups were 245.2(107)U/L, 236.7(48.3)U/L, 241(144.8)U/L, 239(47.26)U/L. The average levels of serum Ca in the 4 groups were 2.46(0.08)mmol/L,2.54(0.09) mmol/L,2.50(0.23) mmol/L,2.48(0.13) mmol/L respectively. The average levels of serum P in the 4 groups were(1.78±1.93)mmol L,(1.82±1.78) mmol L,(1.77±1.36)mmol L,(1.76±1.51)mmol L. 3.2 Serum 25 OHD is on the decline with age, especially after the age of 3, group 1 and group 3 have significant difference as well as group 4 have significant difference(P<0.05),group 2 and group 4 have significant difference(P<0.05), the rest of the groups there are no significant difference. SOS level is the lowest at 7~ 12 years old group, is the highest at 1~ 3years old group. There was no significant difference(P>0.05) between the each group of SOS levels. Serum ALP level is the lowest at ~ 3 years old group, is the highest at 0~ 1years old group, and the level changed not significantly after 3 years old, there was no statistically difference of serum ALP level between each groups(P>0.05). The lowest level of serum PTH in ~ 3 years old group, group of ~ 7 years old is the highest level, their corresponding 25 OHD levels were the highest and the lowest group. The difference was no significant(P>0.05). Serum Ca level increased gradually in 0 ~ 3 years old, declined after the age of 7 years old. Group 1 and group 2 have significant difference as well as group 2 and group4(P<0.05).Serum P changed not significantly with ages, the difference was no significant among each group(P>0.05). 4 Relationship between Serum 25-hydroxyvitamin D, serum Ca, serum P, Parathyroid hormone, serum ALP and ultrasonic bone conduction speed in children: According to serum 25 OHD levels, children were divided into 4 groups like <12.5nmol/L, 12.5-25nmol/L, 25-50nmol/L and 50-75nmol/L groups. The average levels of SOS were 1528(35)m/s, 1549(45)m/s, 1544(38)m/s, and 1542(50) m/s; the average levels of serum ALP were(268.3±88.1)U/L, 253.6(65.5)U/L, 236.7(72.55)U/L, and(224.33±39.11))U/L; the median levels of serum PTH were 2.9(2.60)pmol/L,2.43(1.43)pmol/L, 2.22(1.40)pmol/L and 2.06(1.75)pmol/L; the average levels of serum Ca were(2.4±0.10)mmol/L, 2.54(0.09)mmol/L, 2.50(0.23)mmol/L, 2.48(0.13)mmol/L; the average levels of serum P were(1.78±1.93)mmol/L,(1.82±1.78)mmol/L,(1.77±1.36) mmol/L,(1.76±1.51) mmol/L. The average level of SOS increased significantly in the range(12.5, 25) of 25 OHD, within the scope of [25,75) change was not significant. With the serum 25 OHD elevated, the serum ALP gradually reduced. There was no statistically significant difference between the groups. Along with the increase of serum 25 OHD, serum PTH levels decreased gradually, and there were differences between group 1 and group 3,group 4(P<0.05). Serum Ca levels increased gradually in the range of(12.5,50),there is no significant differences between groups. Serum P level increased in the range of <50, no significant differences between groups. Spearman correlation analysis to evaluate 120 cases of children the correlation between SOS and serum 25 OHD, serum ALP, serum PTH, serum Ca, serum P. Correlation coefficient respectively: r = 0.04, P = 0.68, r = 0.02, P = 0.87, r =-0.10, P = 0.30, r = 0.15, P = 0.09, r = 0.05, P = 0.62). Indicate serum 25 OHD has no correlation with SOS; serum 25 OHD negatively correlated with serum ALP and serum PTH; serum 25 OHD and Ca were positively correlated, there was no statistically significant correlation with serum PConclusion:1 Based on ultrasonic transmission speed(SOS) is not correlate with serum 25 OHD, serum calcium, phosphorus, total alkaline phosphatase and parathyroid hormone, can primarily thought through bone ultrasound(bone quantitative ultrasound instrument) can’t reflect children’s bone health.2 The Vitamin D deficiency of children in the winter of Shijiazhuang area is widespread, especially preschool and school-age children. So stressed that vitamin D supplements not only focuses on within 1years old baby, but throughout the whole childhood, even adolescence.