| Background and ObjectiveBronchial pulmonary dysplasia is the most common serious complications in premature infants,especially in very low and extremely low birth weight infants,it may lead to prolonged hospital stay,high incidence of the chronic respiratory diseases and growth retardation,it is one of the main causes of late neonatal death,which seriously affects the survival rate and quality of life of premature infants and brings serious burden to families and society.At present,the pathogenesis of BPD is still unclear.Some studies have shown that vitamin D and vitamin D binding protein participate in the occurrence and development of lung diseases by regulating fetal lung development and maturation,reducing hyperoxia and lung injury caused by inflammatory reactions.In this study,the changes of serum 25-hydroxy vitamin D and vitamin D-binding protein levels in premature infants were analyzed to explore the relationship between the levels of 25-hydroxy vitamin D,DBP and the occurrence of BPD,so as to provide a new idea for the clinical prevention and treatment of BPD.MethodsThere were 170 premature infants who were born in our hospital and admitted to the neonatal ward of our hospital with gestational age<32 weeks from March 2017 to September 2018,and the general information of perinatal period was recorded in detail.All the premature infants were given 800 IU/d vitamin D supplement at one week after birth.Peripheral blood was collected within 24 h and 28 d after birth.The level of serum25-(OH)D was measured by chemiluminescence immunoassay,and the level of serum DBP was measured by enzyme linked immunosorbent assay.According to the presence of BPD or not at 28 days after birth,the infants were divided into the BPD group and the non-BPD group,furthermore the BPD group was divided into mild group and moderate/severe group according to the oxygen therapy of premature infants with BPD.The serum levels of 25-(OH)D and DBP were compared between different groups.Results1.General condition: A total of 170 children were included,there were 56 cases in the BPD group were divided into 32 cases in the mild group and 24 cases in the moderate/severe group;114 cases were in non-BPD group.56 cases in the BPD group included 34 males(60.7%),the average gestational age was(29.8±1.2)weeks,and the average birth weight was(1198±156.6)g;there were 95 males(56.1%)in the non-BPD group,the mean gestational age was(30.2±1.5)weeks,and the mean birth weight was(1243±146.2)g.There were no significant differences in gestational age,birth weight and male proportion between BPD group and non-BPD group(P>0.05).2.Clinical history: There was no statistical difference in the rate of cesarean section,premature rupture of membranes,severe preeclampsia and gestational diabetes between the BPD group and the non-BPD group(P>0.05);Apgar score(1 minute and 5 minute)of the BPD group was lower than that of the non-BPD group,and the proportion of neonatal pneumonia,neonatal sepsis,neonatal asphyxia,patent arterial catheter,mechanical ventilation time,CPAP time,total oxygen intake time,and hospitalization time were all higher than that of the non-bpd group,the differences were statistically significant(P<0.05).3.Comparison of vitamin D deficiency: In this research,the deficiency rate of vitamin D of premature infants that were measured at birth was 74.6%,which was significantly higher in the BPD group than in the non-BPD group(92.3% vs 68.6%),and the difference was statistically significant(P<0.05).4.Comparison of 25-(OH)D levels between BPD group and non-BPD group: Serum 25-(OH)D level at birth and 28 d after birth in the BPD group was lower than that in the non-bpd group,and the difference was statistically significant(P<0.05);The levels of serum 25-(OH)D of both groups at 28 d after birth were higher than those at birth in the same groups,the difference were statistically significant(P<0.05).5.Comparison of 25-(OH)D levels in premature infants with different degrees of BPD: The levels of serum 25-(OH)D in moderate/severe BPD group were significantly lower than those in mild BPD group,the difference were statistically significant(P<0.05);there was no significant difference between the moderate/severe BPD group and mild BPD group in the levels of serum 25-(OH)D at 28 d after birtht(P>0.05).6.Comparison of DBP levels between BPD group and non-BPD group: There was no significant difference in serum DBP level between BPD group and non-BPD group at birth(P>0.05);at 28 d after birth,the serum DBP level in the BPD group was lower than that in the non-BPD group,and the difference was statistically significant(P<0.05).Serum DBP level of preterm infants in the BPD group decreased at 28 d after birth compared with that of the same group,and the difference was statistically significant(P<0.05);there was no significant difference between the non-BPD group and the same group at birth(P<0.05).7.Comparison of DBP levels in premature infants with different degrees of BPD: There was no significant difference between the levels of serum DBP in moderate/severe BPD group and mild BPD group(P>0.05);but at 28 d after birth the level of serum DBP in moderate/severe BPD group were lower than mild BPD group,the difference was statistically significant(P<0.05).8.Analysis of high risk factors of BPD: Logistic regression analysis showed that neonatal pneumonia(OR=4.331,95%CI=1.269~14.784),neonatal sepsis(OR=4.020,95%CI=1.153~14.015),25-(OH)D level at birth(OR=0.827,95%CI=0.693~1.987),ventilation time(OR=4.216,95%CI=1.205~13.167),CPAP time(OR=4.357,95%CI=1.237~13.252),total oxygen intake time(OR=5.107,95%CI=1.297~14.926)were risk factors for bronchopulmonary dysplasia in premature infants(P<0.05).ConclusionsSerum 25-(OH)D and DBP of premature infants may be participated in the regulation of the occurrence and development of BPD,which have implications for predicting the severity of BPD. |
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