【摘要】 目的 研究新生儿早期维生素A、D缺乏对红细胞参数及铁代谢的影响并探讨其临床意义。方法 回顾性选取山东第一医科大学附属济南妇幼保健院新生儿重症监护室2022-07-01-2023-06-30临床诊断为维生素D缺乏的新生儿，共134例，按胎龄1∶1匹配同期住院的134例维生素D正常新生儿。收集该268名新生儿维生素A水平及缺乏程度、红细胞参数及铁代谢相关资料。计量资料采用独立样本t检验、单因素方差分析、秩和检验、Kruskal-Wallis检验，计数资料采用χ²检验，分析早期维生素A、D缺乏对红细胞参数及铁代谢的影响。结果 胎龄、出生体质量、身长、头围、囟门、性别以及分娩方式在维生素A正常组与缺乏组、维生素D正常组与缺乏组中差异无统计学意义，均P>0.05。维生素A缺乏组铁含量为12.8（7.3,20.0）μmol/L,低于正常组18.2（10.5,25.1）μmol/L,Z=-3.472,P<0.001;平均红细胞体积为109.3（107.2,112.2） fl,低于正常组111.2（107.4,114.8） fl,Z=-1.989,P=0.047;平均红细胞血红蛋白浓度为（334.3±8.3） g/L,高于正常组（330.1±9.6） g/L,t=3.463,P=0.001。维生素D缺乏组红细胞计数为（4.59±0.46）×10¹² L^-1,低于正常组（4.81±0.51）×10¹² L^-1,t=-3.657,P<0.001;血红蛋白为168.0（156.0,179.3） g/L,低于正常组177.5（164.8,191.3） g/L,Z=-3.938,P<0.001;红细胞压积为（50.4±5.1）%,低于正常组（53.1±5.8）%,t=-4.021,P<0.001。维生素D水平与红细胞计数、血红蛋白及红细胞压积呈正相关，r_s值分别为0.245,0.263,0.250,均P<0.001。维生素D缺乏程度与铁代谢相关参数差异无统计学意义，均P>0.05;维生素A、维生素D水平经Spearman相关性分析，两者呈正相关，r_s=0.146,P=0.017。结论 新生儿早期维生素A、D缺乏影响红细胞参数及铁代谢，且维生素A、D水平呈正相关。更多还原

【Abstract】 Objective To study the effects of early vitamin A and D deficiency on red blood cell parameters and iron metabolism in neonates and explore its clinical significance.Methods A retrospective study was conducted.Neonates clinically diagnosed with vitamin D deficiency in the Neonatal Intensive Care Unit of Jinan Maternal and Child Health Care Hospital Affiliated to Shandong First Medical University from July 1,2022 to June 30,2023 were selected,with a total of 134 cases.134 neonates with normal vitamin D levels hospitalized during the same period were matched according to gestational age at a ratio of 1:1.The data on vitamin A levels and deficiency degrees,red blood cell parameters and iron metabolism of these 268 neonates were collected.Independent sample t-test,one-way analysis of variance,rank sum test and KruskalWallis test were used for measurement data,and chi-square test was used for count data to analyze the effects of early vitamin A and D deficiency on red blood cell parameters and iron metabolism.Results There were no statistically significant differences in gestational age,birth weight,body length,head circumference,fontanelle,gender and delivery mode between the vitamin A normal group and the deficiency group,and between the vitamin D normal group and the deficiency group（all P>0.05）.The iron content in the vitamin A deficiency group was 12.8（7.3,20.0） μmol/L,lower than that in the normal group [18.2（10.5,25.1） μmol/L],Z=-3.472,P<0.001.The mean corpuscular volume was 109.3（107.2,112.2） fl,lower than that in the normal group [111.2（107.4,114.8） fl],Z=-1.989,P=0.047.The mean corpuscular hemoglobin concentration was（334.3±8.3） g/L,higher than that in the normal group [（330.1±9.6） g/L],t=3.463,P=0.001.The red blood cell count in the vitamin D deficiency group was（4.59±0.46）×10¹² L^-1,lower than that in the normal group [（4.81±0.51）×10¹² L^-1),t=-3.657,P<0.001;the hemoglobin level was 168.0（156.0,179.3） g/L,lower than that in the normal group [177.5（164.8,191.3） g/L],Z=-3.938, P<0.001.The hematocrit was（50.4±5.1）%,lower than that in the normal group [（53.1±5.8）%],t=4.021,P<0.001.The vitamin D level was positively correlated with red blood cell count,hemoglobin and hematocrit,with rs values of 0.245,0.263 and 0.250 respectively（all P<0.001）.There were no statistically significant differences in the parameters related to iron metabolism among different degrees of vitamin D deficiency（all P>0.05）.Spearman correlation analysis showed that the levels of vitamin A and vitamin D were positively correlated,with r_s=0.146,P=0.017.Conclusion Early vitamin A and D deficiency in neonates affects red blood cell parameters and iron metabolism,and the levels of vitamin A and D are positively correlated.更多还原