目的:早产儿代谢性骨病(MBDP)仍然是极早产儿发病的重要原因。在高危患者中,怀疑诊断和随后的治疗修改,在灵敏度和特异性方面有局限性,依赖低磷水平和/或高水平的碱性磷酸酶(ALP)。我们研究了成纤维细胞生长因子-23(FGF23)作为MBDP的早期标志物的潜力,当在有风险的患者中3-4周时进行测量时。
方法:一项单中心前瞻性观察性非干预性研究,包括男女早产儿,胎龄小于32周和/或出生体重小于1500g。在营养概况中,在生命的3至4周之间进行的MBDP标准生化筛查中,FGF23的测定与其他临床和代谢研究一起纳入.这项研究是在桑坦德侯爵·德瓦尔德利亚大学医院进行的,西班牙,从2020年4月到2021年3月。参与者提供知情同意书。使用各种平台进行生化分析,随访评估由新生儿科医生自行决定.MBDP高危患者接受相应的治疗修改。样本进行了描述性分析,给出连续变量的集中趋势和分散的度量,以及类别数字的绝对数/百分比。使用的测试包括t检验,曼恩·惠特尼U测试,卡方检验,逻辑回归,皮尔逊相关性,和ROC曲线分析(IBMSPSSStatistics19版)。显著性水平:P<0.05。
结果:在涉及25名高危早产儿的研究中,发现20%(n=5)被诊断为MBDP。根据3-4周龄的标准生化评估,这些患者中有3例(60%)被确定为高风险,而另外两名患者(40%)在随后的几周内被诊断出。然而,在所有5名患者中,FGF23水平的测量将允许在其他标志物改变之前早期识别和优化治疗。低水平的FGF23在3-4周,即使磷和ALP水平正常,表明需要修改营养补充剂。
结论:MBDP仍然是极早产新生儿的一个重要问题。目前的诊断方法依赖于有限的生化标记。早期发现低FGF23水平可以及时干预,有可能避免去矿化。
OBJECTIVE: Metabolic bone disease of prematurity (MBDP) remains a significant cause of morbidity in extremely premature newborns. In high-risk patients, suspected diagnosis and subsequent treatment modifications, with limitations in terms of sensitivity and specificity, rely on low phosphorus levels and/or high levels of alkaline phosphatase (ALP). We investigated the potential of fibroblast growth factor-23 (FGF23) as an early marker for MBDP when measured at 3-4 weeks of life in at-risk patients.
METHODS: A single-center prospective observational non-interventional study including preterm newborns of both sexes, with a gestational age of less than 32 weeks and/or a birth weight of less than 1500 g. In the standard biochemical screening for MBDP performed between 3 and 4 weeks of life within a nutritional profile, the determination of FGF23 was included along with other clinical and metabolic studies. The study was conducted at Marqués de Valdecilla University Hospital in Santander, Spain, from April 2020 to March 2021. Participants provided informed consent. Biochemical analyses were conducted using various platforms, and follow-up evaluations were performed at the discretion of neonatologists. Patients at high risk for MBDP received modifications in treatment accordingly. The sample was descriptively analyzed, presenting measures of central tendency and dispersion for continuous variables, and absolute numbers/percentages for categorical ones. Tests used included t-tests, Mann‒Whitney U tests, chi-square tests, logistic regressions, Pearson correlation, and ROC curve analysis (IBM SPSS Statistics version 19). Significance level: P < 0.05.
RESULTS: In the study involving 25 at-risk premature newborns, it was found that 20% (n = 5) were diagnosed with MBDP. Three of these patients (60%) were identified as high-risk based on standard biochemical evaluation at 3-4 weeks of age, while the other two patients (40%) were diagnosed in subsequent weeks. However, in all 5 patients, measurement of FGF23 levels would allow for early identification and optimization of treatment before other markers become altered. Low levels of FGF23 at 3-4 weeks, even with normal phosphorus and ALP levels, indicate the need for modifications in nutritional supplementation.
CONCLUSIONS: MBDP remains a significant concern in extremely premature newborns. Current diagnostic methods rely on limited biochemical markers. Early detection of low FGF23 levels enables timely interventions, potentially averting demineralization.