维生素D缺乏与老年2型糖尿病患者发生骨质疏松、骨骼肌质量减少的相关性研究

目的研究血清25(OH) D缺乏对老年2型糖尿病(type 2 diabetes mellitus,T2DM)患者骨质疏松(osteoporosis,OP)、骨骼肌质量减少(skeletal muscle mass reduction)发生的影响。方法入组了280例老年T2DM患者和135例正常老年人作对照研究。对两组人员均详细采集一般情况,检测ASMI、各部位骨密度(BMD)及血清25(OH) D水平等实验室指标。利用t检验、卡方检验比较组间的差异,采用相关分析、回归分析探讨老年T2DM合并骨质疏松及骨骼肌质量减少的影响因素。结果①观察组的骨质疏松发生率、骨骼肌质量减少发生率以及骨质疏松合并骨骼肌量减少发生率均明显高于对照组(均P0. 05);老年T2DM患者血清25(OH) D水平较对照组显著下降(P0. 05);②在老年T2DM患者中,无骨质疏松无肌少患者平均25(OH) D水平最高,合并骨质疏松及肌少的糖尿病患者平均25(OH) D水平最低,差异有统计学意义(P0. 05); 25(OH) D水平越低,老年T2DM患者骨质疏松、骨骼肌质量减少越严重(P0. 05)。③Pearson相关分析发现,老年T2DM患者血清25(OH) D水平与BMD(r=0. 703,P0. 05)、ASMI(r=0. 536,P0. 05)均呈显著正相关关系,BMD与ASMI (r=0. 381,P0. 05)也呈显著正相关关系。④Logistic回归分析发现,25(OH) D缺乏(OR=14. 47,P=0. 005)是发生骨质疏松的危险因素;25(OH) D缺乏(OR=11. 59,P=0. 015)是发生肌少症的危险因素。结论维生素D缺乏、骨质疏松、骨骼肌质量减少在老年T2DM患者中的发病率均高于正常老年人群。维生素D缺乏是老年T2DM患者发生骨质疏松与骨骼肌质量减少共同的危险因素,维生素D越低,老年T2DM患者骨质疏松、骨骼肌质量减少越严重。     

慢性肾脏病患者维生素D缺乏与动脉僵硬度的相关性

目的 探讨慢性肾脏病患者维生素D缺乏与动脉僵硬度的相关性.方法 选取慢性肾脏病(CKD l～5期)患者300例,根据血25(OH)D3浓度分为维生素D缺乏组[25 (OH)D3＜20 μg/L]和维生素D非缺乏组[25(OH)D3≥20 μg/L].采集临床资料数据,测定动脉僵硬度指标肱踝脉搏波传导速度(baPWV).对血25(OH)D3水平与baPWV间的关系进行单因素相关分析及多元线性回归分析. 结果 维生素D缺乏组188例(62.7％),维生素D非缺乏组112例(37.3％).全部CKD患者25(OH)D3平均浓度为(17.62±8.54) μg/L,维生素D缺乏组和非缺乏组分别为(12.38±4.55) μg/L与(26.44±6.05) μg/L(P＜0.01).维生素D缺乏组baPWV值高于非缺乏组[(1 827.34±429.11) cm/s比(1 555.31±353.14) cm/s,P＜0.01].单因素相关分析显示全体CKD患者(r=-0.38,P＜0.01)以及CKD 2～5期患者[r=-0.30,P＜0.05;r=-0.26,P＜0.05;r=-0.46,P＜0.01;r=-0.57,P＜0.01]血25(OH)D3浓度与baPWV均呈负相关.多元线性回归分析显示血25 (OH)D3浓度下降与baPWV的增加独立相关(模型1:β=-0.18,P＜0.01;模型2:β=-0.17,P=0.01),回归模型1与模型2均可解释baPWV变化的50％.结论 CKD患者普遍存在维生素D缺乏,维生素D缺乏与动脉僵硬度增加相关.维生素D替代治疗可能影响CKD患者的心血管预后,但有待未来研究的进一步明确.     

维持性血液透析患者血清尿酸与25羟维生素D_3的相关性研究

目的分析维持性血液透析(maintenance hemodialysis, MHD)患者血清尿酸与25羟维生素D_3[25-(OH)VitD_3]的关系,并探讨血清尿酸对MHD患者25-(OH)VitD_3的影响。方法选取山东第一医科大学附属青岛医院MHD患者108例,收集患者性别、年龄、透析龄、维生素D类似物使用情况等一般资料。荧光免疫层析法一次性检测25-(OH)VitD_3水平,并完成其血常规、肝功能、肾功能、血清尿酸、校正钙、磷、甲状旁腺素等指标的检测。根据25-(OH)VitD_3水平将其分为维生素D不良组[25-(OH)VitD_330 nmol/L](n=71)和维生素D适宜组[30 nmol/L≤25-(OH)VitD_3100 nmol/L](n=37),比较两组患者的临床资料,并分析25-(OH)VitD_3与其相关性。结果维生素D不良组MHD女性患者的比例(χ~2=4.354,P=0.037)、透析前血清尿酸(t=2.995,P=0.003)、透析前磷(t=2.072,P=0.041)高于维生素D适宜组。相关性分析:25-(OH)VitD_3与女性(r=-0.263,P=0.006)、平均血小板体积(r=-0.270,P=0.005)、血清尿酸(r=-0.210,P=0.030)呈负相关。多元线性回归分析:女性(β=-3.269,P=0.035)、高平均血小板体积(β=-1.610,P=0.007)、高血清尿酸(β=-0.019,P=0.016)是MHD患者25-(OH)VitD_3降低的独立影响因素。结论 MHD患者女性较男性更容易出现25-(OH)VitD_3的缺乏。高血清尿酸、高平均血小板体积可以降低MHD患者25-(OH)VitD_3水平。     

大面积烧伤患者发生早期深静脉置管导管相关性血流感染的危险因素分析

目的:分析大面积烧伤患者发生早期深静脉置管导管相关性血流感染(Catheterrelatedbloodstream infection,CRBSI)的危险因素。方法:收集笔者医院2013年1月-2018年10月收治的110例行深静脉置管输液大面积烧伤患者的临床资料,根据是否发生CRBSI将其分为感染组(n=40)和非感染组(n=70),比较两组临床资料并分析感染危险因素。结果:两组导管类型、留置部位、留置时间、静脉营养、置管次数、营养不良及是否合并糖尿病比较差异具有统计学意义(P0.05);两组性别、年龄、是否手术及输血比较差异无统计学意义(P0.05);Logistic多因素回归分析结果显示,导管类型(OR=1.41,95%CI:1.09～1.84)、留置部位(OR=1.42,95%CI:1.13～1.78)、留置时间(OR=1.42,95%CI:1.04～1.94)、静脉营养(OR=1.39,95%CI:1.03～1.87)、置管次数(OR=1.44,95%CI:1.14～1.81)、营养不良(OR=1.42,95%CI:1.15～1.76)及糖尿病(OR=1.42,95%CI:1.15～1.74)为CRBSI发生的独立危险因素(P0.05)。结论:导管类型、留置部位、留置时间、静脉营养、置管次数、营养不良及是否合并糖尿病为大面积烧伤患者发生早期深静脉置管CRBSI发生的危险因素。     

胱抑素C对维持性血液透析患者肌肉减少症的预测价值分析

目的:探讨胱抑素C(Cys C)对维持性血液透析患者肌肉减少症的预测价值。方法:2018年1月—2019年9月间在本院进行MHD的终末期肾病患者168例作为MHD组,根据肌肉减少症发生情况将MHD患者分为肌肉减少症组、非肌肉减少症组,对比其临床资料差异并进一步采用logistics回归模型分析促使MHD患者肌肉减少症出现的危险因素。采用受试者工作特征(ROC)曲线分析Cys C对MHD患者肌肉减少症出现的预测价值。结果:肌肉减少症组、非肌肉减少症组患者年龄及Alb、Scr、CRP、Cys C水平的分布差异有统计学意义(P0.05);性别、BMI、透析方式、透析时间、原发病及Hb、Ca~(2+)、P~(3-)、iPTH、TG水平的分布差异无统计学意义(P0.05)。Logistics回归分析结果显示,年龄较大,Alb水平较低,Scr、CRP、Cys C水平较高分别是MHD患者肌肉减少症发生的独立危险因素。ROC曲线显示,Cys C预测MHD患者发生肌肉减少症的最佳截断值为1.325 mg/L,AUC为0.815[95%CI 0.743～0.887],对应的灵敏度、特异度分别为69.84%、69.05%。结论:Cys C水平较高是MHD合并肌肉减少症的独立危险因素,且早期测定Cys C水平对肌肉减少症发生具有预测价值。     

2型糖尿病患者血清25-羟维生素D水平与骨密度的关系

目的探讨2型糖尿病患者不同血清25-(OH)D水平与骨密度的关系。方法选择住院的2型糖尿病患者288例,根据25-(OH)D水平对其进行分组:25-(OH)D30ng/mL为维生素D充足组;20ng/mL25-(OH)D≤30ng/mL为维生素D不足组;10ng/mL25-(OH)D≤20ng/mL为维生素D缺乏组;25-(OH)D≤10ng/mL为维生素D严重缺乏组。采用双能X线骨密度仪(DEXA)测量受试者腰椎L_(1-4)、股骨颈及全髋的骨密度。分析不同水平25-(OH)D与骨密度的关系。结果维生素D充足组、维生素D不足组、维生素D缺乏组、维生素D严重缺乏组的患者例数(所占比例)分别为10例(3.5%)、74例(25.7%)、177例(61.5%)、27例(9.3%)。不同性别组25-(OH)D水平无明显差异,但是女性患者的腰椎L_(1-4)、股骨颈、全髋的骨密度均较男性低。pearson相关分析显示25-(OH)D水平与腰椎L_(1-4)、股骨颈、全髋的骨密度均无相关性(分别为r=0.080 P=0.262;r=0.139 P=0.051;r=0.068 P=0.342)。结论 2型糖尿病患者25-(OH)D水平与腰椎L_(1-4)、股骨颈、全髋的骨密度均无明显相关性。     

外周血25-羟基维生素D水平对下肢动脉硬化闭塞症支架植入术后血管再狭窄的预测价值

目的探讨外周血25-羟基维生素D[25-(OH)D]水平对下肢动脉硬化闭塞症(LASO)患者支架植入术后发生血管再狭窄的预测价值。方法收集2018年1月至2019年9月于安徽医科大学附属合肥医院行支架植入术的84例LASO患者的临床资料,对患者均进行了为期2年的随访,根据支架植入术后是否发生血管再狭窄将患者分为再狭窄组(n=38)和无再狭窄组(n=46)。比较两组患者的临床特征及外周血25-(OH)D水平;分析再狭窄LASO患者临床特征与外周血25-(OH)D水平的相关性,以及外周血25-(OH)D水平对LASO患者术后发生血管再狭窄的预测价值。结果84例LASO患者中,支架植入术后血管再狭窄的发生率为45.24%(38/84),平均发生时间为术后(18.15±4.84)个月。再狭窄组有吸烟史、有糖尿病史、发生下肢双侧病变、发生下肢完全闭塞的患者比例均高于无再狭窄组,下肢血管病变长度长于无再狭窄组,而外周血25-(OH)D水平低于无再狭窄组,差异均有统计学意义(P<0.05)。Pearson相关性分析结果显示,再狭窄组患者的外周血25-(OH)D水平与糖尿病史、下肢血管病变长度、下肢双侧病变情况、下肢完全闭塞情况均呈负相关(P<0.05),与吸烟史无相关性(P>0.05)。多因素分析结果显示,下肢血管病变长度、下肢完全闭塞是LASO患者术后发生血管再狭窄的独立危险因素,而25-(OH)D水平是LASO患者术后发生血管再狭窄的独立保护因素(P<0.05)。受试者操作特征(ROC)曲线分析结果显示,外周血25-(OH)D水平早期评估LASO患者术后发生血管再狭窄的曲线下面积为0.823(95%CI:0.744~0.972),最佳临界值为9.00 ng/ml,约登指数为0.619,灵敏度为86.05%,特异度为78.96%。结论LASO患者支架植入术后血管再狭窄的发生与外周血25-(OH)D水平密切相关,外周血25-(OH)D可作为预测LASO患者支架植入术后发生血管再狭窄的可靠血清标志物。     

少肌症、维生素D缺乏在类风湿性关节炎合并脊柱骨质疏松性骨折中的临床研究

目的探讨少肌症和维生素D缺乏在RA患者脊柱骨质疏松性骨折(OPF)中的临床意义。方法入选936例RA患者和158例年龄、性别相匹配的正常健康者,所有入选对象均摄脊柱正侧位X线片(T5-L5),并以半定量(SQ)法作为判断脊柱OPF的标准,其中648例RA患者和对照组采用DXA法测定了腰椎和髋部骨密度(BMD),267例RA患者和156例对照组以生物电阻抗法测定了四肢骨骼肌质量,化学发光法测定了234例RA患者和68例对照组血清25(OH)D水平,同时详细记录RA患者各临床及实验室指标等情况。结果 1RA患者中(141/936,15.1%)OPF的发生率明显高于对照组(6/158,3.8%)(χ2=18.658,P0.0001);少肌症的发生率明显高于对照组(55.8%,149/267 vs 9.0%,14/156,χ2=91.176,P0.0001);RA组血清25(OH)D水平明显低于对照组[(13.41±9.71)ng/m L,(22.40±6.26)ng/m L,t=9.063,P0.0001],维生素D缺乏发生率明显高于对照组[80.8%(189/234)vs 36.8%(25/68),χ2=49.412,P0.0001]。2RA患者OPF组25(OH)D水平明显低于无OPF组[(12.28±5.67)ng/m L vs(17.16±10.90)ng/m L,t=2.600,P=0.01];各部位肌肉量均明显低于无OPF组(P0.01~0.05)。3线性相关分析发现:RA患者的25(OH)D与骨骼肌、右上肢、左上肢和躯干肌肉量呈正直线相关关系(P0.05);RA患者的骨骼肌质量与髋部、腰椎各部位BMD呈正直线相关关系(P0.05)。4多元回归分析显示:女性、HAQ积分和总髖部OP的发生为RA患者发生少肌症的危险因素;年龄为RA患者发生脊柱OPF的危险因素,骨骼肌质量指数(SMI)为RA患者发生脊柱OPF的保护因素。结论 RA患者具有高于正常健康者脊柱OPF的发生率,其25(OH)D水平缺乏普遍存在,少肌症发生率增高;RA患者维生素D缺乏、少肌症与RA患者脊柱OPF的发生密切相关。     

骨质疏松症患者骨密度与血清25羟维生素D的相关性研究

目的分析骨质疏松症患者骨密度与血清25羟维生素D的相关性。方法记录397例50~97岁患者的年龄,检测腰椎1~4、左侧股骨颈、左侧股骨上端的骨密度(bone mineral density,BMD),检测骨质疏松4项[甲状旁腺素(parathyroid hormone,PTH)、总I型胶原氨基端前肽(procollagen type 1 amino-terminal propeptide,P1NP)、β胶原降解产物(beta collagen degradation products,β-CTX)、N端骨钙素(N end of osteocalcin,N-MID)]及血清25羟维生素D[25-(OH)D]的水平,根据BMD水平将受试者分为骨量正常组(n=118)、骨量低下组(n=153)和骨质疏松组(n=126)。结果 (1)骨量低下组及骨质疏松组的BMD均明显低于正常骨量组(P0.01),骨质疏松组又明显低于骨量低下组(P0.01);(2)骨质疏松组25-(OH)D、PTH、P1NP、β-Crosslaps及N-CTX均明显低于正常骨量组(P0.01);(3)25-(OH)D与腰椎1~4、左侧股骨颈、左侧股骨上端的BMD、PTH、P1NP、β-CTX无相关性(P0.05),25-(OH)D与N-MID的相关系数为0.193(P0.01)。不同骨密度组间的25-(OH)D差异无统计学意义(P0.05)。结论老年人群普遍存在维生素D(vitamin D,VD)水平不足的现象,而骨质疏松症患者更为突出,其中VD严重缺乏和缺乏所占比例较大,为骨质疏松症的防治提供一定的数据参考,应注意加强宣教及防治。尚未发现25-(OH)D与骨密度之间存在着直接相关关系。     

血液透析患者血清25(OH)D、α-Klotho水平与血管钙化的关系

目的:探讨血液透析(HD)患者血清25(OH) D、可溶性Klotho蛋白(α-Klotho)水平与血管钙化的关系。方法:选择海军军医大学附属长海医院收治的200例行HD的慢性肾衰竭患者为研究对象,根据钙化特征评分分为无钙化组(n=53)、轻(n=32)、中(n=63)、重度钙化组(n=52)。收集患者的一般资料,并进行血液生化指标的检测。分析HD患者发生血管钙化的危险因素,分析血清25(OH) D、α-Klotho水平与血管钙化评分之间的相关性。结果:四组患者在年龄、女性比例、Ca2+、P3-、ALP、CRE、PTH、25(OH) D、α-Klotho水平比较差异有统计学意义(P 0.05)。Logistic回归结果显示:高龄、高水平PTH为HD患者发生血管钙化的危险因素(P 0.05),而高水平25(OH) D和α-Klotho为保护因素(P 0.05)。HD患者的血清25(OH) D、α-Klotho水平与血管钙化评分具有负相关性(r=-0.498、-0.523,P 0.05),而血清25(OH) D与α-Klotho存在显著的正相关关系(r=0.469,P 0.05)。结论:高龄、高水平PTH、低水平25(OH) D和α-Klotho的HD患者更易发生血管钙化,血清25(OH) D和α-Klotho水平可作为预测血管钙化发生及判断其严重程度的重要参考指标。     

Vitamin D status, bone mass, and bone metabolism in home-dwelling postmenopausal Japanese women: Yokogoshi Study

Little has been understood about vitamin D status in relation to bone health in Asian women. The purpose of this study was to identify how the serum 25-hydroxyvitamin D (25[OH]D) concentration is associated with bone mass and bone metabolism. This cross-sectional, community-based epidemiologic study was conducted among 600 ambulatory postmenopausal women. The serum 25(OH)D concentration was measured with radioimmunoassay. Other blood biochemical measurements were intact parathyroid hormone and markers of bone turnover, including osteocalcin and type I collagen cross-linked N-telopeptides. Bone mineral density (BMD) of the lumbar spine and right femoral neck were measured with the dual-energy X-ray absorptiometry method using a QDR4500a. The mean serum 25(OH)D concentration was 55.6 nmol/L (SD 14.6). Serum 25(OH)D concentration was linearly associated with BMD of the femoral neck (R(2)=0.020, P=0.003), but not with BMD of the lumbar spine. Odds ratios (ORs) for low BMD (defined as t score < or =-2.5 SD) were calculated for strata defined by 25(OH)D concentration. The prevalence of low BMD of the lumbar spine was significantly higher in the 40- to 50-nmol/L 25(OH)D group (adjusted OR=3.0, 95% CI: 1.3-7.0) compared to the reference group (> or =70 nmol/L). Prevalence of low BMD for the femoral neck was significantly higher in the 30- to 40-nmol/L (adjusted OR=3.6, 95% CI: 1.1-12.1) and the 40- to 50-nmol/L (adjusted OR=7.6, 95% CI: 2.5-23.2) groups compared to the reference group (> or =70 nmol/L). The mean serum concentration of intact PTH was significantly higher in subjects with serum 25(OH)D <50 nmol/L compared to those with serum 25(OH)D > or =50 nmol/L. The present study suggests that higher serum 25(OH)D concentrations are associated with increased BMD of the femoral neck, and that a serum 25(OH)D concentration of at least 70 nmol/L is needed to obtain high BMD of the femoral neck, and that of at least 50 nmol/L is needed to achieve normal PTH levels and prevent low BMD in home-dwelling postmenopausal Japanese women.     

Relationship between low vitamin D level and metabolic syndrome in maintenance hemodialysis patients

Objective To evaluate the relationship between low vitamin D level and metabolic syndrome (MS) in maintenance hemodialysis (MHD) patients. Methods A total of 143 patients who had received MHD from Jan 2016 to Jan 2017 in the dialysis center of our hospital were enrolled. Their clinical and laboratory data were collected. The serum 25(OH)D3 levels were measured by chemiluminescence instrument. According to the levels of 25(OH)D3, patients were divided into three groups: sufficient group (＞30 μg/L), insufficient group (15-30 μg/L) and deficient group (＜15 μg/L) to explore how the 25(OH)D3 were associated with MS and abnormal metabolic parameters, including central obesity, raised triglycerides (TG), reduced high-density lipoprotein cholesterol (HDL-C), raised systolic blood pressure (SBP), raised diastolic blood pressure (DBP) and increased fasting blood glucose (FBG). The risk factors of MS and abnormal metabolic factors were analyzed by multivariate logistic regression model. Results Among the 143 MHD patients, the median of serum 25(OH)D3 was 24.30(12.90, 29.50) μg/L and the prevalence of MS was 45.45%(65 cases). Among 3 groups the prevalence of MS, the abdominal circumference and the serum TG showed statistical differences, and they increased with the severity of 25(OH)D3 deficiency (all P＜0.05). The body mass indexes of patients in the insufficient and deficient groups were elevated compared with that in the sufficient group (all P＜0.05). SBP, TG and FBG in deficient group were significantly higher but HDL-C was lower than those in the other two groups (all P＜0.05). The more abnormal metabolism existed, the lower 25(OH)D3 levels patients had (H=61.316, P＜0.001). Multivariate logistic regression analysis showed that in MHD patients low 25(OH)D3 negatively correlated with MS (OR=0.889, 95%CI 0.846-0.934, P＜0.001) and abnormal metabolic factors central obesity (OR=0.913, 95%CI 0.874-0.953, P＜0.001), raised TG (OR=0.932, 95%CI 0.894-0.971, P=0.001), reduced HDL-C (OR=0.901, 95%CI 0.845-0.959, P=0.001), raised SBP (OR=0.898, 95%CI 0.847-0.953, P＜0.001) and raised FBG (OR=0.956, 95%CI 0.920-0.994, P=0.024). Conclusions The prevalence of MS is high in MHD patients and low levels of 25(OH)D3 may be an independent risk factor for MS and abnormal metabolic factors.     

Vitamin A levels in patients with CF are influenced by the inflammatory response.

BACKGROUND: Serum vitamin A, normally depressed in inflammatory conditions, is frequently low in people with CF. Vitamin A is important in respiratory epithelial regeneration and repair. We hypothesised that serum vitamin A would be associated with inflammation and disease severity. METHODS: Serum vitamin A (as retinol), C-reactive protein (CRP), vitamin E, 25-hydroxy vitamin D (25OHD), 1,25-dihydroxy vitamin D (1,25(OH)(2)D), weight, and lumbar spine bone mineral density (LSBMD) were measured in 138 subjects with CF (5-56 years) and 138 control subjects (5-48 years). FEV(1), presence of CF liver disease (CFLD) and hospital admissions were recorded in those with CF. RESULTS: Serum vitamin A level was lower in CF subjects than in controls (mean, 95% CI: 1.29, 1.0-1.37 vs. 1.80, 1.7-1.87 micromol/l, p < 0.0001), and inversely correlated with CRP (r(s) = -0.37, p < 0.0001). CF subjects with low vitamin A (45%) level had poorer FEV(1), weight z-score, LSBMD z-score, and higher CRP compared with those with normal levels. In the CF group CRP, vitamin E, 1,25(OH)(2)D, presence of CFLD, admissions, and age were associated with vitamin A level. CONCLUSIONS: Serum vitamin A is negatively associated with CRP in subjects with CF, consistent with normal population studies. It is important to distinguish between low serum vitamin A associated with the inflammatory response and that due to poor nutritional stores. The role of vitamin A in CF warrants further study, in the contexts both of chronic recurrent inflammatory disease and acute pulmonary exacerbation.     

生物可利用25(OH)D、甲状旁腺素对老年髋部骨折术后功能恢复的影响

目的 研究生物可利用25(OH)D、甲状旁腺素对老年脆性髋部骨折术后功能恢复的影响。方法 采用前瞻性队列研究，收集我院2017年5月至2021年11月318例老年髋部骨折患者，选取同时期在体检中心参加体检的健康人为对照组，采用自行设计调查问卷进行调查，检测钙、白蛋白、维生素D结合蛋白、总25(OH)D、甲状旁腺素水平，计算生物可利用25(OH)D水平。随访评价髋部骨折患者术后功能表现，采用多因素Logistic回归模型分析生物可利用25(OH)D、甲状旁腺素与老年脆性髋部骨折功能的相关性。采用受试者工作曲线下面积（receiver operating characteristic，ROC）研究生物可利用25(OH)D、甲状旁腺素与老年脆性髋部骨折术后功能的预测价值。结果 本研究共纳入318名患者，总25(OH)D（OR=0.866，95 %CI：0.834~0.899，P<0.001）、生物可利用25(OH)D（OR=0.775，95 %CI：0.655~0.917，P=0.003）和甲状旁腺素（OR=1.909，95 %CI：0.852~0.969，P=0.004）与康复效果有关。ROC曲线分析结果显示，总25(OH)D、生物可利用25(OH)D和甲状旁腺素的曲线下面积分别为 0.826、0.644和0.579。结论 高总25-(OH)D、高生物可利用25(OH)D、低甲状旁腺素水平促进老年髋部脆性骨折术后功能恢复。     

Serum 25‐hydroxyvitamin D and clinical fracture risk in a multiethnic cohort of women: The women's health initiative (WHI)

Low 25‐hydroxyvitamin D [25(OH)D] levels have been linked to hip fracture in white women. To study the association of 25(OH)D with risk of fracture in multiethnic women, we performed a nested case‐control study within the prospective Women's Health Initiative (WHI) Observational Study. Incident fractures were identified in 381 black, 192 Hispanic, 113 Asian, and 46 Native American women over an average of 8.6 years. A random sample of 400 white women who fractured was chosen. One control individual was selected per case and matched on age, race/ethnicity, and blood draw date. 25(OH)D, parathyroid hormone, and vitamin D–binding protein (DBP) were measured in fasting baseline serum. Conditional logistic regression models were used to calculate the odds ratio (OR) and 95% CI. In multivariable models, higher 25(OH)D levels compared with levels less than 20 ng/mL were associated with a lower risk of fracture in white women (20 to <30 ng/mL: OR = 0.82, 95% CI 0.58–1.16; ≤30.0 ng/mL: OR = 0.56, 95% CI 0.35–0.90; p trend = 0.02). In contrast, higher 25(OH)D (≥20 ng/mL) compared with levels less than 20 ng/mL were associated with a higher risk of fracture in black women (OR = 1.45, 95% CI 1.06–1.98; p trend = 0.043). Higher 25(OH)D (≥30.0 ng/mL) was associated with higher fracture risk in Asian women after adjusting for DBP (OR = 2.78, 95% CI 0.99–7.80; p trend = 0.04). There was no association between 25(OH)D and fracture in Hispanic or Native American women. Our results suggest divergent associations between 25(OH)D and fracture by race/ethnicity. The optimal level of 25(OH)D for skeletal health may differ in white and black women. © 2011 American Society for Bone and Mineral Research     

Commentary on “Predicted plasma 25-hydroxyvitamin D and risk of renal cell cancer.” Joh HK,Giovannucci EL,Bertrand KA,Lim S,Cho E,Department of Medicine,Seoul National University College of Medicine,Seoul, South Korea.: J Natl Cancer Inst 2013; 105(10):726–32. [Epub 2013 Apr 8]. doi: 10.1093/jnci/djt082.

BackgroundAlthough the kidney is a primary organ for vitamin D metabolism, the association between vitamin D and renal cell cancer (RCC) remains unclear.MethodsWe prospectively evaluated the association between predicted plasma 25-hydroxyvitamin D [25(OH)D] and RCC risk among 72,051 women and 46,380 men in the period from 1986 to 2008. Predicted plasma 25(OH)D scores were computed using validated regression models that included major determinants of vitamin D status (race, ultraviolet B flux, physical activity, body mass index, estimated vitamin D intake, alcohol consumption, and postmenopausal hormone use in women). Hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated using Cox proportional hazards models. All statistical tests were two-sided.ResultsDuring 22 years of follow-up, we documented 201 cases of incident RCC in women and 207 cases in men. The multivariable hazard ratios between extreme quintiles of predicted 25(OH)D score were 0.50 (95% CI = 0.32 to 0.80) in women, 0.59 (95% CI = 0.37 to 0.94) in men, and 0.54 (95% CI = 0.39 to 0.75; P trend<.001) in the pooled cohorts. An increment of 10 ng/mL in predicted 25(OH)D score was associated with a 44% lower incidence of RCC (pooled HR = 0.56, 95% CI = 0.42 to 0.74). We found no statistically significant association between vitamin D intake estimated from food-frequency questionnaires and RCC incidence.ConclusionHigher predicted plasma 25(OH)D levels were associated with a statistically significantly lower risk of RCC in men and women. Our findings need to be confirmed by other prospective studies using valid markers of long-term vitamin D status.     

黑龙江省某医院抽样人群血清25羟维生素D水平回顾性研究

目的回顾性分析黑龙江省某医院2017年10月至2018年10月住院患者的维生素D[25(OH)D]水平,并探讨其影响因素。方法收集该医院病案系统2017-2018年所有测定25(OH)D的病例,获取病例信息,将25(OH)D水平按照不同信息分类并比较。结果研究样本包括876名研究对象,25(OH)D缺乏组与不足组共799人,占总人数的91.21%,25(OH)D充足组77人,占8.79%。男性组25(OH)D水平高于女性组,差异具有统计学意义(P<0.001)。男性组中年龄与25(OH)D水平的相关性差异无统计学意义(P=0.772),女性组呈弱正相关(P<0.05)。骨质疏松组(OP)与非骨质疏松组(NOP)间25(OH)D水平差异无统计学意义(P=0.714),女性骨质疏松治疗组25(OH)D水平高于非骨质疏松组(P=0.024)。结论本研究中样本总体25(OH)D水平偏低,提示该地区人群25(OH)D水平普遍偏低。25(OH)D水平与性别、生活方式有关,与年龄、是否患有骨质疏松无关,服用活性维生素D不能提升血清25(OH)D水平。黑龙江地区人群应当注意补充25(OH)D,可以通过改善生活方式或口服维生素D的方式补充。     

Vitamin D supplementation during pregnancy: Double‐blind,randomized clinical trial of safety and effectiveness

The need, safety, and effectiveness of vitamin D supplementation during pregnancy remain controversial. In this randomized, controlled trial, women with a singleton pregnancy at 12 to 16 weeks' gestation received 400, 2000, or 4000 IU of vitamin D₃ per day until delivery. The primary outcome was maternal/neonatal circulating 25‐hydroxyvitamin D [25(OH)D] concentration at delivery, with secondary outcomes of a 25(OH)D concentration of 80 nmol/L or greater achieved and the 25(OH)D concentration required to achieve maximal 1,25‐dihydroxyvitamin D₃ [1,25(OH)₂D₃] production. Of the 494 women enrolled, 350 women continued until delivery: Mean 25(OH)D concentrations by group at delivery and 1 month before delivery were significantly different (p < 0.0001), and the percent who achieved sufficiency was significantly different by group, greatest in 4000‐IU group (p < 0.0001). The relative risk (RR) for achieving a concentration of 80 nmol/L or greater within 1 month of delivery was significantly different between the 2000‐ and the 400‐IU groups (RR = 1.52, 95% CI 1.24–1.86), the 4000‐ and the 400‐IU groups (RR = 1.60, 95% CI 1.32–1.95) but not between the 4000‐ and. 2000‐IU groups (RR = 1.06, 95% CI 0.93–1.19). Circulating 25(OH)D had a direct influence on circulating 1,25(OH)₂D₃ concentrations throughout pregnancy (p < 0.0001), with maximal production of 1,25(OH)₂D₃ in all strata in the 4000‐IU group. There were no differences between groups on any safety measure. Not a single adverse event was attributed to vitamin D supplementation or circulating 25(OH)D levels. It is concluded that vitamin D supplementation of 4000 IU/d for pregnant women is safe and most effective in achieving sufficiency in all women and their neonates regardless of race, whereas the current estimated average requirement is comparatively ineffective at achieving adequate circulating 25(OH)D concentrations, especially in African Americans. © 2011 American Society for Bone and Mineral Research