Vitamin D deficiency in mothers of rachitic infants

Summary The existence of nutritional deficiency rickets among infants in sunny Riyadh was confirmed radiologically. Most of the rachitic infants were breast-fed, some received unsupplemented infant feeding formulae, and all live in an environment that is devoid of sunlight. Their mean age at the time of onset was 10.5 months. 25-Hydroxyvitamin D (25OHD) levels were found to be low in mothers of the rachitic infants. This maternal deficiency as a factor in pathogenesis of rickets in the infant is discussed. Proposals are made to prevent the occurrence of rickets on this scale.     

液相色谱-质谱联用法（LC-MS/MS）和酶联免疫法(ELISA)对体内25（OH）D3水平的测定

目的 同时用液相色谱-质谱联用法（LC-MS/MS）和酶联免疫法（ELISA）检测患者体内25（OH）D3水平,分析两者结果的差异。方法 随机选取50例住院患者,对同一血清样本分别用LC-MS/MS法和ELISA法测定25（OH）D3水平,同时用LC-MS/MS法测定25（OH）D2的水平。结果 LC-MS/MS法测定的维生素D3的均数为14.99±6.51ng/ml,酶联免疫法测定的均数为20.91±9.70ng/ml,两者的相关系数为0.725（P＜0.01）,线性相关方程为维生素D3（LC-MS/MS法）=4.829+0.486×维生素D3(ELISA法)。LC-MS/MS法组25（OH）D3浓度高于20ng/ml的比例17%,酶联免疫法组为52%,LC-MS/MS法组的25（OH）D2和25（OH）D3总浓度高于20ng/ml的为24%。25（OH）D2占25（OH）D总量的8.4%。 结论 LC-MS/MS法测定的维生素D3的数值明显低于ELISA法,两者正相关性较高,可经方程互换。酶联免疫法低估了体内维生素D的缺乏,检测25（OH）D3的同时需测定25（OH）D2浓度。     

Serum 25-hydroxyvitamin D levels and activities of daily living in noninstitutionalized elderly Japanese requiring care

To date, no study has investigated the nutritional status of vitamin D in frail elderly people living at home. The purposes of this study were to assess serum 25-hydroxyvitamin D (25[OH]D) levels and associated factors in noninstitutionalized elderly people who had various levels of physical disability, and to propose an adequate vitamin D nutritional status for the elderly by interpreting the serum 25(OH)D levels in relation to serum parathyroid hormone (PTH) levels in this population. Health examinations were conducted in the winter and summer of 2003. The subjects were 143 elderly people in the winter, and 120 elderly people in the summer, who all used the long-term care insurance system at home. Serum 25(OH)D concentrations were determined with a chemiluminescence protein-binding assay, and serum intact PTH concentrations were determined with an immunoradiometric assay. The subjects' disease histories and lifestyle information were obtained through an interview. Activities of daily living (ADL) levels were evaluated using the Barthel index, and grip strength was measured with a digital hand dynamometer. Average serum 25(OH)D levels in the winter and summer were 54.2 nmol/l (SD 29.0) and 53.3 nmol/l (SD 32.3), respectively, and intact PTH concentrations in the winter and summer were 4.2 pmol/l (SD 1.8) and 4.3 pmol/l (SD 1.8), respectively. The proportion of people who had a low 25(OH)D (<30 nmol/l) and high intact PTH levels (>6.9 pmol/l) were 15%–20% and 8%, respectively. Significant predictors of low serum 25(OH)D concentrations were low ADL levels, female sex, and low fish consumption in both seasons. Serum 25(OH)D concentrations of less than 50 nmol/l were associated with elevated serum intact PTH concentrations. In conclusion, elderly people requiring care at home are at high risk of hypovitaminosis D, and their low serum 25(OH)D levels are mainly associated with low ADL levels. In addition, maintenance of serum 25(OH)D concentrations above 50 nmol/l may prevent hypovitaminosis D-induced hyperparathyroidism.     

上海市绝经后妇女冬季维生素D状况

目的调查上海市绝经后妇女在冬季(12月份)维生素D的状况。方法在社区101例年龄63.7±7.0岁健康绝经后妇女中,检测血清25羟维生素D[25(OH)D]、甲状旁腺激素(PTH),同时检测血钙、磷、碱性磷酸酶、肝肾功能及空腹血糖。所有研究对象均用双能X线吸收仪检测腰椎和股骨近端骨密度(BMD),同时用问卷调查生活方式。结果本研究101例绝经后女性血清25(OH)D平均值为17.09 ng/ml,PTH平均值51.0 pg/ml,维生素D缺乏者占(<20 ng/ml)68%,维生素D不足者(20～29 ng/ml)占了30%,只有2例维生素D充足(>30 ng/ml)占2%。PTH均值在维生素D缺乏组中(53.7 pg/ml)高于维生素D不足组(44.8 pg/ml),有统计学差异(P<0.05);但未发现血清25(OH)D与PTH有线性回归关系。同时未发现血清25(OH)D与血钙、BMD或BMI相关。结论上海市健康绝经后妇女在冬季维生素D普遍不足,维生素D缺乏组的PTH显著高于维生素D不足组,不良的生活方式及低维生素D和钙的摄入应引起重视。     

北京城区老年妇女维生素D营养状况

目的 了解北京城区老年妇女维生素D营养状况.方法 随机选取北京市3个城区17个社区中60岁以上的老年妇女399人,在2008年5轮?旬至7月初采集清晨空腹静脉血分离血清,采用美国DiaSorin公司生产的放射免疫试剂盒测定血25-羟维生素D(25(OH)D)的浓度.结果 在春末夏初,北京市城区老年妇女血清25(OH)D平均水平为(14.4±5.7)ng/ml,维生素D缺乏率(25(OH)D<10 ng/ml)为21.8%,维生素D不足率(10 ng/ml≤25(OH)D<20 ng/ml)为62.4%;从5月到7月,研究对象血清25(OH)D水平逐渐升高.而随着年龄的增大,血清25(OH)D水平有下降的趋势.结论 北京市城区老年妇女维生素D不足的现象比较普遍.     

Long-term hospitalization during pregnancy is a risk factor for vitamin D deficiency in neonates

 In order to examine the effects of long-term hospitalization during pregnancy on vitamin D metabolism in pregnant women and neonates, we measured the serum 25-hydroxyvitamin D (25OHD) levels in pregnant women, as well as measuring 25OHD levels in cord blood and breast milk. In pregnant women hospitalized for longer than 1 month, the serum 25OHD levels were decreased at delivery compared with those in control subjects (10.9 ± 2.6 ng/l vs 19.5 ± 4.9 ng/l; P < 0.01). Although the levels of 25OHD in the cord blood were not significantly different between the long-term hospitalized and control pregnant women in this study (9.36 ± 1.7 ng/l vs 11.1 ± 3.0 ng/l), the 25OHD concentrations in the cord blood were significantly lower than the maternal levels in both groups; the ratios of the levels in cord blood to sera in the long-term hospitalized women and control subjects were 82.1% and 60.3%, respectively. Long maternal hospitalization does not always cause neonatal vitamin D deficiency, but could be one of its major risk factors. Therefore, sufficient sunlight exposure and intake of sufficient vitamin D are considered to be important to prevent vitamin D deficiency in long-term hospitalized pregrant women as well as their babies. Received: July 10, 2002 / Accepted: October 23, 2002 Acknowledgments. This work was supported in part by a Grant-in Aid from the Ministry of Education, Science, Sports, and Culture of Japan, and a Grant-in Aid from the Research for Metabolic Bone Diseases in Japan. Offprint requests to: S. Nakajima     

血清l，25(OH)2D测定及女性正常值的建立

目的 研究建立血清１,２５（ＯＨ）２Ｄ含量的检测方法及女性正常值。方法 用特定的试剂和分离柱分离纯化样品后,放免分析法测定,并观察不同年龄段女性人群的血清１,２５（ＯＨ）２Ｄ含量变化规律。结果 女性健康人群的血清１,２５（ＯＨ）２Ｄ正常值范围是５．５～６０．８ｐｇ／ｍｌ,均值是２７．７±１１．０ｐｇ／ｍｌ,且血清１,２５（ＯＨ）２Ｄ含量随着年龄的增加逐渐下降（Ｐ〈０．０１）,两呈中度相关（ｒ＝－     

FGF23: its role in renal bone disease

Fibroblast growth factor 23 (FGF23) is a recently characterized peptide hormone produced mainly in the bone. It is secreted in response to dietary phosphorus load, and its main function is the promotion of urinary phosphate excretion and the suppression of active vitamin D (1,25D) production in the kidney. As such, FGF23 plays an important role in the maintenance of systemic phosphate homeostasis. In the advanced stages of chronic kidney disease (CKD), the kidney cannot excrete a phosphate load even in the presence of high levels of FGF23. This results in both hyperphosphatemia and a low level of 1,25D that stimulates the secretion of parathyroid hormone (PTH), leading to the development of secondary hyperparathyroidism. In chronic dialysis patients without residual renal function, FGF23 levels become extremely high due to stimulation by vitamin D therapy as well as by high levels of serum phosphate and PTH. Recent investigations have demonstrated that serum FGF23 level can be a useful marker for the prediction of the future development of refractory hyperparathyroidism and the response to vitamin D therapy in dialysis patients. In addition, putative protective roles of FGF23 against calcification have also been speculated on. Further elucidation of the mechanisms of FGF23 action will be needed to understand the various roles of FGF23 in CKD-Mineral and Bone Disorder (CKD-MBD).     

岳阳地区50岁以上人群25经维生素D水平及其与骨密度的关系

目的 通过测定269名岳阳地区50岁以上人群血清25经维生素D(25(OH)D)和骨密度(BMD)水平,分析岳阳地区50岁以上人群的维生素D ( VitD)状况,并探讨其与BMD的关系。方法 采集受试者的血清后,用电化学发光法测定血清25(OH)D水平,并同时应用双能X线吸收仪测定腰椎及髓部BMD。结果 所有受试者中,VitD严重缺乏者占24. 2 %,缺乏者占45. 0%,不足者占24. 5 %,充足者占6. 3。男、女性受试者的25(OH)D水平、腰椎及髓部的BMD间有统计学差异(P<0.001),男性高于女性。男性各年龄段间25(OH)D水平及各部位BMD无统计学差异(P=0. 101 ,P = 0. 261 ,0. 055 ,0. 170 ,0. 108 ,0. 051 ) ;女性各年龄段之间25(OH)D水平及腰椎BMD无统计学差异(P = 0. 364 , 0. 063 ) ;髓部BMD有统计学差异(P < 0. 001 ),随着年龄的增长而逐步减低。男性受试者中,不同25(OH)D水平组间股骨颈、转子间区及整髓BMD无统计学差异(P = 0. 076 , 0. 425 , 0. 122 );腰椎、大转子区BMD水平间有统计学差异(P=0. 027 , 0. 017 ) , VitD充足组腰椎BMD高于其他各组(P = 0. 005 , 0. 025 , 0. 009 );不足组、严重缺乏组大转子区BMD高于缺乏组(P = 0. 021, 0. 005 )。女性受试者中,不同25(OH)D水平组各部位BMD均无统计学差异(P = 0. 616 , 0. 739 , 0. 559 ; 0. 608 , 0. 641)。结论 在湖南岳阳地区50岁以上人群存在严重的维生素D缺乏及不足;对于维生素D状况与骨密度之间可能无直接关联,需加大样本量进一步观察。     

25-OH-D2、25-OH-D3与股骨颈骨密度的相关性研究

目的研究人体内25羟维生素D2(25-OH-D2)、25羟维生素D3(25-OH-D3)含量与股骨颈骨密度的相关性。方法利用双能X线骨密度测量法检测205例患者股骨颈骨密度,同时用高效液相色谱法检测其血清中25-OH-D2及25-OH-D3的含量,并根据维生素D(VitD)含量分析VitD与骨密度的关系。结果人体内VitD(25-OH-D2+25-OH-D3)含量与50岁以下者的股骨颈骨矿含量无相关性(P0.05),与50岁以上者呈正向直线相关(P0.05或P0.01),男女性别均一致。结论对于50岁以上者,随着年龄的增长,其体内血清VitD的含量降低很可能会导致其股骨颈骨矿含量下降。     

Associations of 25‐Hydroxyvitamin D and 1,25‐Dihydroxyvitamin D With Bone Mineral Density,Bone Mineral Density Change,and Incident Nonvertebral Fracture

Relationships between 1,25‐dihydroxyvitamin D (1,25(OH)₂D) and skeletal outcomes are uncertain. We examined the associations of 1,25(OH)₂D with bone mineral density (BMD), BMD change, and incident non‐vertebral fractures in a cohort of older men and compared them with those of 25‐hydroxyvitamin D (25OHD). The study population included 1000 men (aged 74.6 ± 6.2 years) in the Osteoporotic Fractures in Men (MrOS) study, of which 537 men had longitudinal dual‐energy X‐ray absorptiometry (DXA) data (4.5 years of follow‐up). A case‐cohort design and Cox proportional hazards models were used to test the association between vitamin D metabolite levels and incident nonvertebral and hip fractures. Linear regression models were used to estimate the association between vitamin D measures and baseline BMD and BMD change. Interactions between 25OHD and 1,25(OH)₂D were tested for each outcome. Over an average follow‐up of 5.1 years, 432 men experienced incident nonvertebral fractures, including 81 hip fractures. Higher 25OHD was associated with higher baseline BMD, slower BMD loss, and lower hip fracture risk. Conversely, men with higher 1,25(OH)₂D had lower baseline BMD. 1,25(OH)₂D was not associated with BMD loss or nonvertebral fracture. Compared with higher levels of calcitriol, the risk of hip fracture was higher in men with the lowest 1,25(OH)₂D levels (8.70 to 51.60 pg/mL) after adjustment for baseline hip BMD (hazard ratio [HR] = 1.99, 95% confidence interval [CI] 1.19–3.33). Adjustment of 1,25(OH)₂D data for 25OHD (and vice versa) had little effect on the associations observed but did attenuate the hip fracture association of both vitamin D metabolites. In older men, higher 1,25(OH)₂D was associated with lower baseline BMD but was not related to the rate of bone loss or nonvertebral fracture risk. However, with BMD adjustment, a protective association for hip fracture was found with higher 1,25(OH)₂D. The associations of 25OHD with skeletal outcomes were generally stronger than those for 1,25(OH)₂D. These results do not support the hypothesis that measures of 1,25(OH)₂D improve the ability to predict adverse skeletal outcomes when 25OHD measures are available. © 2015 American Society for Bone and Mineral Research.     

Investigation of serum vitamin D and ischaemia-modified albumin levels in infertile Turkish men

Our aim was to explore the existence of a possible relationship of sperm motility with serum 25-hydroxyvitamin D3 (25-OH VD) levels and with ischaemia-modified albumin ( IMA) levels in infertile Turkish men. A total of 30 men with nonobstructive azoospermia (no spermatozoa in ejaculate), 30 men with oligospermia (total progressive motile sperm count (TPMSC) <15 × 10⁶/ml) and 33 fertile men with normospermia (with at least one child, as the control group) were enrolled in the study. The mean 25-OH VD levels for groups 1, 2 and 3 were 9.31 ± 6.46, 19.71 ± 12.80 and 30.52 ± 12.49 respectively (p < .05). There was a statistically significant difference in serum IMA levels among the groups (479.32 ± 307.56 vs. 296.37 ± 127.27 vs. 150.04 ± 81.05, respectively; p < .05). A positive correlation between serum 25-OH VD levels and TPMSC, and a negative correlation between TPMSC and serum IMA levels were determined. Infertile men had lower serum 25-OH VD and higher IMA levels than fertile men, with a positive correlation between serum 25-OH VD levels and TPMSC, and a negative correlation between TPMSC and serum IMA levels. Vitamin D supplementation may increase the sperm motility.     

Threshold value of serum 25-hydroxyvitamin D concentration in relation to elevated serum parathyroid hormone concentrations in elderly Japanese women

This study was designed to determine the threshold value for 25-hydroxyvitamin D [25(OH)D] concentration in relation to elevated serum parathyroid hormone (PTH) concentrations in elderly Japanese women. The subjects were 582 noninstitutionalized, ambulant women who lived in a community in Japan. Serum 25(OH)D concentrations were determined using the Nichols Advantage chemiluminescent assay, and serum intact PTH concentrations were determined with a two-site immunoradiometric assay. Demographic characteristics, calcium intake, and serum 1,25(OH)₂D levels were also determined. The average age, body mass index (BMI), and calcium intake of the subjects were 74.5 years (SD 4.5), 23.3 kg/m² (SD 3.4), and 579 mg/day (SD 248), respectively. The serum log-transformed intact PTH concentration was significantly predicted by the serum 25(OH)D concentration (r = −0.147, P = 0.0004), but not by age, BMI, the serum log-transformed 1,25(OH)₂D concentration, or the log-transformed calcium intake. Analysis of variance with Dunnett's multiple comparisons showed that mean serum intact PTH concentrations with serum 25(OH)D concentrations less than 30 nmol/l (mean intact PTH = 5.89 pmol/l, P < 0.0001) and in the range 30–39 nmol/l (mean intact PTH = 4.54 pmol/l, P = 0.0067) were significantly higher than mean intact PTH concentrations for serum 25(OH)D concentrations greater than 50 nmol/l (mean intact PTH = 3.65 pmol/l, the baseline level), but the mean serum intact PTH concentration for 25(OH)D concentrations in the range 40–49 nmol/l (mean intact PTH = 3.70 pmol/l, P = 0.9975) was not. We conclude that serum 25(OH)D for ambulant elderly Japanese women should be maintained at 40 nmol/l or higher.     

1,25二羟维生素D3对胆管癌细胞系QBC939增殖和凋亡的影响

目的 探讨1,25二羟维生素D3[1,25(OH)2 D3]对胆管癌细胞系QBC939的体外增殖及凋亡的影响.方法 将不同浓度的1,25(OH)2 D3与胆管癌细胞系QBC939共同培养,采用MTT法测定细胞增殖能力、显微镜观察细胞形态学的改变、流式细胞仪检测细胞周期与凋亡、免疫细胞化学观察bcl-2的表达.结果 0.1～0.5μmol/L的1,25(OH)2 D3对胆管癌细胞QBC939有抑制作用,呈剂量依赖性.经1,25(OH)2 D3作用72h后细胞G1期比例升高,S期比例下降,其中0.5μmol/L组细胞G1期由(50.3±1.0)%上升至(65.5±3.2)%,S期由(39.4±0.5)%下降至(23.6±0.7)%;并且可诱导细胞产生凋亡,0.5μmol/L组作用后细胞凋亡率由0.5%上升至24.6%;bcl-2的表达下调.结论 1,25(OH)2 D3能抑制胆管癌细胞系QBC939增殖并诱导细胞凋亡,其引起凋亡的机制可能与下调bcl-2的表达相关.     

维生素D调控成骨细胞的作用机制

维生素D是体内重要调节激素．而1.25(OH)2D3是维生素D最具活性的代谢产物，它可调控骨细胞，尤其是成分细胞的功能。1.25(OH)2D3调控成分细胞是通过基因途径和非基因途径，基因途径由核内维生素D受体介夺，非基因途径与细胞膜活化有关。     

地塞米松和1，25(OH)2D3对体外人骨髓基质细胞成骨及成脂分化的影响

目的 观察地塞米松（Dex）和1，25（OH）2D3（D3）对骨髓基质细胞（MSCs）成骨及成脂分化的影响。方法 以离心法分离培养人MSCs，以10^-7mol／LDex和，或10^-8mol／Ll，25（OH）2D3作为分化诱导剂对细胞进行干预，分别用细胞碱性磷酸酶（ALP）染液试剂盒及苏丹Ⅲ染液对成骨细胞和脂肪细胞进行组织化学染色，计数；使用RT-PCR技术在转录水平检测成骨细胞标记物骨桥蛋白（OPN）及脂肪细胞标记物过氧化酶体增殖激活受体72（PPARγ2）mRNA的表达。结果细胞染色结果表明各干预组ALP^＋细胞百分比均较对照组增加，与对照组相比有显著性差异（P〈0．05），苏丹Ⅲ^＋细胞百分比Dex组较对照组增多，耽组较对照组减少，差异有显著性（P〈0．05），Dex＋D3组较Dex组苏丹Ⅲ^＋细胞数明显减少，两者相比差异有显著性（P〈0．05）；OPNmRNA及PPARγ2mRNA表达未在对照组测得，Dex诱导了OPNmRNA及PPARγ2mRNA表达，1，25（OH）2D3诱导OPNmRNA表达，并抑制Dex诱导的PPARγ2mRNA的表达。结论 Dex促进MSCs的成骨分化及成脂分化，1，25（OH），D，促进MSCs的成骨分化的同时抑制其成脂分化，与Dex合用抑制Dex成脂分化作用，强化了其成骨分化作用，反映了成骨细胞与脂肪细胞间存在的反变关系，表明两者来源于同一前体细胞的可能性。     

23(S)25(R)-1,25-Dihydroxyvitamin D3-lactone, a naturally occurring metabolite of 1,25-dihydroxyvitamin D3, inhibits osteoclast-like cell formation in human bone marrow cultures

We have used a human bone marrow culture system that forms multinucleated cells (MNCs), 50% of which express the osteoclast phenotype, to examine the 23(S)25(R)-1,25-dihydroxyvitamin D₃-26,23-lactone (1,25-D₃-lactone) on osteoclast-like cell formation. The 1,25-D₃-lactone is a vitamin D₃ metabolite that has recently been detected in human serum under physiological conditions at concentrations of approximately 131 pg/ml (3 × 10⁻¹⁰ M) and can inhibit bone resorption induced by 1,25-dihydroxyvitamin D₃ (1,25-D₃) in vivo and in vitro. We examined the effects of the 1,25-D₃-lactone on the formation of MNC that cross-reacted with 23C6 monoclonal antibody (23C6-positive MNC), which preferentially binds to osteoclasts. All metabolites of 1,25-D₃ except the 1,25-D3-lactone increased both total and 23C6-positive MNC formation in a dose-dependent manner. In contrast, the 1,25-D₃-lactone inhibited both total and 23C6-positive MNC formation, whether the cultures were treated with 1,25-D₃, parathyroid hormone, or interleukin-1β, all potent stimulators of MNC formation. This inhibitory action of 1,25-D₃-lactone on MNC formation was very similar to the inhibitory effects of calcitonin. These data suggest that (1) 1,25-D₃-lactone is a potent natural inhibitor of formation of cells with the osteoclast phenotype at physiological concentrations and (2) the inhibition of these cells by 1,25-D₃-lactone may not result solely from its competitive binding to the 1,25-D₃ receptor. Received: April 24, 1997 / Accepted: May 30, 1997     

三发性甲状旁腺功能亢进症诊治进展

甲状旁腺功能亢进(hyperparathyriodism,HPT)依据其发病原因不同可分为3种类型:原发性、继发性、三发性甲状旁腺功能亢进。一些患者在长期的继发性甲旁亢(secondary hyperparathyroidism,SHPT)的基础上,因甲状旁腺受到长期持久的刺激,增生的腺体有了自主功能,发展成能自主性的分泌甲状旁腺素(parathyroid hormone,PTH)的结节,称之为三发性甲状旁腺功能亢进(tertiary hyperparathyroidism,THPT)。以往国内对于三发性甲旁亢的报道相对较少见,可能与临床医生的认识及经验不足有关。随着国内外肾移植病例的增多,其发病率也呈现逐渐增加的趋势。THPT是影响慢性肾衰竭患者死亡率和生活质量的严重并发症,故加深对THPT的认识,规范内科药物治疗,严格把握手术指征,选择个体化手术方案尤为重要。     

广州地区人群中血清25（OH）VitD的水平

目的评价广州正常人血清25（OH）VitD水平,探讨影响血清25（OH）VitD分布的因素。方法自2010年12月至2011年3月在我院体检人群中检查250名正常人（男性组150例,女性组100例,23～79岁）的血清25（OH）VitD水平。结果 250名正常人血清25（OH）VitD水平为17.80±5.35ng/mL,其中男性：18.54±5.37ng/mL;女性：16.71±5.15ng/mL。男性和女性人群血清25（OH）VitD水平差异无统计学意义（P〉0.05）。男性中VitD缺乏的占67.3%,女性中VitD缺乏的占79.0%。年龄与血清25（OH）VitD水平无线性相关性。结论 72.0%的广州正常成年人25（OH）VitD处于缺乏状态。