Quantitation of serum 25(OH)D2 and 25(OH)D3 concentrations by liquid chromatography tandem mass spectrometry in patients with diabetes mellitus

Vitamin D has been considered to regulate calcium and phosphorus homeostasis and to preserve skeletal integrity. Serum 25-hydroxyvitamin D (25(OH)D) is the best indicator of vitamin D levels. The association of serum 25(OH)D deficiency with increased risk of type 1 diabetes (T1DM) and type 2 diabetes (T2DM) is controversial. We investigated serum 25(OH)D₂ and 25(OH)D₃ levels in diabetes patients by using liquid chromatography tandem mass spectrometry (LC-MS/MS). Serum 25(OH)D2 and 25(OH)D3 levels were measured with liquid chromatography tandem mass spectrometry in electrospray ionization positive mode. Chromatograms were separated using an ACE5 C18 column on a gradient of methanol. The total 25(OH)D levels were calculated as the sum of 25(OH)D3 and 25(OH)D2 levels. A total of 56 patients with T1DM and 41 patients with T2DM were enrolled in this study. There were 42 and 28 non-diabetic, age-matched volunteers who participated as the T1DM controls and the T2DM controls, respectively. The total 25(OH)D levels were lowest in the 21–40 age group. The levels of both 25(OH)D3 and the total 25(OH)D were significantly higher in the T1DM and T2DM groups than in the controls (p < 0.01 in T1DM and p < 0.05 in T2DM group, respectively). The 25(OH)D2 levels were only significantly higher in T1DM patients than in the controls. The percentages of vitamin D deficiency (total 25(OH)D less than 20 ng/mL) in the T1DM, T2DM, the T1DM controls and the T2DM controls were 7.1%, 0%, 14.3% and 3.6%, respectively. The percentages of vitamin D insufficiency (total 25(OH)D less than 30 ng/mL) in the T1DM, T2DM, the T1DM controls and the T2DM controls were 26.8%, 7.3%, 54.8% and 17.9%, respectively. The percentages of vitamin D deficiency and insufficiency were significantly lower in the T1DM patients than in the T1DM controls (p < 0.01). In the present study, both type 1 and type 2 diabetes patients had higher serum 25(OH)D levels and lower percentages of vitamin D deficiency/insufficiency.     

Optimal vitamin D status for the prevention and treatment of osteoporosis

Vitamin D(3) (cholecalciferol) sufficiency is essential for maximising bone health. Vitamin D enhances intestinal absorption of calcium and phosphorus. The major source of vitamin D for both children and adults is exposure of the skin to sunlight. Season, latitude, skin pigmentation, sunscreen use, clothing and aging can dramatically influence the synthesis of vitamin D in the skin. Very few foods naturally contain vitamin D or are fortified with vitamin D. Serum 25-hydroxyvitamin D [25(OH)D; calcifediol] is the best measure of vitamin D status. Vitamin D deficiency [as defined by a serum 25(OH)D level of <50 nmol/L (<20 ng/mL)] is pandemic. This deficiency is very prevalent in osteoporotic patients. Vitamin D deficiency causes osteopenia, osteoporosis and osteomalacia, increasing the risk of fracture. Unlike osteoporosis, which is a painless disease, osteomalacia causes aching bone pain that is often misdiagnosed as fibromyalgia or chronic pain syndrome or is simply dismissed as depression. Vitamin D deficiency causes muscle weakness, increasing the risk of falls and fractures, and should be aggressively treated with pharmacological doses of vitamin D. Vitamin D sufficiency can be sustained by sensible sun exposure or ingesting at least 800-1000 IU of vitamin D(3) daily. Patients being treated for osteoporosis should be adequately supplemented with calcium and vitamin D to maximise the benefit of treatment.     

药物联合行为干预治疗维生素D缺乏患儿对骨代谢相关指标的影响

目的：探讨药物联合行为干预治疗维生素D缺乏的疗效,为临床治疗维生素D缺乏提供参考。方法：选取2017-2018年在我院接受健康体检的610例儿童（3个月~3岁）,检测外周血中25-羟维生素D［25（OH）D］水平,并根据25（OH）D水平将所有研究对象分为维生素D缺乏组（n=60）和正常组（n=550）。分析维生素D缺乏的影响因素,制定行为干预手段。将维生素D缺乏组按随机数字表法分为行为干预组（采用行为干预+维生素D滴剂和葡萄糖酸钙锌口服溶液治疗）和常规治疗组（采用维生素D滴剂和葡萄糖酸钙锌口服溶液治疗）各30例,比较行为干预组和常规治疗组临床疗效及治疗前后骨代谢相关指标水平变化情况。结果：喂养方式、户外活动时间、厌食、腹泻与维生素D缺乏具有相关性（P<0.05）。Logistic回归分析结果显示,喂养方式、户外活动时间、腹泻是维生素D缺乏的独立影响因素（P<0.05）,普通奶粉或其他喂养方式、户外活动时间<2 h/d、经常腹泻患儿更易发生维生素D缺乏。治疗前,行为干预组与常规治疗组25（OH）D水平及骨代谢相关指标差异无统计学意义（P>0.05）,治疗2个月后,行为干预组25（OH）D、血钙、血鳞、骨钙素水平高于常规治疗组,骨碱性磷酸酶（BALP）低于常规治疗组,差异有统计学意义（P<0.05）。结论：在药物治疗的基础上,联合针对喂养方式、消化道功能及户外活动时间等制定的行为干预,可提高治疗维生素D缺乏患儿的临床疗效,改善骨代谢指标。     

New insights into the role of vitamin D and calcium in osteoporosis management: an expert roundtable discussion

BACKGROUND: Adequate vitamin D and calcium nutrition play a critical role in the maintenance of musculoskeletal health and are considered the first step in osteoporosis treatment. ROUNDTABLE DISCUSSION: In February 2008 Merck Sharp & Dohme sponsored a 2-day, evidence-based expert panel on the benefits of vitamin D for the patient with osteoporosis and the role of vitamin D in combination with antiresorptive therapy for the management of osteoporosis. One of the primary objectives of the meeting was to review new data on the optimal serum 25-hydroxy vitamin D [25(OH)D] levels. The symposium was attended by 29 researchers and clinicians from Europe and the Middle East. The discussion focused on optimizing vitamin D and calcium nutrition and reducing falls and fractures in osteoporotic patients. CONCLUSIONS: Current evidence and expert opinion suggests that optimal serum 25(OH)D concentrations should be at least 50 nmol/L (20 ng/mL) in all individuals. This implies a population mean close to 75 nmol/L (30 ng/mL). In order to achieve this level, vitamin D intake of at least 20 microg daily is required. There is a wider therapeutic window for vitamin D than previously believed, and doses of 800 IU per day, regardless of sun exposure, season or additional multivitamin use, appear to present little risk of toxicity. Apart from fracture and fall prevention, optimization of vitamin D status may also have additional general health benefits. Based on newly emerging data regarding calcium supplementation, and recommendations for increased vitamin D intake, the current recommendations for calcium intake in postmenopausal women may be unnecessarily high. In addition to vitamin D and calcium, treatment of patients with osteoporosis at high risk of fractures should also include pharmacologic agents with proven vertebral and non-vertebral fracture efficacy.     

不同维生素D注射剂对健康女性血25羟维生素D水平的影响

目的比较维生素D2注射液与维生素D3注射液在治疗健康女性维生素D缺乏或不足时对血25羟维生素D水平的影响。方法选择常住成都市且年龄在40-55岁的健康女性94名,随机将其分为D2组和D3组各47例。D2组给予维生素D2注射液,每次7.5mg（30万U）,每2周注射1次,共注射4次;D3组给予维生素D3注射液,每次7.5mg（30万U）,每2周注射1次,共注射4次。分别于治疗前、最后1次注射后2周采静脉血测定血清25羟维生素D,血清钙、磷、镁,血清甲状旁腺素（PTH）及血清骨源性碱性磷酸酶（BAP）。结果治疗后,D2组和D3组血清25羟D水平明显升高,差异有统计学意义（P〈0.01）;且治疗后D3组25羟D水平高于D2组,差异有统计学意义（P〈0.01）。治疗前后,2组血清磷、血清PTH均降低,差异有统计学意义（P〈0.01）,血清钙、血清镁、血清BAP无明显变化,差异无统计学意义（P〉0.05）。未出现维生素D中毒或药物相关不良反应表现。结论维生素D针剂无论是D2还是D3治疗维生素D缺乏或不足都是有效的,但在相同用法条件下D3比D2升高血清25羟D水平的幅度更大。维生素D注射剂30万U每2周1次共4次治疗维生素D不足或缺乏是安全的。     

Regulation of sodium, calcium and vitamin D metabolism in Dahl rats on a high-salt/low-potassium diet: genetic and neural influences

1. A dietary combination of high salt and low potassium (HSLK) exacerbates hypertension in Dahl salt-sensitive (DS) rats and renders previously normotensive Dahl salt-resistant (DR) rats hypertensive. In both strains, the severity of hypertension correlates with urinary calcium loss. However, the magnitude of excretory calcium losses is significantly greater in DS rats and is potentiated by chemical sympathectomy in both strains. 2. We hypothesized that a defect in vitamin D metabolism may underlie the observed strain-dependent differences in calcium balance. 3. Arterial blood pressure (ABP), water and mineral balance and serum concentrations of 1,25-dihydroxyvitamin D3 (1,25(OH)2 D3) and 25-hydroxyvitamin D3 (25(OH)D3) were measured in intact and chemically sympathectomized (6-hydroxydopamine; 6-OHDA) DS and DR rats after 8 weeks on a HSLK diet. 4. Chronic ingestion of this diet resulted in marked and moderate levels of hypertension in DS and DR rats, respectively. The hypertension was abated and eliminated by 6-OHDA in the DS and DR strains, respectively. Independent of treatment, DS rats had significantly higher urinary excretion of calcium and reduced intestinal absorption of the ion compared with DR rats. The DS rats had significantly higher serum levels of 1,25(OH)2 D3 and markedly lower serum levels of 25(OH)D3 than DR rats. Chemical sympathectomy tended to increase 1,25(OH)2 D3 and to decrease 25(OH)D3 levels in both strains. 5. These data indicate a genetic difference in vitamin D metabolism between DS and DR rats. The abnormally elevated levels of 1,25(OH)2 D3 in DS rats may be an appropriate compensatory response to excessive excretory calcium loss and reduced target organ sensitivity to the hormone and may, maladaptively, directly contribute to hypertension, by stimulating vascular smooth muscle contractility.     

Vitamin D and the central nervous system

Vitamin D is formed in human epithelial cells via photochemical synthesis and is also acquired from dietary sources. The so-called classical effect of this vitamin involves the regulation of calcium homeostasis and bone metabolism. Apart from this, non-classical effects of vitamin D have recently gained renewed attention. One important yet little known of the numerous functions of vitamin D is the regulation of nervous system development and function. The neuroprotective effect of vitamin D is associated with its influence on neurotrophin production and release, neuromediator synthesis, intracellular calcium homeostasis, and prevention of oxidative damage to nervous tissue. Clinical studies suggest that vitamin D deficiency may lead to an increased risk of disease of the central nervous system (CNS), particularly schizophrenia and multiple sclerosis. Adequate intake of vitamin D during pregnancy and the neonatal period seems to be crucial in terms of prevention of these diseases.     

Effects of synthetic vitamin D analogues on breast cancer cell proliferation in vivo and in vitro.

Calcipotriol (MC903) is a novel vitamin D analogue which effects cellular differentiation and proliferation in vitro and has reduced effects on calcium metabolism in vivo. In the present study its in vitro activity was evaluated using the MCF-7 breast cancer cell line, and its effects on calcium metabolism and mammary tumour growth were measured in vivo in adult female rats. Calcipotriol was compared to the natural metabolite of vitamin D3, 1 alpha,25-dihydroxycholecalciferol [1,25(OH)2D3] and its synthetic analogue 1 alpha hydroxycholecalciferol [1 alpha(OH)D3]. Both calcipotriol and 1,25(OH)2D3 produced significant inhibition of MCF-7 cell proliferation at a concentration of 5 x 10(-11) M. Intraperitoneal administration of calcipotriol to normal female rats showed that the analogue was 100-200 times less active than 1,25(OH)2D3 in raising serum calcium concentration and urinary calcium excretion. Anti-tumour activity of the vitamin D analogues was investigated in vivo using the nitrosomethylurea-induced rat mammary tumor model. Rats, maintained on a low calcium diet, were treated with 1 alpha(OH)D3 (0.25 and 1.25 micrograms/kg). Both doses produced a response rate of 25% but hypercalcaemia developed. Treatment with calcipotriol (50 micrograms/kg) of rats maintained on a normal laboratory diet caused inhibition of tumour progression (response rate 17%) without the development of severe hypercalcaemia. This study supports the concept that vitamin D derivatives may inhibit breast cancer cell proliferation in vivo.     

Vitamin D Supplements in the Indian Market

It is now known that vitamin D deficiency is a worldwide health problem. In our country, as food fortification is lacking, supplementation with pharmaceutical preparations is the only means of treatment of vitamin D deficiency. We aimed to study the composition and availability of various vitamin D preparations in the Indian market, data about which was collected from annual drug compendium. The preparations were assessed for total number, different formulations, constituents and amount of each constituent present in the formulation. Vitamin D3 is available in the form of cholecalciferol, alfacalcidiol and calcitriol as single ingredient products and in combination with calcium and other micronutrients. Most of the supplements contain calcitriol (46.5%) or alfacalcidiol (43%) as tablets (51.1%) and capsules (35.2%). Cholecalciferol, the preferred form for prophylaxis and treatment of vitamin D deficient states, constitutes only 10% of the available market preparations. High market sales of calcium supplements containing calcitriol indicate increasing intake of calcitriol rather than cholecalciferol; which could predispose to toxicity. There is a need for marketing and rational prescribing of the appropriate vitamin D supplement in ostensibly healthy Indian population. Implementation of population-based education and intervention programmes with enforcement of strict regulations could generate awareness and curb unsupervised intake of vitamin D containing dietary supplements. This health challenge mandates effective nutritional policies, fortification and supplementation programmes and partnership between government, healthcare and industry to safeguard the health of Indian population at large.     

An inducible cytochrome P450 3A4-dependent vitamin D catabolic pathway

Vitamin D(3) is critical for the regulation of calcium and phosphate homeostasis. In some individuals, mineral homeostasis can be disrupted by long-term therapy with certain antiepileptic drugs and the antimicrobial agent rifampin, resulting in drug-induced osteomalacia, which is attributed to vitamin D deficiency. We now report a novel CYP3A4-dependent pathway, the 4-hydroxylation of 25-hydroxyvitamin D(3) (25OHD(3)), the induction of which may contribute to drug-induced vitamin D deficiency. The metabolism of 25OHD(3) was fully characterized in vitro. CYP3A4 was the predominant source of 25OHD(3) hydroxylation by human liver microsomes, with the formation of 4β,25-dihydroxyvitamin D(3) [4β,25(OH)(2)D(3)] dominating (V(max)/K(m) = 0.85 ml · min(-1) · nmol enzyme(-1)). 4β,25(OH)(2)D(3) was found in human plasma at concentrations comparable to that of 1α,25-dihydroxyvitamin D(3), and its formation rate in a panel of human liver microsomes was strongly correlated with CYP3A4 content and midazolam hydroxylation activity. Formation of 4β,25(OH)(2)D(3) in primary human hepatocytes was induced by rifampin and inhibited by CYP3A4-specific inhibitors. Short-term treatment of healthy volunteers (n = 6) with rifampin selectively induced CYP3A4-dependent 4β,25(OH)(2)D(3), but not CYP24A1-dependent 24R,25-dihydroxyvitamin D(3) formation, and altered systemic mineral homeostasis. Our results suggest that CYP3A4-dependent 25OHD(3) metabolism may play an important role in the regulation of vitamin D(3) in vivo and in the etiology of drug-induced osteomalacia.     

New insights into the role of vitamin D and calcium in osteoporosis management: an expert roundtable discussion

ABSTRACT

Background: Adequate vitamin D and calcium nutrition play a critical role in the maintenance of musculoskeletal health and are considered the first step in osteoporosis treatment.

Roundtable discussion: In February 2008 Merck Sharp & Dohme sponsored a 2-day, evidence-based expert panel on the benefits of vitamin D for the patient with osteoporosis and the role of vitamin D in combination with antiresorptive therapy for the management of osteo­porosis. One of the primary objectives of the meeting was to review new data on the optimal serum 25-hydroxy­vitamin D [25(OH)D]levels. The symposium was attended by 29 researchers and clinicians from Europe and the Middle East. The discussion focused on optimizing vitamin D and calcium nutrition and reducing falls and fractures in osteoporotic patients.

Conclusions: Current evidence and expert opinion suggests that optimal serum 25(OH)Dconcentrations should be at least 50?nmol/L (20?ng/mL) in all individuals. This implies a population mean close to 75?nmol/L (30?ng/mL). In order to achieve this level, vitamin D intake of at least 20?µg daily is required. There is a wider thera­peutic window for vitamin D than previously believed, and doses of 800?IU per day, regardless of sun exposure, season or additional multivitamin use, appear to present little risk of toxicity. Apart from fracture and fall preven­tion, optimization of vitamin D status may also have additional general health benefits. Based on newly emerging data regarding calcium supplementation, and recommendations for increased vitamin D intake, the current recommendations for calcium intake in postmenopausal women may be unnecessarily high. In addition to vitamin D and calcium, treatment of patients with osteo­porosis at high risk of fractures should also include pharmacologic agents with proven vertebral and non-vertebral fracture efficacy.     

不同维生素D预防剂量婴幼儿血清25-羟基维生素D状况研究

目的：了解重庆地区婴幼儿不同维生素D（vitamin D,VD）预防剂量状态下VD营养状况及其影响因素, 为合理补充VD提供参考。方法：选取重庆市不同经济水平地区5所医院健康体检婴幼儿751例（0~3岁）,采用问卷调查,并检测其血清25-羟基维生素D [25(OH)D]水平,根据不同VD预防剂量、年龄、季节、喂养方式等分组,了解以上因素对25(OH)D的影响。结果：0~3岁婴幼儿VD补充率74.6%（560/751）,VD预防剂量30~1 600 IU/d;25(OH)D水平为（35.29±10.39）ng/mL,并随VD补充量的升高呈现先升高、后保持平稳的趋势;未补充组25(OH)D水平为（30.51±11.03）ng/mL,显著低于补充组;未补充组中VD不足及缺乏率达14.7%,高于补充组（P<0.05）;高剂量补充组（>600 IU/d）较其他组VD缺乏和不足的比率明显下降（P<0.05）;不同季节、年龄、喂养方式、预防剂量可影响25(OH)D水平,以冬春季无食物来源儿童25(OH)D水平最低[（18.44±11.91）ng/mL]。结论：重庆地区0~3岁婴幼儿预防性VD补充率高,但补充剂量差异较大。VD预防性补充是维持婴幼儿体内25(OH)D水平的重要措施,季节和喂养方式可显著影响VD营养状态     

老年住院患者衰弱指数与血清25羟维生素D关系的研究

目的 探讨老年住院患者衰弱指数与血清25羟维生素D水平的相关性.方法 选择老年住院患者100例,依据老年综合评估构建衰弱指数(frailty index based on a Comprehensive Geriatric Assessment,FI-CGA);抽取静脉血标本,测定血清25羟维生素D[25(OH)D]水平;依据25 (OH)D水平将研究人群分为严重缺乏组、缺乏组、不足组和充足组.结果 本研究人群FI-CGA的中位数(四分位数间距)为0.172(0.096～0.216),与维生素D缺乏组[0.154(0.103～0.196)]、不足组[0.107(0.085～0.155)]和充足组[0.071(0.066～0.073)]相比,维生素D严重缺乏组[0.234(0.133～0.367)]的FI-CGA显著升高;Spearman相关分析显示FI-CGA与25 (OH)D呈负相关(r=-0.499,P＜0.001).有序多分类Logistic回归分析结果显示25 (OH)D是FI-CGA的独立保护因素(P＜0.001).结论 老年住院患者中,衰弱指数与维生素D、年龄、性别相关,应注重高龄、女性患者的衰弱筛查,适量补充维生素D可能成为预防和治疗衰弱的一种有效手段.     

Vitamin D status in different subgroups of British Asians.

To assess the effect of religious dietary practices and social customs on the vitamin D status of Asian immigrants, we kept records of the dietary intake and time spent out of doors of 81 Ugandan Asian men, women, and girls (9-19 years old). Sera were analysed for 25-hydroxycholecalciferol (25-OHD3), and 28% of the subjects were found to have levels below the lower limit of normal. The (vegetarian) Hindus had the lowest dietary intakes, least time out of doors, and lowest serum 25-OHD3. The Goan (Roman Catholic) Asians, despite more pigmentation, had 25-OHD3 levels similar to those found among indigenous British people and had the most satisfactory vitamin D intakes. Among Asians, whose exposure to sunlight may be limited, dietary vitamin D becomes the major determinant of serum 25-OHD3.     

Treatment with vitamin 24,25 (OH)2D3 does not change serum levels of 1,25 (OH)2D or urinary calcium excretion rate in man

40 healthy early postmenopausal women participated in a controlled therapeutic trial with the aim of examining whether treatment with 24,25 vitamin D3 changed the serum concentration of either 1,25 (OH)2D and/or the 24-hour urinary calcium excretion rate. The 40 women were randomized to treatment with either 24R,25 (OH)2D3 (10 micrograms daily) or placebo. Serum concentrations of calcium, 25 (OH) D, 1,25 (OH)2D, 24,25 (OH)2D3 and 24-hour urinary calcium excretion rate were measured before (t0) and after (t1) 6 months of treatment. In the 24,25 (OH)2D3 treated group there was a highly significant increase in the mean serum 24,25 (OH)2D3 concentration, whereas serum 25 (OH) D and 1,25 (OH)2D and serum and urinary calcium were unchanged during the trial. In the placebo group all values were similar before and after the trial. We conclude that treatment with 24,25 (OH)2D3 is not an alternative to conventional treatment of renal hypercalciuria.     

Calcidiol [25(OH)D3]: from diagnostic marker to therapeutical agent

Abstract

Objective:

Osteoporosis is a skeletal disorder characterized by diminished bone strength, which results in an increased risk of fracture. Currently, osteoporosis is a public health priority due to the large number of individuals affected and the detrimental effect on quality of life. Primary osteoporosis, the most common form, usually results from age-related reduction in bone mineral strength. Over time, the individual’s capacity to build bone is impaired, as the synthesis of vitamin D, the hormone responsible for calcium absorption, tends to decline. As serum calcium levels decrease, metabolic control serves to increase the removal of calcium from the skeleton to make up for the deficit. The synthesis of the ‘hormone’ vitamin D and its control therefore become central to intervention in involutional osteoporosis syndromes. In humans, plain vitamin D (cholecalciferol), also called parental or native vitamin D, is photosynthesized in the skin and then hydroxylated in the liver into the vitamin D analog calcidiol [25(OH)D3], which is hydroxylated again in the kidney into the vitamin D analog calcitriol [1,25(OH)2D3]. The advantage of administering vitamin D analogs is that the pro-drug calcidiol avoids the effect of declines in hepatic function, while calcitriol avoids the effect of declines in hepatic and kidney function. A strategy to enhance [25(OH)D3] levels to the optimal threshold of vitamin D is supplementation with the calcidiol metabolite itself. The goal of this paper is to review published studies on the efficacy of the calcidiol metabolite in increasing 25(OH)D3 serum levels and improving skeletal health parameters in humans.     

维生素D 缺乏与脊柱结核易感性的关系研究

摘要： 目的 研究维生素 D 缺乏对脊柱结核易感性及病理发展的影响。方法 选取 2013 年 6 月—2016 年 5 月于我院行手术治疗的初治脊柱结核患者 163 例 （病例组）, 同期于我院行健康查体人员 170 例为对照组。应用酶联免疫吸附法检测 2 组样本血清 25-羟基维生素 D ［25 （OH） D］ 水平, 分为严重缺乏 （＜25 nmol/L） 和其他情况 （包括缺乏、 不足及充足）。比较 2 组整体和不同季节的 25 （OH） D 水平变化; 病例组根据病理分型分为增生型和干酪样坏死型, 比较 25 （OH） D 的非严重缺乏 （≥25 nmol/L）、 严重缺乏 （＜25 nmol/L） 组中病理分型的分布情况。结果 病例组 25 （OH） D 表达水平 ［23.99 （20.55, 29.54） nmol/L］ 低于对照组 ［42.94 （35.68, 51.04）nmol/L］, 差异有统计学意义 （P＜ 0.01）, 且不同季节病例组 25 （OH） D 表达水平均低于对照组 （P＜0.05）, 而 2 组夏季 25 （OH） D 表达水平均高于春冬季 （P＜0.008 3）; 病例组春冬季 25 （OH） D 严重缺乏者比例较高, 夏季较低, 严重缺乏者在各季节的分布差异有统计学意义 （P＜0.01）, 对照组一年四季 25 （OH） D 缺乏者比例均较高, 但季节的分布差异无统计学意义 （P＞0.05）。病例组干酪样坏死型有 107 例, 增生型有 56 例, 严重缺乏组干酪样坏死型比例 （79.17%, 76/96） 高于非严重缺乏组（46.27%, 31/67）, 差异有统计学意义 （P＜0.01）。结论 排除季节影响, 维生素 D 缺乏与脊柱结核发病风险增加有关, 并与脊柱结核病理分型有关。     

维生素D对婴幼儿肺炎的临床价值探讨

目的:探讨婴幼儿肺炎血清25(OH)D3水平的变化及维生素D辅助治疗婴幼儿肺炎的临床疗效。方法:选取我院因肺炎住院的78例婴幼儿作为肺炎组,按临床症状轻重不同分成轻症组和重症组,另外选取儿童保健门诊体检的62例婴幼儿作对照组,测定所有患儿血清25(OH)D3水平。再将肺炎组患儿随机分为维生素D治疗组和非治疗组,两组均给予常规的抗感染以及对症支持治疗,治疗组在常规治疗基础上给予维生素D治疗1周,治疗前及治疗后1周分别检测血清25(OH)D3水平,同时比较两组患儿临床疗效。结果:(1)婴幼儿肺炎组血清25(OH)D3水平低于正常对照组,差异有统计学意义(P<0.01)。(2)重症肺炎组血清25(OH)D3水平低于轻症肺炎组,差异有统计学意义(P<0.01)。(3)治疗7 d后,维生素D治疗组血清25(OH)D3水平高于治疗前,差异有统计学意义(P<0.01)。(4)维生素D治疗组的体温恢复正常时间、咳嗽气喘消失时间、肺部啰音消失时间、住院时间均较非治疗组短,差异有统计学意义(P<0.05)。(5)维生素D治疗组总体有效率97.4%,高于非治疗组的82.1%,差异有统计学意义(P<0.05)。结论:维生素D 缺乏可能是婴幼儿肺炎的诱因之一,在判断疾病轻重上也有一定的意义,维生素D 辅助治疗婴幼儿肺炎可缩短病程、改善疗效。