儿童肥胖与维生素D缺乏

儿童肥胖和维生素D缺乏已成为两大公共卫生问题.近年来大量研究表明肥胖及其相关的代谢性疾病与血清低维生素D水平相关,但维生素D缺乏与肥胖之间的因果关系仍不明确.目前仍没有足够证据证明维生素D补充对改善体重、体块指数及脂肪量有益.肥胖可能导致了低维生素D状态,而维生素D和维生素D受体则可能通过作用于脂肪分化、脂肪细胞凋亡、脂质合成和分解、摄食行为及能量消耗方面影响能量平衡.     

Depressed adolescents in a case-series were low in vitamin D and depression was ameliorated by vitamin D supplementation

Aim: The relationship between depression in adolescents and vitamin D was studied in a case‐series that included effects of vitamin D supplementation. Methods: Serum 25OH vitamin D (25OHD) levels in 54 Swedish depressed adolescents were investigated. Subjects with vitamin D deficiency were given vitamin D₃ over 3 months (n = 48). To evaluate well‐being and symptoms related to depression and vitamin D status, the WHO‐5 well‐being scale, the Mood and Feelings Questionnaire (MFQ‐S) and a vitamin D deficiency scale were used. Results: Mean serum 25OHD in the depressed adolescents was 41 at baseline and 91 nmol/L (p < 0.001) after supplementation. Basal 25OHD levels correlated positively with well‐being (p < 0.05). After vitamin D supplementation, well‐being increased (p < 0.001) and there was a significant improvement in eight of the nine items in the vitamin D deficiency scale: depressed feeling (p < 0.001), irritability (p < 0.05), tiredness (p < 0.001), mood swings (p < 0.01), sleep difficulties (p < 0.01), weakness (p < 0.01), ability to concentrate (p < 0.05) and pain (p < 0.05). There was a significant amelioration of depression according to the MFQ‐S (p < 0.05). Conclusion: This study showed low levels of vitamin D in 54 depressed adolescents, positive correlation between vitamin D and well‐being, and improved symptoms related to depression and vitamin D deficiency after vitamin D supplementation.     

婴幼儿反复喘息与血清维生素 D水平相关性研究

目的：探讨婴幼儿反复喘息与血清25-羟维生素D水平之间的相关性,并探讨婴幼儿反复喘息的相关危险因素。方法收集2012年10月至2013年3月在我院哮喘门诊就诊的反复喘息婴幼儿（6～36个月）61例为研究对象;另随机选取同期保健门诊健康婴幼儿（6～36个月）97例为对照组。采用化学发光免疫法测定各组儿童血清25羟-维生素 D的水平,完成病史采集、查体和实验室检查。结果反复喘息组患儿血清25-羟维生素D平均水平（14.38±4.35）μg/L,低于对照组血清25-羟维生素D平均水平（24.07±11.05）μg/L（F＝33.39,P＜0.001）;反复喘息组血清25-羟维生素D≤20μg/L的发生率90％,而对照组11％,前者明显高于后者（ P＜0.001）;多因素回归分析显示特应性过敏体质、吸烟接触史和血清25-羟维生素D≤20μg/L是婴幼儿反复喘息的危险因素（ OR＝9.89,95％CI 3.15～23.11）。结论婴幼儿反复喘息与血清低水平的25-羟维生素D相关。     

维生素D及其受体与佝偻病的研究进展

维生素D通过维生素D受体介导,在体内具有广泛的生物学作用,其中对钙磷代谢的调节作用对于正常的骨骼形成与骨矿化有重要影响.佝偻病为常见的儿童骨代谢性疾病,不同类型佝偻病的病因不同,但其病理生理过程、临床表现及治疗均与维生素D及其受体对骨代谢的影响密切相关.     

新生儿维生素D水平与孕母维生素D水平的关系

目的 探讨新生儿维生素D 水平与孕母维生素D 水平的相关性。方法 2015 年6 月1 日至7月10 日采集102 名足月单胎新生儿脐静脉血及其孕母静脉血,采用同位素稀释超高效液相色谱串联质谱法测定血清25(OH)D 水平。结果 孕母维生素D 不足者39 例(38.2%),缺乏者25 例(24.5%)。新生儿维生素D 不足者27 例(26.5%),缺乏者66 例(64.7%)。不同血清25(OH)D 水平孕母组新生儿25(OH)D 水平差异有统计学意义(P<0.001)。孕母25(OH)D 水平与新生儿维生素D 水平呈正相关(r=0.914,P<0.001)。孕母25(OH)DROC 曲线预测新生儿维生素D 缺乏(≤ 15 ng/mL)的曲线下面积为0.962,95%CI: 0.930~0.994,P<0.001。孕母血清25(OH)D ≤ 27.55 ng/mL 为界值预测新生儿维生素D 缺乏的灵敏度为97.2%,特异度为80.3%。结论 新生儿维生素D 水平与孕母维生素D 水平正相关;孕母维生素D 水平可预测新生儿维生素D 缺乏。     

维生素D缺乏性佝偻病遗传易感性的研究

目的：遗传因素是否参与维生素D缺乏性佝偻病目前尚未明了。拟通过研究维生素D受体基因多态性与维生素D缺乏性佝偻病易感性的相关性,探讨维生素D缺乏性佝偻病的遗传易感性。方法：应用聚合酶链反应-限制性片段长度多态性(PCR-RFLP)分析技术检测159例维生素D缺乏性佝偻病儿童和78例正常儿童(对照组)维生素D受体(VDR)基因FokI位点的多态性,比较两组之间VDR基因型和等位基因的频率。结果：维生素D缺乏性佝偻病患儿和对照组儿童的VDR基因FokI位点基因型分布频率分别为:FF(37%),Ff(51%),ff(12%)和FF(18%),Ff(55%),ff(27%),两组之间的差异有显著性(χ20.01(2)=9.210,χ2=13.3880,P<0.01);佝偻病患儿和对照组儿童的VDR基因FokI位点等位基因分布频率分别为:F(63%),f(37%)和F(46%),f(54%),两组之间的差异有显著性(χ2=6.18,P<0.05)。佝偻病患儿F等位基因分布频率明显高于对照组人群(63%vs46%)两组之间的差异有显著性;而佝偻病患儿f等位基因频率显著低于对照组(37%vs 54%)。结论：VDR基因FokI酶切位点的多态性可能与维生素D缺乏性佝偻病的遗传易感性有关。     

维生素D与支气管哮喘研究进展

维生素D作为一种免疫调节剂与支气管哮喘的发生、发展关系密切.维生素D参与了胎儿肺和免疫系统的发育;流行病学调查发现,维生素D缺乏和哮喘的发病率上升及哮喘的严重程度有关;维生素D对哮喘的发生有早期干预作用,而且在糖皮质激素耐受性哮喘的治疗和特异性免疫疗法中发挥辅助作用.     

Prevalence of vitamin D insufficiency among healthy school-age Cree children

BACKGROUND:

First Nations children are at higher risk for vitamin D deficiency and rickets.

OBJECTIVE:

To assess the prevalence of vitamin D deficiency and the correlations between fat mass, parathyroid hormone and dietary habits with serum vitamin D level in a random sample of Cree children eight to 14 years of age.

METHODS:

Serum 25-hydroxyvitamin D (25[OH]D) levels and additional information regarding anthropometrics and dietary habits were obtained from participants in two Cree communities. Vitamin D deficiency and insufficiency was defined as serum 25(OH)D levels <30 nmol/L and <50 nmol/L, respectively. Proportions to estimate the vitamin D status were weighted to account for the complex sampling design, and Pearson’s correlation coefficients were used to estimate the associations of milk and fish intake, parathyroid hormone and fat mass with serum 25(OH)D levels.

RESULTS:

Data from 52 healthy Cree children (mean [± SD] age 11.1±2.0 years; 27 boys) were included in the analyses. The median serum 25(OH)D level was 52.4 nmol/L (range 22.1 nmol/L to 102.7 nmol/L). Forty-three percent (95% CI 29% to 58%) and 81% (95% CI 70% to 92%) of Cree children had vitamin D levels <50 nmol/L and <75 nmol/L, respectively. Vitamin D intake was positively associated with serum 25(OH)D levels. Obese children had lower vitamin D levels; however, the difference was nonsignificant.

CONCLUSION:

There may be a substantial proportion of Cree children who are vitamin D deficient. Increasing age, lower dietary vitamin D intake and, possibly, higher body mass index were associated with decreased vitamin D levels; however, causality cannot be inferred.     

维生素D与水通道蛋白的研究进展

维生素D是一种脂溶性类固醇激素,通过与维生素D受体(vitamin D receptor,VDR)结合构成1,25 (OH)2D3/VDR信号通路参与调节机体钙磷代谢、糖代谢、脂代谢、水代谢等多种生物功能的调节.水通道蛋白是一类相对分子质量较小的疏水跨膜蛋白,在特殊的组织或细胞中如肾小管、内分泌腺、红细胞等细胞膜上特异表达,参与体内水平衡及代谢的调节.维生素D可以通过抑制肾素-血管紧张素系统在糖尿病肾病等疾病中起积极的作用,而水通道蛋白作为评价肾脏疾病进展及肾脏功能的新指标逐渐走进人们的视线,有研究证实维生素D在参与调节水通道蛋白的表达,维生素D和水通道在肾脏损伤及慢性肾脏疾病发挥着重要作用.     

维生素D、维生素D结合蛋白及维生素D受体和儿童哮喘的关系

越来越多的研究表明,维生素D代谢通路和哮喘发病相关,其机制包括维生素D通路中多个环节异常导致胚胎发育异常及免疫系统的紊乱等。该文主要通过综述维生素D、维生素D结合蛋白、维生素D受体及相关基因多态性和免疫系统之间的关系来阐述哮喘的发病机制及进展。     

Metabolic disturbances and cardiovascular risk factors in obese children with vitamin D deficiency

ObjectivesThe prevalence of obesity among children and adolescents has been rapidly increasing in recent years. Obese individuals are at risk of vitamin D deficiency. The aim of this study was to investigate the relationship between vitamin D deficiency and anthropometric measurements, cardiovascular risk factors, and glucose homeostasis in obese children.MethodsBetween June 2011 and January 2012, 40 obese and 30 non-obese children (between 7 and 14 years of age) were evaluated at Tepecik Training and Research Hospital. The following characteristics were recorded: height; weight; body mass index (BMI); total body fat content; fasting glucose, insulin, and lipid levels; basic biochemical parameters; complete blood count; bilateral carotid intima media thickness; liver ultrasound results; and left ventricular wall thickness were recorded. 25-hydroxy (OH) vitamin D levels were measured from serum.ResultsThe serum 25(OH) vitamin D level was low in 45 children (64.3%). The 24-h ambulatory blood pressure measurements, carotid intima-media thickness, and the prevalence of 25(OH) vitamin D deficiency were different between obese and non-obese children (P < 0.05). The incidence of dyslipidemia was not statistically different between obese and non-obese children (P > 0.05). Plasma 25(OH) vitamin D concentrations were negatively correlated with age, BMI, total body fat content, 24-h ambulatory blood pressure, and carotid intima-media thickness (P < 0.05). Plasma 25(OH) vitamin D levels were not correlated with fasting plasma glucose, HOMA-IR, triglycerides, total cholesterol, low-density cholesterol, and high-density cholesterol (P > 0.05).ConclusionVitamin D deficiency is more prevalent in obese children. Serum 25(OH)vitamin D was significantly associated with several cardiometabolic risk factors. There was no relationship between abnormal glucose homeostasis and dyslipidemia with vitamin D deficiency in obese children.     

维生素D与癫疒间的相关性研究进展

维生素D除参与调节体内钙磷代谢外,其缺乏与全身和神经系统的多种疾病的发病密切相关,如多发性硬化、阿尔茨海默症、帕金森病和脑血管疾病等。近年来研究发现维生素D可能在癫疒间的发病机制中起着重要作用,并可能具有一定的抗惊厥作用。该文对维生素D在癫疒间中的作用,血清维生素D水平及其受体基因的多态性与癫疒间的关系进行了综述,也总结了抗癫疒间药和维生素D之间的相互作用。     

佝偻病维生素D受体基因多态性与25-羟维生素D3相关性

目的：研究1~3岁佝偻病患儿中维生素D受体基因多态性FokⅠ位点与佝偻病相关性,初步探讨维生素D受体基因多态性FokⅠ位点在佝偻病发病中的作用。方法：病例组（佝偻病患儿）62例与对照组（正常健康儿童）60例,用ELISA方法检测血清25-羟维生素D3水平,比较两组之间血清25-羟维生素D3水平。用聚合酶链反应-限制性片段长度多态性（PCR-RFLP）检测病例组和对照组维生素D受体基因多态性FokⅠ位点,比较两组之间基因型和等位基因分布频率。结果病例组血清25-羟维生素D3水平较对照组明显降低,差异有统计学意义（9.1±4.1 ng/mL vs 16.1±6.9 ng/mL;P＜0.05）。维生素D受体基因多态性FokⅠ位点病例组FF基因型明显高于对照组（53% vs 25%）,基因型分布频率差异有统计学意义（χ2=10.221,P＜0.05）,病例组F等位基因频率明显高于对照组（73% vs 57%）,等位基因分布频率差异有统计学意义（χ2=7.511,P＜0.05）。结论维生素D受体基因多态性FokⅠ位点与佝偻病有相关性,提示其在佝偻病遗传易感性方面起重要作用。［中国当代儿科杂志,2010,12（7）：544-546］     

维生素D水平与抗菌肽作用的研究进展

维生素D作为一种免疫调节剂,在抗菌肽的固有免疫调节中发挥重要作用.维生素D可通过Toll样受体识别病原菌,释放抗菌肽,启动固有免疫反应.该文从抗菌肽的功能以及活性维生素D在抗菌肽固有免疫中的作用方面进行综述.     

Therapeutic and collateral effects of 25-hydroxycholecalciferol in vitamin D deficiency

The clinical and biochemical response to 25-hydroxycholecalciferol (25-HCC) and vitamin D₃, 150 g/day for 20 days has been compared in infants aged 3–18 months with nutritional rickets. The infants were allocated at random to Group I (11 infants) treated with 25-HCC and Group II (9 infants) treated with vitamin D₃. In addition 15 matched control children without rickets were allocated to Group III and received 25-HCC 75 g/day for 20 days. Preliminary studies showed that plasma calcium, phosphorus, alkaline phosphatase and urine pH all differed significantly between the rachitic and control groups. The biochemical parameters in both groups of rachitic children became normal after treatment with the exception of plasma alkaline phosphatase which remained elevated. The control group showed a significant increase in plasma and urine calcium values in spite of the low dose of 25-HCC. The findings suggest that 25-HCC is as effective as vitamin D₃ in the treatment of rickets but did not demonstrate any therapeutic advantage.     

血清25-羟维生素D在佝偻病诊断中的应用价值

目的：探讨血清25 羟维生素D［25（OH）D］在维生素D缺乏性佝偻病早期诊断中的意义。方法：检测对照组（73例）、可疑组（45例）和佝偻病组（65例）的血清25（OH）D、钙、磷、碱性磷酸酶浓度,并通过ROC曲线对血清25（OH）D的诊断价值进行评价。结果：对照组、可疑组和佝偻病组的血清25（OH）D水平分别为112±37、83±30和72±31 nmol/L,后两者均显著低于对照组（F=26.174,P0.05）。可疑组和佝偻病组的维生素D缺乏率均显著高于对照组（χ2=33.346, P0.05）。结论：血清25(OH)D水平在可疑及确诊佝偻病的患儿中显著降低,可以反映维生素D的营养状况,适用于佝偻病的早期筛查。     

Metabolic studies in congenital vitamin D deficiency rickets

Congenital rickets in 3 newborns of mothers with advanced nutritional osteomalacia, healed with maternal breast milk feeding when mothers alone were given calcium supplements and 7.5 mg of intravenous D₂ and the mother baby pair protected from sunlight. Maternal plasma biochemistry indicated more severe vitamin D deficiency compared to their newborns (intrauterine foetal priority). The first dose of 7.5 mg of vitamin D₃ and calcium supplements to mother healed osteomalacia but did not appear to heal the rickets of their breast fed infants (extrauterine maternal priority for vitamin D). A second dose given at 3 months interval healed the rickets in their infants and the biochemistry of the mother and baby returned towards normal. Congenital rickets developed when maternal bone mineral and vitamin D stores had been completely exhausted. Raised IPTH levels in the newborn suggested that foetal parathyroids were responsive to hypocalcaemic stimulus.