昆明地区儿童血清 25羟基维生素 D水平检测及维生素 D营养状态分析

目的　了解昆明地区儿童血清 25羟基维生素 D [25（OH）D]水平及维生素 D营养状态,为儿童合理补充维生素 D提供科学依据。方法　选取昆明市第一人民医院 2016年 11月 ~2019年 10月体检儿童 0～ 14岁 600例为研究对象,采用液相色谱串联质谱（ LC-MS/MS）法检测血清 25（OH）D水平,分析不同性别、年龄及季节儿童血清 25（OH）D水平及营养状态。结果　600例 0～ 14岁儿童血清 25（OH）D水平为 27.44±8.82 ng/ml。血清 25（OH）D缺乏率为 19.33%（116/600）,不足率为 47.67%（286/600）,充足率为 33.00%（198/600）。女童的缺乏率（ 24.83%）高于男童（ 14.33%）,儿童血清 25（OH）D的缺乏、不足和充足率在不同性别间差异有统计学意义（ χ2=11.784,P<0.01）。6～ 14岁儿童血清 25（OH）D缺乏率高于 0～ 1岁、1～ 3岁和３～６岁儿童（ 46.81% vs 5.88%,5.86%和 19.53%）,血清 25（OH）D的缺乏、不足和充足率在不同年龄段上差异有统计学意义（ χ2=188.515,P<0.01）。夏、冬季的儿童血清 25（OH）D缺乏率高于春、秋季（ 22.00%,27.50% vs 12.80%,11.43%）,不同季节血清 25（OH）D的缺乏、不足和充足率差异有统计学意义（ χ2=14.492,P<0.05）。结论　昆明地区 0～ 14岁儿童血清 25（OH）D营养状况欠佳,应加强维生素 D健康宣传工作,提高儿童血清 25（OH）D的监测,特别关注 3～ 14岁阶段儿童维生素 D的补充。     

Vitamin D Deficiency and Type 2 Diabetes: A Retrospective Review

Treatment guidelines for the management of patients with type 2 diabetes (T2DM) and vitamin D deficiency do not exist. The primary purpose of this project was to describe vitamin D prescribing patterns, monitoring patterns, and repletion rates for patients with T2DM and vitamin D deficiency. A secondary interest was to consider glycemic control before and after the correction of vitamin D hypovitaminosis to determine if future controlled interventional studies examining the efficacy of treating vitamin D deficiency for patients with T2DM are warranted and support the development of guidelines for managing vitamin D deficiency for patients with T2DM.     

3岁以下哮喘患儿血清维生素D水平及其与肺功能的关系

【目的】探讨3岁以下哮喘儿童与维生素D水平其及与肺功能的关系。【方法】选取106例6个月至3岁哮喘患儿作为观察组;选取同期在儿童保健科体检的健康儿童82例为对照组。分别检测两组儿童血清25-（OH）-D。水平,并测定潮气呼吸肺功能。根据维生素D检测水平分类维生素D不足（〈50nmol／L）和维生素缺乏（〈25nmol／L）。【结果】观察组的维生素D缺乏、不足比例均高于对照组（x2-9．111,P-0．011）。观察组中维生素D缺乏者的气道重度阻塞率显著高于维生素D不足者和维生素D正常者,且随着25-（0H）-D。水平的逐渐降低,阻塞程度也不断加重（P〈O．01）。维生素D缺乏者的支气管舒张试验阳性率显著高于维生素D不足者和维生素D正常者,且随着25-（OH）-D。水平的逐渐降低,支气管舒张试验阳性率也逐渐增大（P〈0．05）。【结论】维生素D缺乏或不足与3岁以下儿童哮喘密切相关,25-（OH）-Ds水平与哮喘加重具有相关性,加重了小气道的阻塞程度,并可增加3岁以下儿童哮喘患儿的气道反应性。     

Screening Adolescents at Risk for Vitamin D Deficiency: A Retrospective Study

Clinical practice guidelines differ on screening recommendations and definitions for adequate vitamin D levels. A chart review of 32 overweight/obese adolescents showed that 91% had low vitamin D levels based on the Endocrine Society definition of sufficient levels (≥ 30 ng/mL), whereas only 56% were low based on the American Academy of Pediatrics definition of sufficient levels (>20 ng/mL). Nurse practitioners should routinely inquire about exercise, healthy diet, and outdoor activities to identify those at risk for low vitamin D. A consensus in recommendations for vitamin D screening and sufficient serum levels would be beneficial for nurse practitioners for early recognition and consistency in care.     

Relationship of Vitamin D3 Deficiency to Depression in Older Adults: A Systematic Review of the Literature From 2008-2013

In 2009, the seminal integrative literature review on vitamin D and the occurrence of depression included 17 studies on older adults and determined the relationship between vitamin D and depression to be largely circumstantial. Since this publication, 10 studies have assessed the relationship of vitamin D status/supplementation to depression in elders. Six studies indicated a link between vitamin D deficiency, depressive symptoms, and overall psychological health, and 4 studies highlight vitamin D supplementation and the effect on depressive symptoms. More studies are needed to confirm a definitive relationship between vitamin D status, supplementation, and effect on depression in geriatric populations.     

Correlations between Serum P2X7, Vitamin A, 25‐hydroxy Vitamin D,and Mycoplasma Pneumoniae Pneumonia

BackgroundIdentifying new molecular diagnostic markers for Mycoplasma Pneumoniae Pneumonia (MPP) has always been an essential topic since MPP cases have increased every year, especially among children. Here, we examined the correlation between serum level of Purinergic receptor P2X7, vitamin A, and 25‐hydroxy vitamin D (25(OH)D) and the severity of MPP, aiming to identify molecules that have the potential to become diagnostic markers.MethodsThis study was conducted on 186 cases aged 1–14 (136 MPP and 50 non‐MPP patients). Serum levels of Purinergic receptor P2X7, vitamin A, 25(OH)D, and multiple inflammatory and immune factors were measured, compared, and tested for statistical significance.ResultsSerum P2X7, tumor necrosis factor‐α (TNF‐α), and interleukin‐1β (IL‐1β) levels were significantly increased in severe MPP patients, while serum vitamin A, 25(OH)D, IgA, and IgG levels were significantly decreased.ConclusionOur results demonstrated a positive correlation between serum P2X7 level and the severity of MPP, and negative correlations between serum levels of vitamin A and 25(OH)D and the severity of MPP, suggesting that high serum levels of P2X7 and low serum levels of vitamin A and 25(OH)D may indicate relatively severer MPP.     

Serum 25-Hydroxyvitamin D Values and Risk of All-Cause and Cause-Specific Mortality: A Population-Based Cohort Study

Objective

To determine the relationship between 25-hydroxyvitamin D (25[OH]D) values and all-cause and cause-specific mortality.

Sunlight in Vitamin D Deficiency: Clinical Implications

Recent evidence shows that hypovitaminosis D can lead to increased morbidity and mortality. This article highlights the role of sunlight in vitamin D deficiency and its consequences for age-related diseases among older adults. The unique content of this article is the review of factors influencing vitamin D levels, primarily the lack of sun exposure whereby health providers’ strategies can impact the reduction of vitamin D deficiency and its complications. Recommendations for vitamin D₃ supplementation are discussed. Clinical trials are needed to investigate specific measures to increase exposure to sunlight, mobilizing providers to take action to eliminate vitamin D deficiency worldwide.     

血清25-羟维生素D水平与急性脑梗死预后的关系

目的 探讨在急性脑梗死患者中25-羟维生素D[25(OH)D]水平与病情预后的关系.方法 入选130例急性脑梗死患者,检测25(OH)D的水平,根据水平分为A组维生素D充足(≥75 nmol/L)、B组不足(50.0~74.9 nmol/L)、C组缺乏(≤49.9 nmol/L).并于入院时及治疗2周后分别测定神经功能受损程度(NIHSS)、日常生活活动(ADL)量表的Barthel指数(BI),根据NIHSS差值判定预后.结果 A、B、C 3组间入院时及治疗2周后NIHSS及BI评分差异均有统计学意义(P＜0.05).A组NIHSS及BI评分明显高于B组、C组.血清25(OH)D水平与患者入院时及治疗2周后的NIHSS评分呈负相关,与患者入院时及治疗2周后BI评分呈正相关.A组的基本痊愈、显著进步、进步例数明显高于B组、C组,两两比较差异有统计学意义.A组、B组无变化、恶化例数明显低于C组,差异有统计学意义.结论 25(OH)D可作为急性脑梗死的危险预测因子,是判断患者病情及预后的客观指标.     

大连市儿童血清25-羟维生素D水平分析

目的：通过对该地区儿童血清25-羟维生素 D 水平检测,为佝偻病防治提供依据。方法选取2012年3月至2013年3月儿保科门诊就诊儿童共445例。取清晨空腹血,采用串联质谱法检测其血清25-羟维生素 D水平。结果大连市儿童各年龄组血清25-羟维生素 D 水平均呈偏态分布,以中位数表示,分别为0～1岁组34．4 ng/mL（27．9～42．9 ng/mL）;1～3岁组32．5 ng/mL（25．6～38．8 ng/mL）;3～6岁组24．9 ng/mL（16．3～31．2）ng/mL;＞6岁组19．7 ng/mL（13．2～29．1）ng/mL;经秩和检验,不同年龄组维生素水平差异有统计学意义（P ＜0．01）。各年龄组除0～1岁组男性高于女性（P ＜0．05）外,其他年龄组男女性别无统计学意义（P ＞0．05）。445例儿童中,维生素 D 严重缺乏（＜5 ng/mL）占0．23％（1/445）;缺乏（5．1～15 ng/mL）占8．76％（39/445）;不足或以下（15．1～20 ng/mL）占6．97％（31/445）;充足（20．1～100 ng/mL）占84．04％（374/445）;过量（＞100 ng/mL）为0。维生素 D 不足（＜20 ng/mL）的儿童占15．95％（71/445）,其中0～1岁组为5．79％（8/138）;1～3岁组为5．20％（9/173）;3～6岁组为32．05％（25/78）;＞6岁组为51．78％（29/56）,以3岁以上儿童为主,各组间存在显著性差异（P＜0．01）。不同季节血清维生素 D 值差异有统计学意义（P ＜0．01）。结论大连市儿童维生素 D 营养状况良好,血清25-羟维生素 D 水平随着年龄波动,3岁以上儿童需重视维生素 D 的补充,特别是冬季春季节。     

Serum 25-Hydroxyvitamin D and Subsequent Cancer Incidence and Mortality: A Population-Based Retrospective Cohort Study

ObjectiveTo determine the relationship between 25-hydroxyvitamin D (25[OH]D) values and subsequent cancer incidence and mortality.Patients and MethodsWe identified all adult patients living in Olmsted County, Minnesota, between January 1, 2005, and December 31, 2011, who had at least 1 25(OH)D measurement and no prior diagnosis of cancer. Cancer outcomes were retrieved starting 30 days after 25(OH)D measurement and until patients’ final clinical visit as an Olmsted County resident; December 31, 2014; or death. Cox proportional hazards regression was used to analyze data.ResultsA total of 8700 individuals had a 25(OH)D measurement and no history of cancer, with a mean ± SD 25(OH)D value of 29.7±12.8 ng/mL (to convert to nmol/L, multiply by 2.496). The mean ± SD age was 51.5±16.4 years, and most were women (78.1%; n=6796) and White (85.7%; n=7460). A total of 761 individuals developed cancer (skin cancer, n=360; nonskin cancer, n=401) during a median follow-up of 4.6 (interquartile range, 3.4-6.1) years. Compared with participants with 25(OH)D values of 20 to 50 ng/mL (reference group), those with 25(OH)D values less than 12 ng/mL had a greater nonskin cancer incidence (hazard ratio [HR], 1.56; 95% CI, 1.03 to 2.36; P=.04) after adjustment. There was no association between 25(OH)D values and total cancer or skin cancer incidence. Compared with individuals from the reference group, 25(OH)D levels less than 12 ng/mL (HR, 2.35; 95% CI, 1.01 to 5.48; P=.047) and 12 to 19 ng/mL (HR, 2.10; 95% CI, 1.05 to 4.22; P=.04) were associated with increased cancer mortality.ConclusionLow 25(OH)D levels were associated with increased risk for incident nonskin cancer and cancer-related mortality.     

The Association Between Body Mass Index and Mortality on Peritoneal Dialysis: A Prospective Cohort Study

♦ Background: Previous studies have demonstrated that increased body mass index (BMI) is associated with decreased mortality in hemodialysis (HD) patients. However, the association between BMI and survival has not been well established in patients undergoing peritoneal dialysis (PD). The aim of the study was to determine the association between BMI and mortality in the PD population using the Clinical Research Center (CRC) registry for end-stage renal disease (ESRD) cohort in Korea.♦ Methods: Prevalent patients with PD were selected from the CRC registry for ESRD, a prospective cohort study on dialysis patients in Korea. Patients were categorized into four groups by quartiles of BMI. Cox regression analysis was used to calculate the adjusted hazard ratio (HR) of mortality with a BMI of quartile 2 (21.4 - 23.5 kg/m²) as the reference.♦ Results: A total of 900 prevalent patients undergoing PD were included. The median follow-up period was 24 months. The multivariate Cox proportional hazard model showed that the lowest quartile of BMI was associated with higher mortality (HR 3.00, 95% confidence interval (CI), 1.26 - 7.15). However, the higher quartiles of BMI were not associated with mortality compared with the reference category of BMI quartile 2 (Quartile 3: HR 1.11, 95% CI, 0.43 - 2.85, Quartile 4: HR 1.64, 95% CI, 0.66 - 4.06) after adjustment for clinical variables.♦ Conclusions: Lower BMI was a significant risk factor for death, but increased BMI was not associated with mortality in Korean PD patients.     

Vitamin D status assessed by a validated HPLC method: within and between variation in subjects supplemented with vitamin D3

Objective. The aim of this study was to develop and validate a high‐pressure liquid chromatography (HPLC) method for assessing vitamin D status as 25‐hydroxyvitamin D₂ (S‐25OHD₂) and 25‐hydroxyvitamin D₃ (S‐25OHD₃) in serum. Material and methods. We assessed the within‐ and between‐subject variation of vitamin D status in serum samples from four different dietary intervention studies in which subjects (n = 92) were supplemented with different doses of vitamin D₃ (5–12?µg/day) and for different durations (4–20 months). Results. The HPLC method was applicable for 4.0–200?nmol S‐25OHD/L, while the within‐day and between‐days variations were 3.8?% and 5.7?%, respectively. There was a concentration‐dependent difference between results obtained by a commercial radioimmunoassay and results from the HPLC method of ?5 to 20?nmol 25OHD/L in the range 10–100?nmol 25OHD/L. The between‐subject variation estimated in each of the four human intervention studies did not differ significantly (p = 0.55). Hence, the pooled standard deviation was 15.3?nmol 25OHD₃/L. In the studies with 6–8 samplings during 7–20 months of supplementation, the within‐subject variation was 3.9–7.2?nmol 25OHD₃/L, while vitamin D status was in the range 47–120?nmol/L. Conclusions. The validated HPLC method was applied in samples from human intervention studies in which subjects were supplemented with vitamin D₃. The estimated standard deviation between and within subjects is useful in the forthcoming decision on setting limits for optimal vitamin D status.     

Vitamin D Status Is Associated With In-Hospital Mortality and Mechanical Ventilation: A Cohort of COVID-19 Hospitalized Patients

ObjectiveTo explore the possible associations of serum 25-hydroxyvitamin D [25(OH)D] concentration with coronavirus disease 2019 (COVID-19) in-hospital mortality and need for invasive mechanical ventilation.Patients and MethodsA retrospective, observational, cohort study was conducted at 2 tertiary academic medical centers in Boston and New York. Eligible participants were hospitalized adult patients with laboratory-confirmed COVID-19 between February 1, 2020, and May 15, 2020. Demographic and clinical characteristics, comorbidities, medications, and disease-related outcomes were extracted from electronic medical records.ResultsThe final analysis included 144 patients with confirmed COVID-19 (median age, 66 years; 64 [44.4%] male). Overall mortality was 18%, whereas patients with 25(OH)D levels of 30 ng/mL (to convert to nmol/L, multiply by 2.496) and higher had lower rates of mortality compared with those with 25(OH)D levels below 30 ng/mL (9.2% vs 25.3%; P=.02). In the adjusted multivariable analyses, 25(OH)D as a continuous variable was independently significantly associated with lower in-hospital mortality (odds ratio, 0.94; 95% CI, 0.90 to 0.98; P=.007) and need for invasive mechanical ventilation (odds ratio, 0.96; 95% CI, 0.93 to 0.99; P=.01). Similar data were obtained when 25(OH)D was studied as a continuous variable after logarithm transformation and as a dichotomous (<30 ng/mL vs ≥30 ng/mL) or ordinal variable (quintiles) in the multivariable analyses.ConclusionAmong patients admitted with laboratory-confirmed COVID-19, 25(OH)D levels were inversely associated with in-hospital mortality and the need for invasive mechanical ventilation. Further observational studies are needed to confirm these findings, and randomized clinical trials must be conducted to assess the role of vitamin D administration in improving the morbidity and mortality of COVID-19.     

上海市徐汇区住院患者血中维生素D水平分析

目的:调查上海市徐汇区住院患者血中维生素D水平。方法:上海市徐汇区中心医院2012年5月—2013年1月收治2315例住院患者。采用液相色谱-质谱联用法(LC-MS/MS)测定患者的血清25-羟基维生素D2[25(OH)D2]、25-羟基维生素D3[25(OH)D3],同时采用常规生化法测定患者的甲状旁腺素(PTH)水平。结果:受试者的25(OH)D2血清浓度为(1.58±2.08)ng/mL,25(OH)D3为(14.23±7.47)ng/mL,总25-羟基维生素D[25(OH)D,包括25(OH)D2和25(OH)D3]为(15.81±7.98)ng/mL,PTH为(48.92±28.65)pg/mL。各年龄段中,大于90岁受检者的25(OH)D浓度最低,其次为小于40岁者,而60~69岁组最高。1787例(77.19%)受试者的PTH血清浓度正常[(10~65)pg/mL],相对应的25(OH)D2为(1.62±2.02)ng/mL,25(OH)D3为(4.62±7.06)ng/mL,25(OH)D血清浓度为(16.24±7.28)ng/mL,PTH与25(OH)D呈负相关(pearson相关系数为-0.212,P0.01)。结论:上海市徐汇区住院患者的维生素D水平普遍偏低。     

Associations Between Serum-Intact Parathyroid Hormone,Serum 25-Hydroxyvitamin D,Oral Vitamin D Analogs and Metabolic Syndrome in Peritoneal Dialysis Patients: A Multi-Center Cross-Sectional Study

♦ Introduction: Although previous studies have suggested associations between serum intact parathyroid hormone (iPTH), 25-hydroxyvitamin D (25(OH)D) and metabolic syndrome (MS) in the general population, these associations are still uncharacterized in peritoneal dialysis (PD) patients.♦ Methods: In total, 837 prevalent PD patients from 5 centers in China were enrolled between April 1, 2011 and November 1, 2011. The demographic data, biochemical parameters and medical records were collected, except for serum 25(OH)D which was measured in 347 of 837 patients. The definition of MS was modified from National Cholesterol Education Program Third Adult Treatment Panel (NCEP-ATPIII).♦ Results: 55.4% of 837 patients were found to have MS. The median concentration of iPTH, 25(OH)D and doses of oral vitamin D analogs for participants with MS was significantly lower than those without MS. The iPTH, 25(OH)D values and doses of vitamin D analogs were all associated with one or more components of MS. After multivariate adjustment, low serum iPTH values and oral vitamin D analogs, rather than serum 25(OH)D, were significantly associated with the presence of MS, abnormal fasting blood glucose (FBG) and high-density lipoprotein cholesterol (HDL-C). Compared to iPTH < 130pg/mL, iPTH 130-585 pg/mL and > 585pg/mL were associated with a lower risk of MS with adjusted odds ratio (OR) of 0.59 and 0.33, respectively. Taking vitamin D analogs was also associated with a lower risk of MS with adjusted OR of 0.55.♦ Conclusions: Serum iPTH and the use of active vitamin D supplements rather than serum 25(OH)D were independently associated with the presence of MS in patients on PD.