Pronicka E, Rowińska E, Buczeń K, Lorenc R, Gradzka I
Department of Metabolic Diseases, Child Health Centre, Warsaw.
Endokrynol Pol. 1992;43(2):145-52.
Growth rate of five children with vitamin D-dependent rickets was analyzed during the long-term treatment with an active analog of vitamin D3. Considerable increase in growth rate together with the improvement of biochemical values and radiological pattern took place during the initial phase of administration of 1-hydroxyvitamin D3. During the maintenance treatment of long duration with 1-hydroxyvitamin D3 both the acceleration of growth and catch-up growth persisted. However, in 4 among 5 children studied an inhibition of growth was observed during different periods of time. Only in one boy was this connected with the conclusion of the process of physiological growth. In three remaining children a slow-down in growth rate appeared during the pre-pubertal period or was the effect of lowering the dose of 1-hydroxyvitamin D3 as an countermeasure to hypercalciuria. In such cases inhibition of growth was caused by the administration of too small a dose of 1-hydroxyvitamin D3 in relation to the requirement. In all cases the appearance of biochemical features of rickets aggravation, such as low blood serum phosphate concentration and elevated alkaline phosphatase activity, preceded the observable inhibition of growth. The results obtained allow us to conclude that the inhibition of growth observed during the long-term treatment of rickets with 1-hydroxyvitamin D3 may be regarded as the first signal of inadequate dosage of 1-hydroxy vitamin D3.
对5名维生素D依赖性佝偻病患儿在长期使用维生素D3活性类似物治疗期间的生长速率进行了分析。在给予1-羟基维生素D3的初始阶段，生长速率显著增加，同时生化指标和放射学表现也有所改善。在使用1-羟基维生素D3进行长期维持治疗期间，生长加速和追赶生长持续存在。然而，在研究的5名儿童中，有4名在不同时间段观察到生长受到抑制。只有1名男孩的生长抑制与生理生长过程的结束有关。其余3名儿童在青春期前出现生长速率减慢，或者是作为对高钙尿症的对策而降低1-羟基维生素D3剂量的结果。在这种情况下，生长抑制是由于给予的1-羟基维生素D3剂量相对于需求过小所致。在所有病例中，佝偻病加重的生化特征，如血清磷酸盐浓度降低和碱性磷酸酶活性升高，在可观察到的生长抑制之前出现。所得结果使我们得出结论，在使用1-羟基维生素D3长期治疗佝偻病期间观察到的生长抑制可被视为1-羟基维生素D3剂量不足的首个信号。
