Chavasse R J, Francis J, Balfour-Lynn I, Rosenthal M, Bush A
Department of Paediatrics, Royal Brompton Hospital, London, UK.
Pediatr Pulmonol. 2004 Aug;38(2):119-22. doi: 10.1002/ppul.20047.
Osteopenia is increasingly recognized in adults with cystic fibrosis (CF), and is potentially related to vitamin D deficiency in both adulthood and childhood. Vitamin D supplements are recommended and prescribed to all pancreatic-insufficient patients. We aimed to ascertain whether vitamin D deficiency in children with CF was prevalent. 25-hydroxyvitamin D (25-OHD) was measured in 290 children attending a specialist pediatric CF clinic for annual assessment. 25-OHD levels were compared with reference values and to other biochemical markers, lung function, and growth. Levels were also analyzed by pancreatic status and by the presence of CF-related liver disease. Median 25-OHD was 65 (range, 9-190) nmol/l. One percent had levels below 15 nmol/l, and 6% had levels less than 25 nmol/l. Levels were lower in adolescents (P < 0.001) and during the "winter" months (P < 0.001). No relationship was found with pancreatic status or liver disease. In conclusion, the majority of children had normal 25-OHD levels. Interpretation is difficult due to a lack of knowledge of optimal levels of 25-OHD required for healthy bone accretion. Lower levels in adolescents may be a precursor to low levels in adulthood, and did not seem to be simply related to poor compliance with supplementation. This may reflect normal physiology.
骨质疏松症在患有囊性纤维化（CF）的成年人中越来越受到关注，其可能与成人期和儿童期的维生素D缺乏有关。建议并给所有胰腺功能不全的患者开具维生素D补充剂。我们旨在确定CF患儿中维生素D缺乏是否普遍存在。对290名到专科儿科CF诊所进行年度评估的儿童测量了25-羟维生素D（25-OHD）。将25-OHD水平与参考值以及其他生化指标、肺功能和生长情况进行了比较。还按胰腺状况和是否存在CF相关肝病对水平进行了分析。25-OHD的中位数为65（范围9-190）nmol/l。1%的儿童水平低于15 nmol/l，6%的儿童水平低于25 nmol/l。青少年的水平较低（P<0.001），在“冬季”月份也较低（P<0.001）。未发现与胰腺状况或肝病有关。总之，大多数儿童的25-OHD水平正常。由于缺乏关于健康骨骼生长所需的25-OHD最佳水平的知识，解读存在困难。青少年中较低的水平可能是成年期低水平的先兆，似乎并非仅仅与补充剂依从性差有关。这可能反映了正常的生理情况。
