Premaor Melissa Orlandin, Alves Gustavo Vasconcelos, Crossetti Ligia Beatriz, Furlanetto Tania Weber
Division of Internal Medicine, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil, Rua Ramiro Barcellos 2350/700, 90035-003--Porto Alegre, RS, Brazil.
Endocrine. 2004 Jun;24(1):47-53. doi: 10.1385/ENDO:24:1:047.
Hypovitaminosis D has been reported in tropical countries, but this hormone has seldom been studied in Brazil. Our purpose was to study the prevalence of hypovitaminosis D in patients hospitalized in internal medicine wards in Southern Brazil. Possible associated factors were studied. We studied 81 adult patients in early spring. Mean serum 25(OH)D was 12 +/- 8.57 ng/mL; hypovitaminosis D was severe (< 10 ng/mL) in 27 (33.3%) patients, and moderate (> or = 10 ng/mL and < 20 ng/mL) in 36 (44.5%) patients. Clinical evaluation did not yield any data associated with hypovitaminosis D. Serum 25(OH)D levels of up to 20 ng/mL were associated with decreased mean serum total calcium (p = 0.001), ionized calcium (p = 0.01), and phosphorus (p = 0.044) levels, and increased mean serum PTH level (p = 0.001). In a multiple regression model, serum PTH level was independently affected by serum total calcium (p = 0.01), phosphorus (p = 0.009), and albumin (p = 0.009) levels. Hypovitaminosis D patients had lower mean serum albumin levels (p = 0.004), and serum 25(OH)D levels were directly correlated to serum albumin levels (p < 0.0001). Albumin influenced independently PTH response to hypovitaminosis D; normoalbuminemic hypovitaminosis D patients had higher mean serum PTH than hypoalbuminemic patients.
Hypovitaminosis D prevalence was very high in medical inpatients in Southern Brazil, in early spring. Nevertheless, secondary hyperparathyroidism was less intense in hypoalbuminemic hypovitaminosis D patients suggesting that in these patients free serum 25(OH)D was closer to normal.
热带国家已报道维生素D缺乏症，但在巴西对这种激素的研究很少。我们的目的是研究巴西南部内科病房住院患者中维生素D缺乏症的患病率，并研究可能的相关因素。我们在早春时节对81名成年患者进行了研究。血清25(OH)D平均水平为12±8.57 ng/mL；27名（33.3%）患者存在严重维生素D缺乏（<10 ng/mL），36名（44.5%）患者存在中度维生素D缺乏（≥10 ng/mL且<20 ng/mL）。临床评估未得出与维生素D缺乏相关的任何数据。血清25(OH)D水平高达20 ng/mL与血清总钙平均水平降低（p = 0.001）、离子钙水平降低（p = 0.01）和磷水平降低（p = 0.044）相关，且与血清甲状旁腺激素平均水平升高（p = 0.001）相关。在多元回归模型中，血清甲状旁腺激素水平独立受血清总钙水平（p = 0.01）、磷水平（p = 0.009）和白蛋白水平（p = 0.009）影响。维生素D缺乏症患者的血清白蛋白平均水平较低（p = 0.004），血清25(OH)D水平与血清白蛋白水平直接相关（p < 0.0001）。白蛋白独立影响甲状旁腺激素对维生素D缺乏症的反应；正常白蛋白血症的维生素D缺乏症患者的血清甲状旁腺激素平均水平高于低白蛋白血症患者。
早春时节，巴西南部内科住院患者中维生素D缺乏症的患病率非常高。然而，低白蛋白血症的维生素D缺乏症患者继发性甲状旁腺功能亢进程度较轻，提示这些患者的游离血清25(OH)D更接近正常水平。
