Ybarra Juan, Sánchez-Hernández Joan, Gich Ignasi, De Leiva Alberto, Rius Xavier, Rodríguez-Espinosa Jose, Pérez Antonio
Department of Endocrinology, Hospital de Sant Pau, Barcelona, Spain.
Obes Surg. 2005 Mar;15(3):330-5. doi: 10.1381/0960892053576758.
Morbidly obese patients have been reported to present with vitamin D insufficiency and secondary hyperparathyroidism. We assessed whether bariatric surgery alters the 25-hydroxyvitamin D (calcidiol) and intact parathyroid hormone (iPTH) levels in patients presenting with morbid obesity.
A cross-sectional survey was conducted on 144 patients of whom 80 had not undergone bariatric surgery, while 64 had bariatric surgery at a mean of 36 months previously. Calcidiol levels were defined as being normal (>50 nmol/L), insufficient (2550 nmol/L) and deficient (<25 nmol/L). Mild secondary hyperparathyroidism was defined as iPTH >7.3 pmol/L with simultaneous normal values for creatinine, calcium and phosphorus.
80% of the patients presented low vitamin D levels and mild secondary hyperparathyroidism. Previous surgery or the presence of diabetes did not influence calcidiol levels. Corrected serum calcium, phosphorus, alkaline phosphatase, iPTH and Calcidiol were similar between subjects with and without surgery.
Vitamin D deficient states with secondary hyperparathyroidism in the morbidly obese precede and are not significantly affected by bariatric surgery. Hypovitaminosis D with secondary hyperparathyroidism due to low calcidiol bio-availability should be added to the crowded list of sequelae of morbid obesity. While further studies are warranted, it seems advisable to support vitamin D supplementation in the morbidly obese population.
据报道，病态肥胖患者存在维生素D缺乏和继发性甲状旁腺功能亢进。我们评估了减肥手术是否会改变病态肥胖患者的25-羟维生素D（骨化二醇）和完整甲状旁腺激素（iPTH）水平。
对144例患者进行了横断面调查，其中80例未接受减肥手术，64例平均在36个月前接受了减肥手术。骨化二醇水平被定义为正常（>50 nmol/L）、不足（25-50 nmol/L）和缺乏（<25 nmol/L）。轻度继发性甲状旁腺功能亢进被定义为iPTH>7.3 pmol/L，同时肌酐、钙和磷值正常。
80%的患者维生素D水平低且有轻度继发性甲状旁腺功能亢进。既往手术或糖尿病的存在不影响骨化二醇水平。手术组和非手术组受试者的校正血清钙、磷、碱性磷酸酶、iPTH和骨化二醇相似。
病态肥胖患者中维生素D缺乏伴继发性甲状旁腺功能亢进在减肥手术之前就已存在，且不受减肥手术的显著影响。由于骨化二醇生物利用度低导致的维生素D缺乏伴继发性甲状旁腺功能亢进应被添加到病态肥胖后遗症的众多列表中。虽然有必要进行进一步研究，但在病态肥胖人群中支持补充维生素D似乎是可取的。
