Maiya S, Sullivan I, Allgrove J, Yates R, Malone M, Brain C, Archer N, Mok Q, Daubeney P, Tulloh R, Burch M
Department of Cardiology, Great Ormond Street Hospital for Children, Great Ormond Street, London, UK.
Heart. 2008 May;94(5):581-4. doi: 10.1136/hrt.2007.119792. Epub 2007 Aug 9.
In recent large paediatric cardiomyopathy population studies from North America and Australia, vitamin D deficiency was not identified as a cause of infant heart failure. However, rickets is resurgent in developed countries.
To review the prevalence of this cardiomyopathy in paediatric cardiology units of southeast England and determine the prognosis.
A retrospective review from 2000 to 2006 in southeast England. Sixteen infants (6 Indian subcontinent, 10 black ethnicity) were identified: median (range) age at presentation was 5.3 months (3 weeks-8 months). All had been breast fed. Ten presented at the end of the British winter (February-May). Median shortening fraction was 10% (range 5-18%) and median left ventricular end diastolic dimension z score was 4.1 (range 3.1-7.0). Six had a cardiac arrest; three infants died. Eight were ventilated, two required mechanical circulatory support and 12 required intravenous inotropic support. Two were referred for cardiac transplantation. Median (range) of biochemical values on admission was: total calcium 1.5 (1.07-1.74) mmol/l; alkaline phosphatase 646 (340-1057) IU/l; 25-hydroxyvitamin D 18.5 (0-46) nmol/l (normal range >35) and parathyroid hormone 34.3 (8.9-102) pmol/l (normal range <6.1). The clinical markers and echocardiographic indices of all survivors have improved. The mean time from diagnosis to achieve normal fractional shortening was 12.4 months.
Vitamin D deficiency and consequent hypocalcaemia are seen in association with severe and life-threatening infant heart failure. That no infant or mother was receiving the recommended vitamin supplementation highlights the need for adequate provision of vitamin D to ethnic minority populations.
在北美和澳大利亚近期开展的大型儿科心肌病人群研究中，维生素D缺乏未被认定为婴儿心力衰竭的病因。然而，佝偻病在发达国家正再度流行。
回顾英格兰东南部儿科心脏病科中这种心肌病的患病率并确定其预后。
对2000年至2006年期间英格兰东南部进行回顾性研究。共确定了16名婴儿（6名来自印度次大陆，10名黑人）：就诊时的中位（范围）年龄为5.3个月（3周 - 8个月）。所有婴儿均为母乳喂养。10名在英国冬季末（2月至5月）就诊。中位缩短分数为10%（范围5 - 18%），左心室舒张末期内径z评分中位数为4.1（范围3.1 - 7.0）。6名发生心脏骤停；3名婴儿死亡。8名需要通气，2名需要机械循环支持，12名需要静脉注射强心支持。2名被转诊进行心脏移植。入院时生化指标的中位（范围）值为：总钙1.5（1.07 - 1.74）mmol/L；碱性磷酸酶646（340 - 1057）IU/L；25 - 羟基维生素D 18.5（0 - 46）nmol/L（正常范围>35），甲状旁腺激素34.3（8.9 - 102）pmol/L（正常范围<6.1）。所有幸存者的临床指标和超声心动图指数均有所改善。从诊断到达到正常缩短分数的平均时间为12.4个月。
维生素D缺乏及随之而来的低钙血症与严重且危及生命的婴儿心力衰竭相关。没有婴儿或母亲接受推荐的维生素补充剂，这凸显了向少数民族人群充分提供维生素D的必要性。
