Sadlier D M, Magee C C
Renal Division, Brigham and Women's Hospital, Boston, MA, USA.
Clin Transplant. 2007 Nov-Dec;21(6):683-8. doi: 10.1111/j.1399-0012.2007.00696.x.
25(OH) Vitamin D (calcidiol) is the major circulating form of vitamin D and is considered the most reliable measure of vitamin D status. Adequate vitamin D status is important for bone health but there is increasing evidence that low serum concentrations of calcidiol (<30 ng/mL) are associated with many adverse health outcomes in the general population. Little is known about calcidiol status at the time of renal transplantation, a period when bone loss is greatest and immunosuppression is highest. We prospectively measured serum calcidiol and parathyroid hormone immediately after transplant from March 2005 onwards. Of 112 patients studied, 29% had calcidiol deficiency (<10 ng/mL), 59% had calcidiol insufficiency (10-29 ng/mL) and only 12% of patients had a normal calcidiol concentration (>30 ng/mL). The prevalence of calcidiol deficiency in black recipients was extremely high at 41%. Serum calcidiol tended to be lower in winter than other seasons. In conclusion, the prevalence of 25(OH) vitamin D (calcidiol) deficiency/insufficiency at the time of renal transplant is very high. The clinical effects of this deficiency/insufficiency deserve further study.
25(OH)维生素D(骨化二醇)是维生素D在血液循环中的主要形式,被认为是评估维生素D状态最可靠的指标。充足的维生素D状态对骨骼健康很重要,但越来越多的证据表明,血清骨化二醇浓度低(<30 ng/mL)与普通人群的许多不良健康结局相关。对于肾移植时的骨化二醇状态了解甚少,而肾移植时期是骨质流失最严重且免疫抑制最强的阶段。从2005年3月起,我们对移植后立即采集的血清骨化二醇和甲状旁腺激素进行了前瞻性测量。在研究的112例患者中,29%存在骨化二醇缺乏(<10 ng/mL),59%存在骨化二醇不足(10 - 29 ng/mL),只有12%的患者骨化二醇浓度正常(>30 ng/mL)。黑人受者中骨化二醇缺乏的患病率极高,为41%。血清骨化二醇在冬季往往低于其他季节。总之,肾移植时25(OH)维生素D(骨化二醇)缺乏/不足的患病率非常高。这种缺乏/不足的临床影响值得进一步研究。