Hillman Laura S, Cassidy James T, Chanetsa Fungai, Hewett John E, Higgins Barry J, Robertson John D
Department of Child Health, University of Missouri, Columbia, MO 65212, USA.
Arthritis Rheum. 2008 Oct;58(10):3255-63. doi: 10.1002/art.23809.
To assess whether percent true calcium absorption (alpha) is normal and whether supplementation with placebo, vitamin D3 (2,000 IU/day), calcium (1,000 mg/day), or vitamin D3 plus calcium improves alpha, mineral metabolism, or bone mass accrual in children with arthritis.
Eighteen children received all 4 treatments, each for 6 months, in 4 different, randomly assigned orders. Changes in levels of 25-hydroxyvitamin D (25[OH]D), 1,25-dihydroxyvitamin D (1,25[OH]2D), parathyroid hormone, bone turnover markers, and minerals and in bone mineral content were measured. Calcium absorption was determined with a dual stable isotope method using 48Ca administered intravenously and 46Ca administered orally, and measuring 48Ca, 46Ca, and 42Ca in a 24-hour urine specimen by high-resolution inductively coupled plasma mass spectroscopy. Wilcoxon's signed rank test was used both to identify significant change over the treatment period with a given regimen and to compare change with an experimental treatment versus change with placebo.
Percent true calcium absorption was in the lower-normal range and did not differ by treatment (mean+/-SD 28.3+/-20.2% with placebo, 26.1+/-12.1% with calcium, 19.2+/-11.7% with vitamin D3, and 27.1+/-16.5% with vitamin D3 plus calcium). With vitamin D3 and vitamin D3 plus calcium treatment, 25(OH)D levels were increased and 1,25(OH)2D levels were maintained. Serum calcium levels were increased only with vitamin D3 and vitamin D3 plus calcium treatment. Levels of bone turnover markers and increases in bone mineral content did not differ by treatment.
The findings of this study indicate that percent true calcium absorption is low-normal in children with arthritis. Vitamin D3 at 2,000 IU/day increases serum 25(OH)D and calcium levels but does not improve bone mass accretion. Calcium at 1,000 mg/day also failed to improve bone mass.
评估真性钙吸收百分比（α）是否正常，以及补充安慰剂、维生素D3（2000国际单位/天）、钙（1000毫克/天）或维生素D3加钙是否能改善关节炎患儿的α、矿物质代谢或骨量增加。
18名儿童按4种不同的随机分配顺序接受了全部4种治疗，每种治疗持续6个月。测量了25-羟基维生素D（25[OH]D）、1,25-二羟基维生素D（1,25[OH]2D）、甲状旁腺激素、骨转换标志物、矿物质水平以及骨矿物质含量的变化。采用双稳定同位素法测定钙吸收，静脉注射48Ca，口服46Ca，并通过高分辨率电感耦合等离子体质谱法测量24小时尿液样本中的48Ca、46Ca和42Ca。采用Wilcoxon符号秩检验来确定给定治疗方案在治疗期间的显著变化，并比较实验治疗与安慰剂治疗的变化。
真性钙吸收百分比处于正常低限范围，且不同治疗组之间无差异（安慰剂组平均±标准差为28.3±20.2%，钙组为26.1±12.1%，维生素D3组为19.2±11.7%，维生素D3加钙组为27.1±16.5%）。维生素D3和维生素D3加钙治疗后，25(OH)D水平升高，1,25(OH)2D水平维持不变。仅维生素D3和维生素D3加钙治疗可使血清钙水平升高。骨转换标志物水平和骨矿物质含量增加在不同治疗组之间无差异。
本研究结果表明，关节炎患儿的真性钙吸收百分比处于正常低限。每天2000国际单位的维生素D3可提高血清25(OH)D和钙水平，但不能改善骨量增加。每天1000毫克的钙也未能改善骨量。
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