Beck-Nielsen Signe Sparre, Jensen Tina Kold, Gram Jeppe, Brixen Kim, Brock-Jacobsen Bendt
Department of Pediatrics, Hospital of Southwest Denmark, Esbjerg, Denmark.
Eur J Pediatr. 2009 Aug;168(8):941-9. doi: 10.1007/s00431-008-0864-1. Epub 2008 Nov 5.
This study describes clinical and biochemical characteristics of nutritional rickets and risk factors at diagnosis among children living in Denmark. All medical records from patients with rickets referred to or discharged from hospitals in Southern Denmark from 1985 to 2005 were identified by register search.
Patients included were younger than 15 years of age and fulfilled the diagnostic criteria of primary, nutritional rickets. A total of 112 patients with nutritional rickets were included: 29 were of ethnic Danish origin, and 83 were immigrants.
Patients diagnosed before the age of 4 (median 1.4) years displayed the classic clinical signs of rickets, whereas patients diagnosed after the age of 4 (median 12.5) years had few clinical signs and unspecific symptoms. Ethnic Danish patients were only diagnosed before age 24 months, and they accounted for 73% of all cases presenting with hypocalcemic seizures, but biochemically, they did not have more severe rickets. Of patients diagnosed before the age of 4 years, 45% were ethnic Danish. In early childhood, insufficient or no vitamin D supplementation was given in 88% of all cases. Among immigrant girls older than 4 years of age, 78% were veiled.
Nutritional rickets in Denmark is predominantly a disease among immigrants, but ethnic Danish patients comprised nearly half of all patients diagnosed before the age of 4 years, and they presented more frequently with hypocalcemic seizures. The main risk factors were omitted, such as vitamin D prophylaxis among the youngest patients and veiling among older children/teenagers.
本研究描述了丹麦儿童营养性佝偻病的临床和生化特征以及诊断时的风险因素。通过登记搜索确定了1985年至2005年转诊至丹麦南部医院或从丹麦南部医院出院的佝偻病患者的所有病历。
纳入的患者年龄小于15岁，符合原发性营养性佝偻病的诊断标准。共纳入112例营养性佝偻病患者：29例为丹麦族裔，83例为移民。
4岁前（中位数1.4岁）诊断的患者表现出佝偻病的典型临床体征，而4岁后（中位数12.5岁）诊断的患者临床体征较少且症状不具特异性。丹麦族裔患者仅在24个月前被诊断，他们占所有低钙血症惊厥病例的73%，但在生化方面，他们的佝偻病并不更严重。4岁前诊断的患者中，45%为丹麦族裔。在幼儿期，88%的病例维生素D补充不足或未补充。在4岁以上的移民女孩中，78%戴面纱。
丹麦的营养性佝偻病主要是移民中的一种疾病，但丹麦族裔患者占4岁前诊断的所有患者的近一半，且他们更常出现低钙血症惊厥。主要风险因素被遗漏，如最年幼患者的维生素D预防以及大龄儿童/青少年的戴面纱情况。
