Klein Gordon L, Herndon David N, Chen Tai C, Kulp Gabriela, Holick Michael F
Department of Pediatrics, University of Texas Medical Branch, Children's Hospital Room 3.270, 301 University Boulevard, Galveston, TX, 77555-0352, USA.
J Bone Miner Metab. 2009;27(4):502-6. doi: 10.1007/s00774-009-0065-7. Epub 2009 Mar 17.
Children suffering severe burns develop progressive vitamin D deficiency because of inability of burned skin to produce normal quantities of vitamin D(3) and lack of vitamin D supplementation on discharge. Our study was designed to determine whether a daily supplement of a standard multivitamin tablet containing vitamin D(2) 400 IU (10 microg) for 6 months would raise serum levels of 25-hydroxyvitamin D [25(OH)D] to normal. We recruited eight burned children, ages 5-18, whose families were deemed reliable by the research staff. These children were given a daily multivitamin tablet in the hospital for 3 months in the presence of a member of the research staff and then given the remainder at home. At 6 months, the subjects returned for measurements of serum levels of 25(OH)D,1,25-dihydroxyvitamin D [1,25(OH)(2)D], intact parathyroid hormone (iPTH), Ca, P, albumin, and total protein as well as bone mass by dual energy X-ray absorptiometry. Serum 25(OH)D levels were compared to a group of seven age-matched burned children studied at an earlier date without the vitamin supplement but with the same method of determination of 25(OH)D at 6 months post-burn. In addition, the chewable vitamins were analyzed for vitamin D(2) content by high performance liquid chromatography. Serum concentration of 25(OH)D was 21 +/- 11(SD) ng/ml (sufficient range 30-100) with only one of the eight children having a value in the sufficient range. In comparison, the unsupplemented burn patients had mean serum 25(OH)D level of 16 +/- 7, P = 0.33 versus supplemented. Serum levels of 1,25(OH)(2)D, iPTH, Ca, P, albumin, and total protein were all normal in the supplemented group. Vitamin D(2) content of the chewable tablets after being saponified and extracted was 460 +/- 20 IU. Bone mineral content of the total body and lumbar spine, as well as lumbar spine bone density, failed to increase as expected in the supplemented group. No correlations were found between serum 25(OH)D levels and age, length of stay, percent body surface area burn or third-degree burn. Supplementation of burned children with a standard multivitamin tablet stated to contain 400 IU of vitamin D(2) failed to correct the vitamin D insufficiency.
严重烧伤儿童会逐渐出现维生素D缺乏，原因是烧伤皮肤无法产生正常量的维生素D(3)，且出院时缺乏维生素D补充。我们的研究旨在确定每天补充一片含400国际单位（10微克）维生素D(2)的标准复合维生素片，持续6个月是否能使血清25-羟基维生素D [25(OH)D]水平恢复正常。我们招募了8名年龄在5至18岁的烧伤儿童，研究人员认为他们的家庭可靠。这些儿童在医院时，在研究人员在场的情况下每天服用一片复合维生素片，持续3个月，然后在家中服用剩余的。6个月时，受试者返回进行血清25(OH)D、1,25-二羟基维生素D [1,25(OH)(2)D]、完整甲状旁腺激素（iPTH）、钙、磷、白蛋白和总蛋白水平的测量，以及通过双能X线吸收法测量骨量。将血清25(OH)D水平与一组7名年龄匹配的烧伤儿童进行比较，这组儿童在更早的时候进行了研究，未补充维生素，但在烧伤后6个月采用相同的方法测定25(OH)D。此外，通过高效液相色谱法分析咀嚼片的维生素D(2)含量。血清25(OH)D浓度为21±11（标准差）纳克/毫升（充足范围为30 - 100），8名儿童中只有1名的值在充足范围内。相比之下，未补充维生素的烧伤患者血清25(OH)D平均水平为16±7，与补充组相比，P = 0.33。补充组的血清1,25(OH)(2)D、iPTH、钙、磷、白蛋白和总蛋白水平均正常。咀嚼片经皂化和提取后的维生素D(2)含量为460±40国际单位。补充组全身和腰椎的骨矿物质含量以及腰椎骨密度未能如预期那样增加。在血清25(OH)D水平与年龄、住院时间、体表面积烧伤百分比或三度烧伤之间未发现相关性。给烧伤儿童补充标明含有400国际单位维生素D(2)的标准复合维生素片未能纠正维生素D不足。
