Department of Internal Medicine, Rijnstate Hospital Arnhem, Wagnerlaan 55, 6800 TA Arnhem, The Netherlands.
Eur J Endocrinol. 2010 Apr;162(4):805-11. doi: 10.1530/EJE-09-0932. Epub 2010 Feb 5.
Severe vitamin D deficiency is very common. Evidence-based guidelines for rapid correction with high-dose oral cholecalciferol are not yet available.
To develop a practical cholecalciferol loading dose regimen.
A total of 208 vitamin D-deficient subjects (serum 25-hydroxyvitamin D(3) (25-OHD(3)) level <50 nmol/l), aged 18-88 years, were treated with solubilized cholecalciferol, 50,000 IU/ml. They received either 25,000 IU every fortnight for 8 weeks (total dose 100,000 IU), 25,000 IU every week for 6 weeks (total dose 150,000 IU), or 25 000 IU every week for 8 weeks (total dose 200,000 IU). Blood samples were collected at baseline and 10 days after the final dose of cholecalciferol. Results Most patients were severely vitamin D deficient: 76% had a serum 25-OHD(3) level <30 nmol/l at baseline. Cholecalciferol in a cumulative dose of 100,000, 150,000, and 200,000 IU increased mean serum 25-OHD(3) level by 29 nmol/l (95% confidence interval (CI): 23-35 nmol/l), 43 nmol/l (95% CI: 36-50 nmol/l), and 69 nmol/l (95% CI: 64-75 nmol/l) respectively. The change in 25-OHD(3) (Delta25-OHD(3)) was related to the dose per kilogram body weight (R(2)=0.38, P<0.0001), and is described by the equation: Delta25-OHD(3)=0.025x(dose per kg body weight).
The cholecalciferol loading dose required to reach the serum 25-OHD(3) target level of 75 nmol/l can be calculated as follows: dose (IU)=40x(75-serum 25-OHD(3))xbody weight.
严重维生素 D 缺乏非常常见。目前尚无循证指南推荐使用大剂量口服胆钙化醇进行快速纠正。
制定实用的胆钙化醇负荷剂量方案。
共纳入 208 例维生素 D 缺乏的受试者（血清 25-羟维生素 D(3)（25-OHD(3)）水平<50 nmol/l），年龄 18-88 岁，采用溶解的胆钙化醇（50000 IU/ml）治疗。他们接受每两周 25000 IU，共 8 周（总剂量 100000 IU）；每周 25000 IU，共 6 周（总剂量 150000 IU）；或每周 25000 IU，共 8 周（总剂量 200000 IU）。在胆钙化醇最后一次给药后 10 天采集血样。结果：大多数患者严重维生素 D 缺乏：76%的患者基线时血清 25-OHD(3)水平<30 nmol/l。胆钙化醇的累积剂量为 100000、150000 和 200000 IU，分别使平均血清 25-OHD(3)水平增加 29 nmol/l（95%置信区间（CI）：23-35 nmol/l）、43 nmol/l（95%CI：36-50 nmol/l）和 69 nmol/l（95%CI：64-75 nmol/l）。25-OHD(3)的变化（Delta25-OHD(3)）与每公斤体重的剂量相关（R(2)=0.38，P<0.0001），由以下方程描述：Delta25-OHD(3)=0.025x（每公斤体重的剂量）。
达到血清 25-OHD(3)目标水平 75 nmol/l 所需的胆钙化醇负荷剂量可以按以下公式计算：剂量（IU）=40x（75-血清 25-OHD(3)）x体重。
