Department of I+D+i, Sanyres Group, University of Córdoba, Mineral Metabolism Unit, Hospital Reina Sofia, E-14004 Córdoba, Spain.
J Steroid Biochem Mol Biol. 2010 Jul;121(1-2):452-5. doi: 10.1016/j.jsbmb.2010.03.078. Epub 2010 Apr 21.
Vitamin D deficiency is recognized as one of the most common chronic medical conditions in the world. Vitamin deficiency has been associated with increased mortality. The aim of the study here presented was to evaluate the vitamin D endocrine system (VDES) status in healthy blood donors and critically ill patients baseline and in response to treatment during a week with two doses of 1.5 mg of 25-hydroxyvitamin D3 and 2 microg calcitriol (1,25(OH)2D3) IV on alternate days, by monitoring levels in serum of major vitamin D metabolites in critically ill patients. Group 1: healthy blood donors (control group) (n=92), and group 2: critically ill subjects from an intensive care unit (ICU) (n=33). Critically ill patients were divided into three groups: group A (n=12) is the control group; group B (n=11), administration PO 1,5 mg of 25(OH)D3, in days 0 and 4 of treatment; and group C (n=11), administration IV of 2 microg 1,25(OH)2D3 on alternate days. Baseline serum levels of vitamin D2 and 25(OH)D2 were not detected. Vitamin D3 (9.8 vs 26.0 nM) (p<0.05), 25(OH)D3 (13.3 vs 52.3 nM) (p<0.001), and 1,25(OH)2D3 (53.8 vs 120.5 pM) (p<0.01) serum levels were significantly lower in critically ill subjects than in healthy donors. After treatment in group B: 25OHD3 increased to 46.0+/-16.5 ng/ml (p<0.0001) (22.2%<75 nM, 11.1% <50 nM). 1,25(OH)2D3 increased to 121.8+/-61.8 pM<0.01 whereas were slightly decreased in the other groups during the study. 24,25(OH)2D3 serum levels were increased in patients treated with calcitriol 8.5+/-5.3 vs 24.8+/-16.3 nM (p<0.05) while the levels kept stable in group A patients. In summary, critically ill patients have a severe vitamin D deficiency, which can be easily corrected by administration of high doses of 25OHD (PO). The VDES functional deficiency could be probably also corrected through administration of calcitriol (IV). Both treatments could produce an improvement in the general health and probably a reduction in overall mortality risk of the critically ill patients.
维生素 D 缺乏症被认为是世界上最常见的慢性疾病之一。维生素缺乏与死亡率增加有关。本研究旨在评估健康献血者和危重病患者的维生素 D 内分泌系统 (VDES) 状态，在一周内给予两次 1.5 毫克 25-羟维生素 D3 和 2 微克骨化三醇 (1,25(OH)2D3)IV，每天交替使用，通过监测危重病患者血清中主要维生素 D 代谢物的水平。第 1 组：健康献血者（对照组）（n=92），第 2 组：来自重症监护病房（ICU）的危重病患者（n=33）。危重病患者分为三组：A 组（n=12）为对照组；B 组（n=11），口服 1,5 毫克 25(OH)D3，治疗第 0 和 4 天；C 组（n=11），每天交替给予 2 微克 1,25(OH)2D3IV。未检测到维生素 D2 和 25(OH)D2 的基线血清水平。与健康供体相比，危重病患者的维生素 D3（9.8 对 26.0 nM）（p<0.05）、25(OH)D3（13.3 对 52.3 nM）（p<0.001）和 1,25(OH)2D3（53.8 对 120.5 pM）（p<0.01）血清水平显著降低。在 B 组治疗后：25OHD3 增加至 46.0+/-16.5ng/ml（p<0.0001）（22.2%<75 nM，11.1%<50 nM）。1,25(OH)2D3 增加至 121.8+/-61.8 pM<0.01，而其他组在研究期间略有下降。接受骨化三醇治疗的患者的 24,25(OH)2D3 血清水平升高 8.5+/-5.3 对 24.8+/-16.3 nM（p<0.05），而 A 组患者的水平保持稳定。总之，危重病患者存在严重的维生素 D 缺乏症，通过给予高剂量 25OHD（PO）可轻易纠正。VDES 功能缺陷也可能通过给予骨化三醇（IV）得到纠正。两种治疗方法都可以改善患者的整体健康状况，并可能降低危重病患者的总体死亡率风险。
