维生素 D 状态在慢性肾脏病患儿中的表现。
Vitamin D status in children with chronic kidney disease.
机构信息
Department of Pediatrics, Children's Hospital Boston, Boston, MA, USA.
出版信息
Pediatr Nephrol. 2012 Aug;27(8):1341-50. doi: 10.1007/s00467-012-2143-7. Epub 2012 Mar 28.
BACKGROUND
The role of vitamin D status in patients with renal insufficiency and its relation to dietary intake and parathyroid hormone (PTH) secretion is of utmost interest given the morbidity and mortality associated with the disordered mineral metabolism seen in chronic kidney disease (CKD).
METHODS
We conducted a cross-sectional study of 100 pediatric patients with a diagnosis of CKD stage 1-5 at Children's Hospital Boston, measuring blood levels of 25-hydroxyvitamin D [25(OH)D], 1,25-dihydroxyvitamin D [1,25(OH)(2)D], and parathyroid hormone and obtaining data on nutrient intake and other variables related to vitamin D status.
RESULTS
Subjects ranged in age from 6 months to 18 years, and 60 were male, 40 female. Of the 100 patients, 16 % were deficient in 25(OH)D (≤ 20 ng/mL) and another 24 % were insufficient (≤ 30 ng/mL), with 40 % in the suboptimal range. Serum 25(OH)D and dietary vitamin D intake were not correlated.
CONCLUSIONS
We found a high prevalence of hyperparathyroidism in early-stage CKD and a significant relationship between 25(OH)D and PTH regardless of calcitriol level. Our study results support the suggestion that optimization of vitamin D levels may provide additional benefit in preventing or improving hyperparathyroidism in patients with early CKD and likely remains important as an adjunctive therapy in children with advanced CKD.
背景
由于慢性肾脏病（CKD）患者矿物质代谢紊乱与发病率和死亡率密切相关，因此维生素 D 状态在肾功能不全患者中的作用及其与饮食摄入和甲状旁腺激素（PTH）分泌的关系引起了极大的关注。
方法
我们对波士顿儿童医院 100 名诊断为 CKD 1-5 期的儿科患者进行了横断面研究，测量了血液中 25-羟维生素 D [25(OH)D]、1,25-二羟维生素 D [1,25(OH)(2)D]和甲状旁腺激素的水平，并获得了与维生素 D 状态相关的营养素摄入量和其他变量的数据。
结果
受试者年龄从 6 个月到 18 岁不等，其中 60 名男性，40 名女性。100 名患者中，16%的患者 25(OH)D 缺乏（≤20ng/mL），另有 24%的患者 25(OH)D 不足（≤30ng/mL），40%的患者处于亚最佳范围。血清 25(OH)D 和膳食维生素 D 摄入量之间没有相关性。
结论
我们发现早期 CKD 患者甲状旁腺功能亢进症的患病率较高，25(OH)D 与 PTH 之间存在显著关系，而与钙三醇水平无关。我们的研究结果支持这样一种观点，即优化维生素 D 水平可能在预防或改善早期 CKD 患者的甲状旁腺功能亢进症方面提供额外的益处，并且可能仍然是儿童晚期 CKD 辅助治疗的重要手段。
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