Abdullah Anwar K, Khan Salman, Mustafa Shaheen F, Qutubuddin Abu A, Davis Charles M
Central State Hospital, Petersburg,Virginia, USA.
Prim Care Companion CNS Disord. 2012;14(1). doi: 10.4088/PCC.11m01221. Epub 2012 Feb 9.
Low vitamin D levels are common in psychiatric patients, but a need for vitamin D supplementation in these individuals remains controversial. Low vitamin D levels are reportedly associated with high prevalence of cardiometabolic risk factors, and both are common in psychiatric patients, but the relationship between diagnosis and severity of illness and cardiometabolic risk status and the effect of vitamin D treatment on them is not known. We studied these relationships and effect of vitamin D(3) treatment on them in 290 long-term psychiatric inpatients.
All patients admitted to the hospital during April 2009-March 2010 who agreed to 25-hydroxyvitamin-D testing were included. Serum 25-hydroxyvitamin D level, Brief Psychiatric Rating Scale (BPRS) score, body mass index, blood pressure, and fasting levels of blood glucose, triglycerides, high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C) were measured at baseline, and changes after vitamin D(3) treatment for up to 12 months were observed. For the purposes of this study, 25-hydroxyvitamin-D levels < 32 ng/mL were considered as "low"; < 20 ng/mL, as "insufficient"; and < 12 ng/mL, as "deficient."
A serum 25-hydroxyvitamin-D level < 32 ng/mL was found in 90.0% of patients, and a level <20 ng/mL was found in 48.6% of patients. A BPRS score > 36 was present in 56.0% of patients; obesity, in 75.7%; hypertension, in 44.8%; low HDL-C, in 43.6%; high triglycerides, in 31.2%; high LDL-C, in 17.8%; and increased glucose, in 14.6%. Serum 25-hydroxyvitamin-D levels correlated poorly with BPRS score and the other variables listed above (R, -0.02 to -0.22). After vitamin D(3) treatment, 25-hydroxyvitamin-D level increased to ≥ 20 ng/mL in all patients and ≥ 32 ng/mL in 85% of patients, but despite > 124% increase in mean 25-hydroxyvitamin-D level, mean improvement in other variables was < 12%.
Nearly half of our patients had vitamin D levels < 20 ng/mL, putting them at risk for poor bone health and requiring vitamin D supplementation. Cardiometabolic risk factors were also highly prevalent, but correlated poorly with vitamin D levels in their severity. Increasing vitamin D levels to ≥ 32 ng/mL was not associated with improvement in BPRS score or any cardiometabolic risk factor, emphasizing that intensification of therapeutic measures other than vitamin D supplementation is required.
精神科患者中维生素D水平低很常见，但这些个体是否需要补充维生素D仍存在争议。据报道，低维生素D水平与心血管代谢危险因素的高患病率相关，这两者在精神科患者中都很常见，但疾病的诊断和严重程度与心血管代谢风险状况之间的关系以及维生素D治疗对它们的影响尚不清楚。我们在290名长期住院的精神科患者中研究了这些关系以及维生素D(3)治疗对它们的影响。
纳入2009年4月至2010年3月期间入院并同意进行25-羟维生素D检测的所有患者。在基线时测量血清25-羟维生素D水平、简明精神病评定量表（BPRS）评分、体重指数、血压以及空腹血糖、甘油三酯、高密度脂蛋白胆固醇（HDL-C）和低密度脂蛋白胆固醇（LDL-C）水平，并观察维生素D(3)治疗长达12个月后的变化。在本研究中，25-羟维生素D水平<32 ng/mL被视为“低”；<20 ng/mL，为“不足”；<12 ng/mL，为“缺乏”。
90.0%的患者血清25-羟维生素D水平<32 ng/mL，48.6%的患者水平<20 ng/mL。56.0%的患者BPRS评分>36；75.7%的患者肥胖；44.8%的患者高血压；43.6%的患者HDL-C低；31.2%的患者甘油三酯高；17.8%的患者LDL-C高；14.6%的患者血糖升高。血清25-羟维生素D水平与BPRS评分及上述其他变量的相关性较差（R，-0.02至-0.22）。维生素D(3)治疗后，所有患者的25-羟维生素D水平均升至≥20 ng/mL，85%的患者升至≥32 ng/mL，但尽管平均25-羟维生素D水平升高了>124%，其他变量的平均改善幅度<12%。
近一半的患者维生素D水平<20 ng/mL，这使他们面临骨骼健康不佳的风险，需要补充维生素D。心血管代谢危险因素也非常普遍，但在严重程度上与维生素D水平的相关性较差。将维生素D水平提高到≥32 ng/mL与BPRS评分或任何心血管代谢危险因素的改善无关，这强调除了补充维生素D之外，还需要加强其他治疗措施。
