Pleasure D, Wyszynski B, Sumner A, Schotland D, Feldman B, Nugent N, Hitz K, Goodman D B
J Clin Invest. 1979 Nov;64(5):1157-67. doi: 10.1172/JCI109569.
The myopathy associated with vitamin D deficiency has not been well characterized, and it is not known if weakness is a result of a specific effect of vitamin D deficiency on skeletal muscle. Chicks were raised from hatching on a vitamin D-deficient diet, and by 3 wk of age were hypocalcemic and appeared weak. Tension generated by triceps surae during repetitive stimulation of posterior tibial nerve was significantly less than that developed by chicks given vitamin D(3) supplements (309 g tension/g wet weight of triceps surae, SD 60, for vitamin D-deficient chicks; 470, SD 77, for vitamin D(3)-treated chicks, P < 0.01). Histochemical and electron microscopic examination of skeletal muscles of these chicks showed no abnormalities, and there were no electrophysiologic evidences of motor nerve or neuromuscular junction dysfunction. The concentration of ATP in skeletal muscle of the vitamin D-deficient chicks (5.75 mumol/g wet weight, SD 0.17) was not significantly different from that in vitamin D-treated chicks (5.60, SD 0.50). There was no correlation between strength and serum calcium, serum inorganic phosphate, or skeletal muscle inorganic phosphate. Relaxation of tension after tetanic stimulation was slowed in the vitamin D-deficient chicks (20.6 ms, SD 1.7, vs. 15.4, SD 1.3, in vitamin D-treated chicks and 15.3, SD 1.0, in normal control chicks), and in vitro (45)Ca(++) transport by sarcoplasmic reticulum from the vitamin D-deficient chicks was reduced. Calcium content of mitochondria prepared from leg muscles of vitamin D-deficient chicks (24 nmol/mg mitochondrial protein, SD 6) was considerably lower than that of mitochondria from normal control chicks (45, SD 8) or from chicks treated with vitamin D for 2 wk or more (66-100, depending upon level and duration of therapy). Treatment of the vitamin D-deficient chicks from hatching with sufficient dietary calcium to produce hypercalcemia did not significantly raise skeletal muscle mitochondrial calcium content (31 nmol/mg mitochondrial protein, SD 7) and did not prevent weakness. These studies demonstrate objective weakness as a result of myopathy in vitamin D-deficient chicks, and provide evidence that vitamin D deficiency has effects on skeletal muscle calcium metabolism not secondary to altered plasma concentrations of calcium and phosphate.
与维生素D缺乏相关的肌病尚未得到充分描述,目前尚不清楚肌无力是否是维生素D缺乏对骨骼肌产生特定影响的结果。雏鸡从孵化起就以缺乏维生素D的饲料饲养,到3周龄时出现低钙血症并显得虚弱。在重复刺激胫后神经期间,腓肠肌产生的张力明显低于补充维生素D3的雏鸡(缺乏维生素D的雏鸡,腓肠肌每克湿重产生的张力为309克,标准差60;经维生素D3处理的雏鸡为470克,标准差77,P<0.01)。对这些雏鸡的骨骼肌进行组织化学和电子显微镜检查未发现异常,也没有运动神经或神经肌肉接头功能障碍的电生理证据。缺乏维生素D的雏鸡骨骼肌中ATP的浓度(每克湿重5.75微摩尔,标准差0.17)与经维生素D处理的雏鸡(5.60,标准差0.50)无显著差异。力量与血清钙、血清无机磷或骨骼肌无机磷之间没有相关性。在缺乏维生素D的雏鸡中,强直刺激后的张力松弛减慢(20.6毫秒,标准差1.7,而经维生素D处理的雏鸡为15.4毫秒,标准差1.3,正常对照雏鸡为15.3毫秒,标准差1.0),并且来自缺乏维生素D的雏鸡的肌浆网的体外(45)Ca(++)转运减少。从缺乏维生素D的雏鸡腿肌制备的线粒体的钙含量(每毫克线粒体蛋白24纳摩尔,标准差6)明显低于正常对照雏鸡(45,标准差8)或经维生素D处理2周或更长时间的雏鸡(66 - 100,取决于治疗水平和持续时间)。从孵化起就用充足的膳食钙治疗缺乏维生素D的雏鸡以产生高钙血症,并没有显著提高骨骼肌线粒体钙含量(每毫克线粒体蛋白31纳摩尔,标准差7),也没有预防肌无力。这些研究证明了缺乏维生素D的雏鸡因肌病而出现客观的肌无力,并提供证据表明维生素D缺乏对骨骼肌钙代谢有影响,并非继发于血浆钙和磷浓度的改变。