Division of Endocrinology and Metabolism, University of Rochester Medical Center, Rochester, New York 14642, USA.
Endocr Pract. 2013 May-Jun;19(3):420-5. doi: 10.4158/EP12155.OR.
To evaluate the safety of vitamin D replacement in patients with vitamin D deficiency and primary hyperparathyroidism.
Retrospective chart review of 35 patients from our endocrine clinic, age 22 to 89 years, diagnosed with primary hyperparathyroidism and vitamin D deficiency, and treated with either 1,000 to 2,000 international units (IU) of vitamin D daily or 50,000 IU of vitamin D weekly for 5 months. Data were collected before and after treatment on serum calcium, 25-hydroxyvitamin D (25-OH D), intact parathyroid hormone (iPTH), phosphorus, alkaline phosphatase, nephrolithiasis, fractures, and osteoporosis.
25-OH D increased significantly, from a baseline of 14.65 ± 6.57 ng/mL to 42.17 ± 12.98 ng/mL after weekly treatment with 50,000 IU of vitamin D (P<.0001), and from 22.42 ± 5.47 ng/mL to 33.33 ± 6.39 ng/mL following daily treatment with 1,000 to 2,000 IU of vitamin D (P<.0001). Pre- and posttreatment unadjusted serum calcium remained stable in the high-dose group (10.80 ± 0.43 mg/dL vs. 10.72 ± 0.67 mg/dL; P = .47), but decreased slightly in the low-dose group (10.76 ± 0.58 mg/dL vs. 10.11 ± 0.54 mg/dL; P = .0007). After adjusting for age, sex, vitamin D, and PTH levels, the small calcium difference in the low-dose group became statistically insignificant. Treatment with either high or low doses of vitamin D did not significantly change iPTH levels. Creatinine remained stable in all patients, and no new cases of nephrolithiasis were reported.
Replacing vitamin D in mild primary hyperparathyroidism is safe, effective, and does not increase calcium to dangerous levels.
评估维生素 D 替代治疗维生素 D 缺乏和原发性甲状旁腺功能亢进症患者的安全性。
对我院内分泌科 35 例年龄 22 至 89 岁的原发性甲状旁腺功能亢进症合并维生素 D 缺乏患者的病历进行回顾性分析，给予患者每日 1000 至 2000 国际单位（IU）或每周 50000 IU 维生素 D 治疗 5 个月。分别在治疗前后检测血清钙、25-羟维生素 D（25-OH D）、全段甲状旁腺素（iPTH）、磷、碱性磷酸酶、肾结石、骨折和骨质疏松情况。
与每周接受 50000 IU 维生素 D 治疗相比，患者接受高剂量维生素 D 治疗后 25-OH D 水平显著升高（从基线时的 14.65±6.57ng/mL 增加至 42.17±12.98ng/mL，P<.0001），与每日接受 1000 至 2000 IU 维生素 D 治疗相比，患者接受低剂量维生素 D 治疗后 25-OH D 水平也显著升高（从基线时的 22.42±5.47ng/mL 增加至 33.33±6.39ng/mL，P<.0001）。高剂量组治疗前后血清钙水平未发生明显变化（10.80±0.43mg/dL 比 10.72±0.67mg/dL；P=.47），但低剂量组血清钙水平略有下降（10.76±0.58mg/dL 比 10.11±0.54mg/dL；P=.0007）。校正年龄、性别、维生素 D 和甲状旁腺激素水平后，低剂量组的血钙差异无统计学意义。无论高剂量还是低剂量维生素 D 治疗均未显著改变 iPTH 水平。所有患者的血肌酐水平保持稳定，且未报告新的肾结石病例。
在轻度原发性甲状旁腺功能亢进症患者中补充维生素 D 安全、有效，不会将血钙水平提高到危险水平。
