瑞士青少年四肢骨折患者维生素D不足的患病率：一项100例病例的前瞻性研究
Prevalence of vitamin D insufficiency in Swiss teenagers with appendicular fractures: a prospective study of 100 cases.
作者信息
Ceroni Dimitri, Anderson de la Llana Rebecca, Martin Xavier, Lamah Léopold, De Coulon Geraldo, Turcot Katia, Dubois-Ferrière Victor
机构信息
Pediatric Orthopedic Unit, Department of Child and Adolescent, University of Geneva Children's Hospitals and University of Geneva Faculty of Medicine, 6 Rue Willy-Donzé, 1211 Geneva 14, Switzerland.
出版信息
J Child Orthop. 2012 Dec;6(6):497-503. doi: 10.1007/s11832-012-0446-7. Epub 2012 Oct 11.
BACKGROUND
The significance of subclinical vitamin D deficiency in the pathogenesis of fractures in children and adolescents currently remains unclear.
OBJECTIVE
We aimed to determine the prevalence of vitamin D insufficiency and its effect on bone mineral density (BMD) and bone mineral content (BMC) values in a collective of Swiss Caucasian children with a first episode of appendicular fracture.
DESIGN AND METHODS
One hundred teenagers with a first episode of appendicular fracture [50 upper limb fractures (group 1) and 50 lower limb fractures (group 2)] and 50 healthy controls (group 3) were recruited into a cross-sectional study. The BMC and BMD values were measured by dual-energy X-ray absorptiometry, and serum 25 hydroxyvitamin D [25(OH)D] was assessed by electrochemiluminescence immunoassays.
RESULTS
From the 100 injured teenagers in the study, 12 % had deficient vitamin D levels (<20 ng/mL; <50 nmol/L) and 36 % had insufficient levels (≥20 <30 ng/mL; ≥50 <78 nmol/L), whereas 6 and 34 % of healthy controls were, respectively, vitamin D deficient and insufficient. There were no significant differences for serum 25(OH)D levels, L2-L4 BMD Z-score, and L2-L4 BMC Z-score variables (p = 0.216) between the three groups nor for the calcaneal BMD Z-score variables (p = 0.278) between healthy controls and lower limb fracture victims. Investigations on the influences of serum 25(OH)D on BMD and BMC showed no correlation between serum 25(OH)D and L2-L4 BMD Z-scores (r = -0.15; p = 0.135), whereas low but significant inverse correlations were, surprisingly, detected between serum 25(OH)D and calcaneal BMD Z-scores (r = -0.21; p = 0.034) and between serum 25(OH)D and L2-L4 BMC Z-scores (r = -0.22; p = 0.029).
CONCLUSIONS
A significant proportion of Swiss Caucasian teenagers were vitamin D insufficient, independent of limb fracture status, in our study. However, this study failed to show an influence of low vitamin D status on BMD and/or BMC of the lumbar spine and heel.
背景
目前尚不清楚亚临床维生素D缺乏在儿童和青少年骨折发病机制中的意义。
目的
我们旨在确定瑞士白种人儿童首次发生四肢骨折时维生素D不足的患病率及其对骨密度（BMD）和骨矿物质含量（BMC）值的影响。
设计与方法
100名首次发生四肢骨折的青少年[50例上肢骨折（第1组）和50例下肢骨折（第2组）]以及50名健康对照者（第3组）被纳入一项横断面研究。通过双能X线吸收法测量BMC和BMD值，并通过电化学发光免疫分析法评估血清25羟维生素D[25(OH)D]。
结果
在该研究的100名受伤青少年中，12%的维生素D水平不足（<20 ng/mL；<50 nmol/L），36%的水平为不足（≥20<30 ng/mL；≥50<78 nmol/L），而健康对照者中分别有6%和34%维生素D缺乏和不足。三组之间血清25(OH)D水平、L2-L4 BMD Z评分和L2-L4 BMC Z评分变量（p = 0.216）以及健康对照者与下肢骨折患者之间的跟骨BMD Z评分变量（p = 0.278）均无显著差异。关于血清25(OH)D对BMD和BMC影响的研究表明，血清25(OH)D与L2-L4 BMD Z评分之间无相关性（r = -0.15；p = 0.135），然而，令人惊讶的是，血清25(OH)D与跟骨BMD Z评分之间（r = -0.21；p = 0.034）以及血清25(OH)D与L2-L4 BMC Z评分之间（r = -0.22；p = 0.029）检测到低但显著的负相关。
结论
在我们的研究中，相当比例的瑞士白种人青少年维生素D不足，与四肢骨折状态无关。然而，本研究未能显示低维生素D状态对腰椎和足跟的BMD和/或BMC有影响。
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