Piso Rein Jan, Rothen Madeleine, Rothen Jean Pierre, Stahl Matthias, Fux Christoph
Department of Medicine, Kantonsspital, Olten, Switzerland.
BMC Infect Dis. 2013 Dec 6;13:577. doi: 10.1186/1471-2334-13-577.
Osteoporosis and bone fractures seem to be higher in HIV-infected Patients compared to the general populations. Moreover, bone turnover markers are increased in patients on antiretroviral therapy and vitamin D deficiency is prevalent in HIV-infected patients. However, the influence of per oral cholecalciferol on bone metabolism in HIV infected patients is not well understood.
We measured the bone turnover markers in 96 HIV-infected patients: Bone specific alkaline phosphatase (BSAP), Pyridinoline (PYR), Desoxypyridinoline (DPD) and 25-OH vitamin D. If 25-OH vitamin D was below 75 nnol/L (87/96 patients), 300000 IU cholecalciferol was given per os. 25OH-vitamin D and bone turn over markers were determinded 3 month later. 25 OH-vitamin D was corrected for circannual rythm y'=y+17.875sin2π/365day+2.06, whereas bone turnover markers were not corrected. The paired students t-Test was used to compare the two periods. No calcium supplementation or biphosphonate therapy was given.
Corrected 25OH-vitamin D levels increased significantly after supplementation (42.7 ± 26.61 vs. 52.85 ± 21.8 nmol/L, p < 0.001). After supplementation, bone turnover markers were significantly lower. The values decreased for BSAP from 21.31 ± 14.32 to 17.53 ± 8.17 μg/L (p < 0.001), PYR from 74.57 ± 36.83 to 54.82 ± 21.43 nmol/mmol creatinine (p < 0.001) and DPD from 15.17 ± 8.34 to 12.61 ± 5.02 nmol/mmol creatinine (p = 0.01).
After per oral substitution with cholecalciferol, bone formation as well as bone resorption markers decreased significant. We postulate a protective effect on bone structure with cholecalciferol supplementation.
与普通人群相比，HIV感染患者的骨质疏松和骨折发生率似乎更高。此外，接受抗逆转录病毒治疗的患者骨转换标志物升高，且HIV感染患者普遍存在维生素D缺乏。然而，口服胆钙化醇对HIV感染患者骨代谢的影响尚不清楚。
我们测量了96例HIV感染患者的骨转换标志物：骨特异性碱性磷酸酶（BSAP）、吡啶啉（PYR）、脱氧吡啶啉（DPD）和25-羟基维生素D。如果25-羟基维生素D低于75nmol/L（96例患者中的87例），则口服300000IU胆钙化醇。3个月后测定25-羟基维生素D和骨转换标志物。25-羟基维生素D根据年度节律进行校正y'=y+17.875sin2π/365day+2.06，而骨转换标志物未进行校正。采用配对学生t检验比较两个时期。未给予补钙或双膦酸盐治疗。
补充后校正的25-羟基维生素D水平显著升高（42.7±26.61 vs.52.85±21.8nmol/L，p<0.001）。补充后，骨转换标志物显著降低。BSAP值从21.31±14.32降至17.53±8.17μg/L（p<0.001），PYR从74.57±36.83降至54.82±21.43nmol/mmol肌酐（p<0.001），DPD从15.17±8.34降至12.61±5.02nmol/mmol肌酐（p=0.01）。
口服胆钙化醇替代治疗后，骨形成和骨吸收标志物均显著降低。我们推测补充胆钙化醇对骨骼结构有保护作用。
