Priyambada L, Bhatia V, Singh N, Bhatia E
Department of Endocrinology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.
J Postgrad Med. 2014 Jan-Mar;60(1):52-6. doi: 10.4103/0022-3859.128812.
Vitamin D deficiency is widely prevalent in India and subjects who have almost no exposure to sunlight are severely deficient. Daily oral doses of cholecalciferol (vitamin D3) are costly as compared to stoss doses and further, take a long time for the serum levels to reach a plateau. Compliance to supplementation may also be better if a regimen involves single oral doses of vitamin D at specified intervals rather than daily doses. Evidence-based guidelines regarding the dosing and the frequency of dosing for prophylactic intermittent supplementation (stoss doses) in severely-deficient subjects are few.
In a prospective intervention study, we serially assessed 30 asymptomatic healthy medical staff for serum 25-hydroxyvitamin D [25(OH)D] and parathyroid hormone (PTH); (a) at baseline; (b) monthly for 3 months after single oral 60,000 units (U) cholecalciferol; (c) monthly for 3 months after 120,000 (or 180,000 for those with elevated alkaline phosphatase) U cholecalciferol; and, (d) subsequently, at 3 months after a repeat dose of 60,000 U cholecalciferol by repeated measures analysis of variance.
The baseline serum 25(OH)D was 7.1 ± 5.4 ng/mL (< 10 ng/mL in 85% subjects) which increased to 18.7 ± 8.9 ng/mL at 1 month after 60,000 U of cholecalciferol (P < 0.001) and decreased to 11.1 ± 5.3 ng/mL by the 3 rd month. The higher dose of 120,000 (or 180,000) U increased mean 25(OH)D to 28.9 ± 9.9 ng/mL at the end of 1 st month, declining to 17.9 ± 4.9 ng/mL (P < 0.001) at 3 months. With the subsequent 60,000 U the serum 25(OH)D was 18.4 ± 3.9 ng/mL at 3 months. PTH showed a corresponding negative trend. No hypercalcemia was observed.
Vitamin D deficiency is highly prevalent amongst medical staff in Northern India. An initial dose of 120,000-180,000 U of cholecalciferol is required to elevate 25(OH)D out of the deficiency range. Maintenance dose is needed at 2 months.
维生素D缺乏在印度广泛流行，几乎没有阳光照射的人群严重缺乏维生素D。与冲击剂量相比，每日口服胆钙化醇（维生素D3）成本较高，而且血清水平达到稳定状态需要很长时间。如果一种方案是按特定间隔单次口服维生素D而不是每日服用，补充的依从性可能会更好。关于严重缺乏维生素D的受试者预防性间歇补充（冲击剂量）的给药剂量和给药频率的循证指南很少。
在一项前瞻性干预研究中，我们对30名无症状健康医护人员的血清25-羟基维生素D[25(OH)D]和甲状旁腺激素（PTH）进行了连续评估；（a）在基线时；（b）单次口服60,000单位（U）胆钙化醇后3个月内每月评估一次；（c）120,000（或碱性磷酸酶升高者为180,000）U胆钙化醇后3个月内每月评估一次；以及，（d）随后，在重复给予60,000 U胆钙化醇3个月后，通过重复测量方差分析进行评估。
基线血清25(OH)D为7.1±5.4 ng/mL（85%的受试者<10 ng/mL），在给予60,000 U胆钙化醇后1个月时升至18.7±8.9 ng/mL（P<0.001），到第3个月降至11.1±5.3 ng/mL。较高剂量的120,000（或180,000）U在第1个月末将平均25(OH)D提高到28.9±9.9 ng/mL，在3个月时降至17.9±4.9 ng/mL（P<0.001）。随后给予60,000 U，3个月时血清25(OH)D为18.4±3.9 ng/mL。PTH呈现相应的负向趋势。未观察到高钙血症。
印度北部医护人员中维生素D缺乏非常普遍。需要初始剂量120,000 - 180,000 U的胆钙化醇才能使25(OH)D升高至缺乏范围之外。2个月时需要维持剂量。
