Dudenkov Daniel V, Yawn Barbara P, Oberhelman Sara S, Fischer Philip R, Singh Ravinder J, Cha Stephen S, Maxson Julie A, Quigg Stephanie M, Thacher Tom D
Department of Internal Medicine, Mayo Clinic, Rochester, MN.
Olmsted Medical Center, Rochester, MN.
Mayo Clin Proc. 2015 May;90(5):577-86. doi: 10.1016/j.mayocp.2015.02.012.
To determine the incidence trend of 25-hydroxyvitamin D (25(OH)D) values above 50 ng/mL and associated toxicity.
We conducted a retrospective population-based study in Olmsted County, Minnesota, in the 10-year period from January 1, 2002, through December 31, 2011, by using the Rochester Epidemiology Project. Individuals were eligible if they resided in Olmsted County during the study period and had a measured 25(OH)D value above 50 ng/mL. The date of the first 25(OH)D value above 50 ng/mL was considered the index date for incidence determination. Hypercalcemia, the primary vitamin D toxicity, was considered potentially associated with the 25(OH)D concentration if it was measured within 3 months of the 25(OH)D measurement, and such cases had a medical record review.
Of 20,308 total 25(OH)D measurements, 1714 (8.4%), 123 (0.6%), and 37 (0.2%) unique persons had 25(OH)D values above 50, 80 and above, and 100 ng/mL and above, respectively. The age- and sex-adjusted incidence of 25(OH)D values above 50 ng/mL increased from 9 to 233 cases per 100,000 person-years from 2002 to 2011 (P<.001), respectively, and was greatest in persons aged 65 years and older (P<.001) and in women (P<.001). Serum 25(OH)D values were not significantly related to serum calcium values (P=.20) or with the risk of hypercalcemia (P=.24). A medical record review identified 4 cases (0.2%) in whom 25(OH)D values above 50 ng/mL were temporally associated with hypercalcemia, but only 1 case had clinical toxicity associated with the highest observed 25(OH)D value of 364 ng/mL.
The incidence of 25(OH)D values above 50 ng/mL increased significantly between 2002 and 2011 without a corresponding increase in acute clinical toxicity.
确定25-羟维生素D（25(OH)D）水平高于50 ng/mL的发生率趋势及其相关毒性。
我们利用罗切斯特流行病学项目，于2002年1月1日至2011年12月31日的10年期间，在明尼苏达州奥尔姆斯特德县开展了一项基于人群的回顾性研究。研究对象需在研究期间居住在奥尔姆斯特德县，且25(OH)D测量值高于50 ng/mL。首次25(OH)D测量值高于50 ng/mL的日期被视为确定发病率的索引日期。如果在25(OH)D测量后3个月内检测到高钙血症（主要的维生素D毒性），则认为其可能与25(OH)D浓度相关，并对这些病例进行病历审查。
在总共20308次25(OH)D测量中，分别有1714例（8.4%）、123例（0.6%）和37例（（0.2%）的个体25(OH)D值高于50 ng/mL、80 ng/mL及以上和100 ng/mL及以上。2002年至2011年期间，年龄和性别调整后的25(OH)D值高于50 ng/mL的发病率从每10万人年9例增至233例（P<0.001），在65岁及以上人群中最高（P<0.001），女性中也最高（P<0.001）。血清25(OH)D值与血清钙值（P=0.20）或高钙血症风险（P=0.24）无显著相关性。病历审查发现4例（0.2%）患者的25(OH)D值高于50 ng/mL与高钙血症存在时间关联，但只有1例患者出现与观察到的最高25(OH)D值364 ng/mL相关的临床毒性。
2002年至2011年期间，25(OH)D值高于50 ng/mL的发病率显著增加，但急性临床毒性并未相应增加。
