Wallace Gregory, Jodele Sonata, Howell Jonathan, Myers Kasiani C, Teusink Ashley, Zhao Xueheng, Setchell Kenneth, Holtzapfel Catherine, Lane Adam, Taggart Cynthia, Laskin Benjamin L, Davies Stella M
Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
Division of Endocrinology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
Biol Blood Marrow Transplant. 2015 Sep;21(9):1627-31. doi: 10.1016/j.bbmt.2015.06.009. Epub 2015 Jun 18.
Vitamin D has endocrine function as a key regulator of calcium absorption and bone homeostasis and also has intracrine function as an immunomodulator. Vitamin D deficiency before hematopoietic stem cell transplantation (HSCT) has been variably associated with higher risks of graft-versus-host disease (GVHD) and mortality. Children are at particular risk of growth impairment and bony abnormalities in the face of prolonged deficiency. There are few longitudinal studies of vitamin D deficient children receiving HSCT, and the prevalence and consequences of vitamin D deficiency 100 days after transplant has been poorly studied. Serum samples from 134 consecutive HSCT patients prospectively enrolled into an HSCT sample repository were tested for 25-hydroxy (25 OH) vitamin D levels before starting HSCT (baseline) and at 100 days after transplantation. Ninety-four of 134 patients (70%) had a vitamin D level < 30 ng/mL before HSCT, despite supplemental therapy in 16% of subjects. Post-transplant samples were available in 129 patients who survived to day 100 post-transplant. Vitamin D deficiency persisted in 66 of 87 patients (76%) who were already deficient before HSCT. Moreover, 24 patients with normal vitamin D levels before HSCT were vitamin D deficient by day 100. Overall, 68% of patients were vitamin D deficient (<30 ng/mL) at day 100, and one third of these cases had severe vitamin D deficiency (<20 ng/mL). Low vitamin D levels before HSCT were not associated with subsequent acute or chronic GVHD, contrary to some prior reports. However, severe vitamin D deficiency (<20 ng/mL) at 100 days post-HSCT was associated with decreased overall survival after transplantation (P = .044, 1-year rate of overall survival: 70% versus 84.1%). We conclude that all pediatric transplant recipients should be screened for vitamin D deficiency before HSCT and at day 100 post-transplant and that aggressive supplementation is needed to maintain sufficient levels.
维生素D具有内分泌功能，是钙吸收和骨骼稳态的关键调节因子，还具有作为免疫调节剂的自分泌功能。造血干细胞移植（HSCT）前维生素D缺乏与移植物抗宿主病（GVHD）和死亡率的较高风险存在不同程度的关联。面对长期缺乏维生素D的情况，儿童尤其有生长发育受损和骨骼异常的风险。关于接受HSCT的维生素D缺乏儿童的纵向研究很少，移植后100天维生素D缺乏的患病率和后果也鲜有研究。对连续纳入HSCT样本库的134例HSCT患者的血清样本，在开始HSCT前（基线）和移植后100天检测25-羟基（25 OH）维生素D水平。134例患者中有94例（70%）在HSCT前维生素D水平<30 ng/mL，尽管16%的受试者接受了补充治疗。129例移植后存活至第100天的患者有移植后的样本。87例HSCT前就已缺乏维生素D的患者中，66例（76%）维生素D缺乏持续存在。此外，24例HSCT前维生素D水平正常的患者到第100天时维生素D缺乏。总体而言，68%的患者在第100天时维生素D缺乏（<30 ng/mL），其中三分之一的病例有严重维生素D缺乏（<20 ng/mL）。与一些先前的报告相反，HSCT前维生素D水平低与随后的急性或慢性GVHD无关。然而，HSCT后100天严重维生素D缺乏（<20 ng/mL）与移植后总体生存率降低相关（P = 0.044，1年总体生存率：70%对84.1%）。我们得出结论，所有儿科移植受者在HSCT前和移植后第100天都应筛查维生素D缺乏情况，并且需要积极补充以维持足够水平。
