Kocián J
Vnitr Lek. 1989 Dec;35(12):1211-9.
The author examined a group of 143 patients with osteomalacia of different origin before treatment and after adequate treatment with vitamin D, using laboratory tests, assessment of body weight and muscular strength (grip of the dominant hand). After treatment there was a significant rise of calcaemia, phosphataemia and calciuria and a drop of alkaline phosphatase activity. The body weight increased within the first month of treatment on average by 1.27 kg, during the second month by another 1.15 kg. The patients gained a total of 2.42 kg. The muscular strength increased during the first month on average by 3.23 kg and during the second month by another 2.16 kg, i.e. a total of 5.39 kg. From these results it may be concluded that vitamin D may have a certain anabolic effect if used in pharmacological does either due to an increased nutrient absorption from the gut because of hypertrophy of the intestinal wall or indirectly via hypercalcaemia which increases the hydrochloric acid secretion in the stomach as well as pepsin secretion, and promotes activation of trypsin and lipase in the duodenum and moreover causes retardation of the intestinal transit. The increased muscular strength in due to a rise of calcaemia, improved muscle contraction and probably also due to the mentioned nutritional factors. There may be also the factor of an improved lifestyle due to the immunomodulating action of vitamin D and disappearance of bone pain.
作者对143名不同病因的骨软化症患者在治疗前以及用维生素D进行充分治疗后进行了检查,采用了实验室检测、体重评估和肌肉力量(优势手握力)评估等方法。治疗后,血钙、血磷和尿钙显著升高,碱性磷酸酶活性下降。治疗第一个月体重平均增加1.27千克,第二个月又增加1.15千克。患者体重总共增加了2.42千克。肌肉力量在第一个月平均增加3.23千克,第二个月又增加2.16千克,即总共增加5.39千克。从这些结果可以得出结论,维生素D如果以药理剂量使用,可能具有一定的合成代谢作用,这要么是由于肠壁肥大导致肠道对营养物质的吸收增加,要么是通过高钙血症间接起作用,高钙血症会增加胃中盐酸的分泌以及胃蛋白酶的分泌,并促进十二指肠中胰蛋白酶和脂肪酶的激活,此外还会导致肠道运输减慢。肌肉力量增加是由于血钙升高、肌肉收缩改善,可能还由于上述营养因素。也可能存在由于维生素D的免疫调节作用和骨痛消失导致生活方式改善的因素。