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意大利中部泌尿科患者血清25(OH)D的季节性变化

Serum 25(OH)D seasonality in urologic patients from central Italy.

作者信息

Calgani Alessia, Iarlori Marco, Rizi Vincenzo, Pace Gianna, Bologna Mauro, Vicentini Carlo, Angelucci Adriano

机构信息

Dipartimento di Scienze Cliniche Applicate e Biotecnologiche, Università Degli Studi dell'Aquila, 67100 L'Aquila, Italy.

CETEMPS/Dipartimento di Scienze Fisiche e Chimiche, Università Degli Studi dell'Aquila, 67100 L'Aquila, Italy.

出版信息

J Photochem Photobiol B. 2016 Sep;162:361-366. doi: 10.1016/j.jphotobiol.2016.06.053. Epub 2016 Jul 9.

Abstract

Hypovitaminosis D is increasingly recognized as a cofactor in several diseases. In addition to bone homeostasis, vitamin D status influences immune system, muscle activity and cell differentiation in different tissues. Vitamin D is produced in the skin upon exposure to UVB rays, and sufficient levels of serum 25(OH)D are dependent mostly on adequate sun exposure, and then on specific physiologic variables, including skin type, age and Body Mass Index (BMI). In contrast with common belief, epidemiologic data are demonstrating that hypovitaminosis D must be a clinical concern not only in northern Countries. In our study, we investigated vitamin D status in a male population enrolled in a urology clinic of central Italy. In addition, we evaluated the correlation between vitamin D status and UVB irradiance measured in our region. The two principal pathologies in the 95 enrolled patients (mean age 66years) were benign prostate hypertrophy and prostate carcinoma. >50% of patients had serum 25(OH)D values in the deficient range (<20ng/mL), and only 16% of cases had serum vitamin D concentration higher than 30ng/mL (optimal range). The seasonal stratification of vitamin D concentrations revealed an evident trend with the minimum mean value recorded in April and a maximum mean value obtained in September. UVB irradiance measured by pyranometer in our region (Abruzzo, central Italy) revealed a large difference during the year, with winter months characterized by an UV irradiance about tenfold lower than summer months. Then we applied a mathematical model in order to evaluate the expected vitamin D production according to the standard erythemal dose measured in the different seasons. In winter months, the low available UVB radiation and the small exposed skin area resulted not sufficient to obtain the recommended serum doses of vitamin D. Although in summer months UVB irradiance was largely in excess to produce vitamin D in the skin, serum vitamin D resulted sufficient in September only in those patients who declared an outdoor time of at least 3h per day in the previous summer. In conclusion, hypovitaminosis D is largely represented in elderly persons in our region. Seasonal fluctuation in serum 25(OH)D was explained by a reduced availability of UVB in winter and by insufficient solar exposure in summer. The relatively high outdoor time that emerged to be correlated with sufficient serum 25(OH)D in autumn warrants further studies to individuate potential risk co-variables for hypovitaminosis D in elderly men.

摘要

维生素D缺乏症日益被认为是多种疾病的一个辅助因素。除了骨骼稳态外,维生素D状态还会影响免疫系统、肌肉活动以及不同组织中的细胞分化。皮肤暴露于紫外线B(UVB)射线时会产生维生素D,血清25(OH)D的充足水平主要取决于充足的阳光照射,其次取决于特定的生理变量,包括皮肤类型、年龄和体重指数(BMI)。与普遍看法相反,流行病学数据表明,维生素D缺乏症不仅在北方国家,在其他地区也必须成为临床关注的问题。在我们的研究中,我们调查了意大利中部一家泌尿外科诊所收治的男性人群的维生素D状态。此外,我们评估了维生素D状态与我们所在地区测量的UVB辐照度之间的相关性。95名入组患者(平均年龄66岁)的两种主要病症是良性前列腺增生和前列腺癌。超过50%的患者血清25(OH)D值处于缺乏范围(<20ng/mL),只有16%的病例血清维生素D浓度高于30ng/mL(最佳范围)。维生素D浓度的季节性分层显示出明显的趋势,4月份记录到最低平均值,9月份获得最高平均值。我们所在地区(意大利中部阿布鲁佐)用总日射表测量的UVB辐照度在一年中差异很大,冬季月份的紫外线辐照度比夏季月份低约十倍。然后我们应用一个数学模型来根据不同季节测量的标准红斑剂量评估预期的维生素D生成量。在冬季月份,可用的UVB辐射量低且暴露的皮肤面积小,不足以获得推荐的血清维生素D剂量。尽管在夏季月份UVB辐照度大大超过皮肤产生维生素D的量,但血清维生素D仅在那些宣称前一个夏天每天户外时间至少3小时的患者中在9月份才充足。总之,维生素D缺乏症在我们地区的老年人中很普遍。血清25(OH)D的季节性波动是由于冬季UVB可用性降低以及夏季阳光照射不足所致。秋季出现的与充足的血清25(OH)D相关的相对较高户外时间值得进一步研究,以确定老年男性维生素D缺乏症的潜在风险协变量。

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