Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina.
Department of Pediatrics, Eastern Virginia Medical School, Norfolk, Virginia.
Pediatr Res. 2017 Jul;82(1):55-62. doi: 10.1038/pr.2017.13. Epub 2017 Jan 17.
Vitamin D has neuroprotective and immunomodulatory properties, and deficiency is associated with worse stroke outcomes. Little is known about effects of hypoxia-ischemia or hypothermia treatment on vitamin D status in neonates with hypoxic-ischemic encephalopathy (HIE). We hypothesized vitamin D metabolism would be dysregulated in neonatal HIE altering specific cytokines involved in Th17 activation, which might be mitigated by hypothermia.
We analyzed short-term relationships between 25(OH) and 1,25(OH) vitamin D, vitamin D binding protein, and cytokines related to Th17 function in serum samples from a multicenter randomized controlled trial of hypothermia 33 C for 48 h after HIE birth vs. normothermia in 50 infants with moderate to severe HIE.
Insufficiency of 25(OH) vitamin D was observed after birth in 70% of infants, with further decline over the first 72 h, regardless of treatment. 25(OH) vitamin D positively correlated with anti-inflammatory cytokine IL-17E in all HIE infants. However, Th17 cytokine suppressor IL-27 was significantly increased by hypothermia, negating the IL-27 correlation with vitamin D observed in normothermic HIE infants.
Serum 25(OH) vitamin D insufficiency is present in the majority of term HIE neonates and is related to lower circulating anti-inflammatory IL-17E. Hypothermia does not mitigate vitamin D deficiency in HIE.
维生素 D 具有神经保护和免疫调节作用，缺乏维生素 D 与更差的中风预后有关。关于缺氧缺血或低温治疗对缺氧缺血性脑病（HIE）新生儿维生素 D 状态的影响知之甚少。我们假设，维生素 D 代谢在新生儿 HIE 中会失调，改变参与 Th17 激活的特定细胞因子，而低温可能会减轻这种失调。
我们分析了在一项多中心随机对照试验中，50 例中度至重度 HIE 婴儿出生后接受 33°C 低温治疗 48 小时与正常体温治疗的血清样本中，25（OH）和 1,25（OH）维生素 D、维生素 D 结合蛋白和与 Th17 功能相关的细胞因子之间的短期关系。
出生后 70%的婴儿出现 25（OH）维生素 D 不足，无论治疗如何，在最初的 72 小时内进一步下降。25（OH）维生素 D 与所有 HIE 婴儿的抗炎细胞因子 IL-17E 呈正相关。然而，低温显著增加了 Th17 细胞因子抑制物 IL-27，否定了在正常体温 HIE 婴儿中观察到的 IL-27 与维生素 D 的相关性。
足月 HIE 新生儿中，大多数存在血清 25（OH）维生素 D 不足，且与循环中较低的抗炎性 IL-17E 相关。低温不能减轻 HIE 中维生素 D 缺乏。
