Seth Anju, Aneja Satinder, Singh Ritu, Majumdar Ritu, Sharma Neera, Gopinath Muthuselvan
a Department of Pediatrics , Lady Hardinge Medical College , New Delhi , India.
b Department of Biochemistry , Lady Hardinge Medical College , New Delhi , India.
Paediatr Int Child Health. 2017 Aug;37(3):193-198. doi: 10.1080/20469047.2016.1266116. Epub 2017 Feb 1.
Children with cerebral palsy (CP) are vulnerable to developing vitamin D deficiency. There is little information on the prevalence and severity of vitamin D deficiency in these patients.
To study vitamin D status in children with CP with special reference to their intake of anti-epileptic drugs (AED) and ambulatory status.
The relative effects of AED use and ambulatory status on the vitamin D status of 120 children with CP aged 2-10 years were examined in this observational study. The patients were classified into four groups (30 in each) on the basis of AED use and ambulatory status: ambulatory (CPA), ambulatory receiving AED (CPAD), non-ambulatory (CPNA) and non-ambulatory receiving AED (CPNAD). A control group of 30 age-matched healthy children was also included. Parameters assessed included dietary calcium intake, sun exposure, serum total and ionised calcium (tCa, iCa), inorganic phosphate (iP), alkaline phosphatase (ALP), parathormone (PTH), 25 hydroxy vitamin D [25(OH)D] levels and a wrist radiograph to detect rickets. Vitamin D status was defined on the basis of serum 25(OH)D levels as normal (>50 nmol/L), mild deficiency (25-50 nmol/L), moderate deficiency (12.5-25 nmol/L), severe deficiency (<12.5 nmol/L).
Median (IQR) serum 25 (OH)D levels in patients with CP were 35.6 (26.75-64) nmol/L compared with 60 (37-69.25) nmol/L in controls (p = 0.04). Sixty per cent of children with CP and 36.7% of controls were vitamin D-deficient [25(OH)D < 50 nmol/L]. Children with CP had a significantly lower dietary calcium intake and sun exposure than controls (p < 0.0001 each). Serum tCa and iCa levels were significantly lower (p = 0.01 and p < 0.001, respectively) and PTH and ALP levels significantly higher (p = 0.04 and p = 0.001, respectively) in children with CP than in controls. Patients in the CPNAD group were the worst affected, 83.3% of them being vitamin D-deficient with median (IQR) 25(OH)D levels of 33.5 (12.5-45.25) nmol/L. Also, 53.3% of them had raised ALP and 17.2% raised PTH levels.
Children with CP are highly vulnerable to vitamin D deficiency. In these patients, AED use and lack of sun exposure contribute towards poor vitamin D status, the effect being more pronounced when they co-exist.
脑瘫（CP）患儿易患维生素D缺乏症。关于这些患者维生素D缺乏症的患病率和严重程度的信息很少。
研究CP患儿的维生素D状况，并特别参考他们抗癫痫药物（AED）的摄入量和活动状态。
在这项观察性研究中，检查了AED使用和活动状态对120名2至10岁CP患儿维生素D状况的相对影响。根据AED使用情况和活动状态，将患者分为四组（每组30人）：能活动的（CPA）、能活动且接受AED治疗的（CPAD）、不能活动的（CPNA）和不能活动且接受AED治疗的（CPNAD）。还纳入了一个由30名年龄匹配的健康儿童组成的对照组。评估的参数包括膳食钙摄入量、日照时间、血清总钙和离子钙（tCa、iCa）、无机磷（iP）、碱性磷酸酶（ALP）、甲状旁腺激素（PTH）、25羟维生素D [25(OH)D]水平以及用于检测佝偻病的腕部X光片。根据血清25(OH)D水平将维生素D状况定义为正常（>50 nmol/L）、轻度缺乏（25 - 50 nmol/L）、中度缺乏（12.5 - 25 nmol/L）、重度缺乏（<12.5 nmol/L）。
CP患儿血清25(OH)D水平的中位数（IQR）为35.6（26.75 - 64）nmol/L，而对照组为60（37 - 69.25）nmol/L（p = 0.04）。60%的CP患儿和36.7%的对照组儿童维生素D缺乏[25(OH)D < 50 nmol/L]。CP患儿的膳食钙摄入量和日照时间明显低于对照组（均p < 0.0001）。CP患儿的血清tCa和iCa水平明显较低（分别为p = 0.01和p < 0.001），PTH和ALP水平明显较高（分别为p = 0.04和p = 0.001）。CPNAD组的患者受影响最严重，其中83.3%维生素D缺乏，血清25(OH)D水平的中位数（IQR）为33.5（12.5 - 45.25）nmol/L。此外，其中53.3%的患者ALP升高，17.2%的患者PTH水平升高。
CP患儿极易患维生素D缺乏症。在这些患者中，使用AED和缺乏日照导致维生素D状况不佳，当两者同时存在时影响更为明显。
