Loh Huai H, Lim Lee L, Yee Anne, Loh Huai S, Vethakkan Shireene R
Faculty of Medicine and Health Sciences, University of Malaysia Sarawak, Jalan Datuk Mohd Musa, Kota Samarahan, Sarawak, Malaysia -
Division of Endocrinology, Department of Medicine, Faculty of Medicine, University of Malaya, Lembah Pantai, Kuala Lumpur, Malaysia.
Minerva Endocrinol. 2019 Jun;44(2):221-231. doi: 10.23736/S0391-1977.17.02584-6. Epub 2017 Mar 14.
We conducted a meta-analysis to assess the effects of vitamin D replacement on biochemical and skeletal parameters in subjects with mild primary hyperparathyroidism (PHPT) and coexistent vitamin D deficiency.
A systematic search of all English-language medical literature published from 1980 till May 2016 using PubMed, Embase and Ovid was performed. Nine observational studies were evaluated after fulfilling the inclusion and exclusion criteria.
A total of 547 patients were examined. All studies used vitamin D2/D3 or calcifediol (25-hydroxyvitamin D3), There was significant improvement of serum 25(OH)D with unchanged serum iPTH level after vitamin D replacement, with pooled d+: 3.10 (95% CI 2.25 to 3.95), P<0.01 and pooled d+: 0.82 (95% CI -0.35 to 1.98), P=0.16 respectively. There was neither worsening of the pre-existing hypercalcemia (pooled d+: -0.27 [95% CI -1.09 to 0.64, P=0.56]) nor hypercalciuria (pooled d+: 3.64 [95% CI -0.55 to 7.83, P=0.09]). Two studies assessed in this meta-analysis reported unchanged bone density with vitamin D replacement.
Vitamin D replacement in subjects with mild PHPT and coexistent vitamin D deficiency improved serum 25(OH)D level without worsening of pre-existing hypercalcemia or hypercalciuria. Well-designed multicenter randomized controlled trials examining pre- and postoperative outcomes of vitamin D therapy in patients with different severities of PHPT and vitamin D inadequacy are warranted to elucidate the most appropriate vitamin D treatment protocol and determine the long-term safety concerns.
我们进行了一项荟萃分析，以评估维生素D补充对轻度原发性甲状旁腺功能亢进症（PHPT）合并维生素D缺乏患者生化和骨骼参数的影响。
利用PubMed、Embase和Ovid对1980年至2016年5月发表的所有英文医学文献进行了系统检索。在符合纳入和排除标准后，对9项观察性研究进行了评估。
共检查了547例患者。所有研究均使用维生素D2/D3或骨化二醇（25-羟基维生素D3），维生素D补充后血清25(OH)D显著改善，血清iPTH水平不变，合并d+分别为3.10（95%CI 2.25至3.95），P<0.01和合并d+为0.82（95%CI -0.35至1.98），P=0.16。既没有使原有的高钙血症恶化（合并d+：-0.27 [95%CI -1.09至0.64，P=0.56]），也没有使高钙尿症恶化（合并d+：3.64 [95%CI -0.55至7.83，P=0.09]）。本荟萃分析中评估的两项研究报告维生素D补充后骨密度无变化。
对轻度PHPT合并维生素D缺乏的患者补充维生素D可改善血清25(OH)D水平，而不会使原有的高钙血症或高钙尿症恶化。有必要开展精心设计的多中心随机对照试验，研究不同严重程度的PHPT和维生素D不足患者维生素D治疗的术前和术后结果，以阐明最合适的维生素D治疗方案并确定长期安全性问题。
