Developmental Neurosciences, UCL Great Ormond Street Institute of Child Health, London, United Kingdom; Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.
Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States; Cancer and Blood Diseases Institute, Division of Hematology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.
Complement Ther Med. 2020 Mar;49:102342. doi: 10.1016/j.ctim.2020.102342. Epub 2020 Feb 15.
Sickle cell disease (SCD) is the most prevalent inherited hematological disorder and affects 100,000 individuals in the United States. Pain is the most common cause of emergency department (ED) visits in the SCD population, which profoundly affects quality of life. Vitamin D supplementation is a potential target for reducing pain. Thus, the goal of the present study was to identify the prevalence of vitamin D deficiency and explore the relationship between vitamin D supplementation and ED visits in pediatric patients with SCD.
We conducted a retrospective chart review of 110 patients with SCD aged 8-16 years who had at least one ED visit for SCD pain during the 6-year study period. Patients were categorized into three vitamin D supplementation groups: patients who did not receive supplementation, patients supplemented with 25-hydroxyvitamin D levels (< 30 ng/mL), and patients supplemented with at least one sufficient 25-hydroxyvitamin D level (≥ 30 ng/mL).
Overall, 45 % of patients were vitamin D deficient. Only 20 % of patients had sufficient vitamin D levels. This number increased to 55 % when examining only patients who did not receive vitamin D supplementation. For patients supplemented with vitamin D, the number of ED visits was significantly lower after they reached the sufficient range (≥ 30 ng/mL), p = 0.03.
Our findings indicate that reductions in the number of pain-related ED visits may be achieved by normalizing 25-hydroxyvitamin D levels with supplementation. In addition, findings highlight the need for screening and vitamin D supplementation being incorporated into routine care for pediatric patients with SCD.
镰状细胞病（SCD）是最常见的遗传性血液病，影响美国 10 万人。疼痛是 SCD 人群中急诊就诊最常见的原因，这极大地影响了生活质量。维生素 D 补充剂是减少疼痛的潜在目标。因此，本研究的目的是确定维生素 D 缺乏的患病率，并探讨 SCD 儿科患者维生素 D 补充与 ED 就诊之间的关系。
我们对 110 名年龄在 8-16 岁的 SCD 患者进行了回顾性图表审查，这些患者在 6 年的研究期间至少有一次因 SCD 疼痛而到 ED 就诊。患者被分为三组维生素 D 补充剂：未接受补充剂的患者、25-羟维生素 D 水平（<30ng/mL）补充剂的患者和至少有一次补充足够 25-羟维生素 D 水平（≥30ng/mL）的患者。
总体而言，45%的患者维生素 D 缺乏。只有 20%的患者有足够的维生素 D 水平。当仅检查未接受维生素 D 补充的患者时，这一数字增加到 55%。对于接受维生素 D 补充的患者，当达到足够的范围（≥30ng/mL）时，ED 就诊次数显著减少，p=0.03。
我们的研究结果表明，通过补充使 25-羟维生素 D 水平正常化，可能会减少与疼痛相关的 ED 就诊次数。此外，这些发现强调了对 SCD 儿科患者进行筛查和维生素 D 补充，并将其纳入常规护理的必要性。
