患有慢性神经疾病儿童的维生素D缺乏症：发生率及致病因素

Vitamin D Insufficiency in Children with Chronic Neurological Diseases: Frequency and Causative Factors.

作者信息

Isik Gunes, Ustundag Bilal, Dogan Yasar

机构信息

Adiyaman University Faculty of Medicine, Pediatric Nephrology Department, Adiyaman, Turkey.

Firat University, Faculty of Medicine, Division of Clinical Biochemistry, Elazig, Turkey.

出版信息

Iran J Child Neurol. 2023 Spring;17(2):31-38. doi: 10.22037/ijcn.v17i2.35938. Epub 2023 Mar 15.

DOI:10.22037/ijcn.v17i2.35938

PMID:37091462

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10114278/

Abstract

OBJECTIVE

Vitamin D insufficiency/rickets is a metabolic bone disease that leads to insufficient mineralization of bone. Chronic neurological diseases, including cerebral palsy (CP), convulsive disorders, neural tube defects, myopathy, immobility, lack of sun exposure, inadequate nutrition, and antiepileptic drugs (AEDs) can cause vitamin D insufficiency and osteopenia in children.

MATERIALS & METHODS: In this study, the authors searched the frequency and causative factors of vitamin D insufficiency in children with chronic neurological diseases such as CP, hypoxic-ischemic encephalopathy, mental motor retardation, epilepsy, neurodegenerative and neuromuscular diseases, meningitis-encephalitis sequelae, neural tube defects, paralysis, and paresis. This cross-sectional study included 108 children (forty-five (41.6%) females; sixty-three (58.4%) males), aged between one and 18 years with chronic neurological diseases, and a control group of thirty age-matched healthy children (16 (53.3%) females; 14 (46.7%) males.

RESULTS

Vitamin D levels were significantly lower, and parathyroid hormone (PTH) levels were significantly higher in the patient group than in the control group (p<0.05). The patient group was divided into four subgroups: (i) Epilepsy (n=41; 38%), (ii) Neural tube defects (n=14; 13%), (iii) CP (n=21; 19%), and (iv) other diseases (neurodegenerative and neuromuscular diseases, meningitis sequelae, intracranial hemorrhage, psychomotor retardation, hypoxic-ischemic. encephalopathy) (n=32; 30%) to identify any differences in the measured levels. In the patient group, eighty-three (76.9%) had vitamin D deficiency, and 17 (15.7%) had vitamin D insufficiency, while in the control group, twenty-one (70%) had vitamin D insufficiency. The use of AEDs had no significant effect on serum Ca, P, ALP, PTH, or vitamin D levels (p>0.05), and serum Ca levels were significantly higher in ambulant patients than in non-ambulant patients (p<0.05). Vitamin D levels were significantly higher in the non-ambulant than in the ambulant patients (p<0.05). No rickets was determined in the control group, while in the patient group, nine (8.3%) had level-1 rickets, six (5.6%) had level-2 rickets, and two (1.9%) had level-3 rickets.

CONCLUSION

Children with chronic neurological diseases have low serum vitamin D levels, and vitamin D prophylaxis is essential in this group.

摘要

目的

维生素D缺乏/佝偻病是一种导致骨骼矿化不足的代谢性骨病。慢性神经疾病，包括脑瘫（CP）、惊厥性疾病、神经管缺陷、肌病、活动受限、缺乏日照、营养不足以及抗癫痫药物（AEDs）可导致儿童维生素D缺乏和骨质减少。

材料与方法

在本研究中，作者调查了患有CP、缺氧缺血性脑病、精神运动发育迟缓、癫痫、神经退行性和神经肌肉疾病、脑膜炎-脑炎后遗症、神经管缺陷、瘫痪和轻瘫等慢性神经疾病儿童维生素D缺乏的频率及病因。这项横断面研究纳入了108名年龄在1至18岁之间患有慢性神经疾病的儿童（45名（41.6%）女性；63名（58.4%）男性），以及一个由30名年龄匹配的健康儿童组成的对照组（16名（53.3%）女性；14名（46.7%）男性）。

结果

患者组的维生素D水平显著低于对照组，甲状旁腺激素（PTH）水平显著高于对照组（p<0.05）。患者组被分为四个亚组：（i）癫痫（n = 41；38%），（ii）神经管缺陷（n = 14；13%），（iii）CP（n = 21；19%），以及（iv）其他疾病（神经退行性和神经肌肉疾病、脑膜炎后遗症、颅内出血、精神运动发育迟缓、缺氧缺血性脑病）（n = 32；30%），以确定测量水平上的任何差异。在患者组中，83名（76.9%）有维生素D缺乏，17名（15.7%）有维生素D不足，而在对照组中，21名（70%）有维生素D不足。使用AEDs对血清钙、磷、碱性磷酸酶、PTH或维生素D水平无显著影响（p>0.05），能活动的患者血清钙水平显著高于不能活动的患者（p<0.05）。不能活动的患者维生素D水平显著高于能活动的患者（p<0.05）。对照组未发现佝偻病，而在患者组中，9名（8.3%）有1级佝偻病，6名（5.6%）有2级佝偻病，2名（1.9%）有3级佝偻病。