Department of Pediatric Endocrinology, Faculty of Medicine, Inonu University, Malatya.
Department of Developmental Pediatrics, Faculty of Medicine, Inonu University, Malatya, Türkiye.
Turk J Pediatr. 2023;65(3):406-415. doi: 10.24953/turkjped.2022.860.
Nutritional rickets (NR) is still a major problem and is exacerbated by an increasing influx of immigrants. In this study, Turkish and immigrant cases followed with the diagnosis of NR in our pediatric endocrinology clinic were retrospectively evaluated.
Detailed data of cases diagnosed with NR between 2013 and 2020 and followed for at least six months were reviewed.
In the study period, 77 cases of NR were identified. Turkish children constituted 76.6% (n=59) while 18 (23.4%) were immigrant children. The mean age at diagnosis was 8.1±7.8 months, 32.5% (n=25) were female, and 67.5% (n=52) were male. The 25-hydroxyvitamin D3 was below normal in all patients, with a mean value of 4.3±2.6 ng/mL. Parathyroid hormone (PTH) was above normal in all and the mean value was 301.7±139.3 pg/ mL. While there were 3.9 cases of NR in 10,000 endocrine clinic patients in 2013, this rate increased more than four-fold to 15.7 patients in 2019.
Despite the vitamin D prophylaxis program in Türkiye, NR is seen significantly more frequently in recent years, which may be associated with an increasing number of refugees. High PTH levels indicate the severity of NR cases admitted to our clinic. However, clinically significant NR is only the tip of the iceberg and the true burden of subclinical rickets is unknown. Increasing compliance with the vitamin D supplementation program in refugee and Turkish children is important for the prevention of nutritional rickets.
营养性佝偻病（NR）仍然是一个主要问题，并且随着移民的不断涌入而加剧。在本研究中，我们回顾性评估了在儿科内分泌科诊所被诊断为 NR 的土耳其和移民病例。
回顾性分析了 2013 年至 2020 年间被诊断为 NR 并至少随访 6 个月的病例的详细数据。
在研究期间，共发现 77 例 NR 病例。土耳其儿童占 76.6%（n=59），移民儿童占 23.4%（n=18）。诊断时的平均年龄为 8.1±7.8 个月，32.5%（n=25）为女性，67.5%（n=52）为男性。所有患者的 25-羟维生素 D3 均低于正常值，平均值为 4.3±2.6ng/ml。所有患者的甲状旁腺激素（PTH）均高于正常值，平均值为 301.7±139.3pg/ml。2013 年，每 10000 名内分泌科患者中有 3.9 例 NR，而到 2019 年，这一比例增加了四倍多，达到 15.7 例。
尽管在土耳其开展了维生素 D 预防计划，但近年来 NR 的发病率显著增加，这可能与难民人数的增加有关。高 PTH 水平表明我们诊所收治的 NR 病例的严重程度。然而，临床上明显的 NR 只是冰山一角，亚临床佝偻病的真实负担尚不清楚。增加对难民和土耳其儿童维生素 D 补充计划的依从性对于预防营养性佝偻病非常重要。
