Ogiwara Yasuko, Shibata Nao, Ishii Akira, Higuchi Shinji, Nagasaki Keisuke, Kamasaki Hotaka, Yorifuji Tohru, Hasegawa Yukihiro
Division of Endocrinology and Metabolism, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan.
Division of Pediatrics, Department of Homeostatic Regulation and Development, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.
Clin Pediatr Endocrinol. 2025 Apr;34(2):115-120. doi: 10.1297/cpe.2024-0070. Epub 2025 Mar 5.
The 25-hydroxyvitamin D [25(OH)D] level and clinical symptoms are used to diagnose vitamin D deficiency (VDD). The current 25(OH)D cutoff value is based on biochemical findings, such as elevated parathyroid hormone (PTH) levels, rather than clinical symptoms. However, low 25(OH)D levels do not necessarily produce clinical symptoms. The present study proposed a 25(OH)D cutoff value for diagnosing manifest VDD, defined as VDD that is diagnosable based on either clinical symptoms, such as rickets and/or hypocalcemia (symptomatic VDD), or biochemical findings, such as elevated PTH and alkaline phosphatase levels (biochemical VDD). One hundred and eighty participants aged 0-15 yr with suspected VDD were enrolled, and receiver operating characteristic curve analysis was performed. Sixty-seven and ten patients had symptomatic and biochemical VDD, respectively. A chemiluminescent immunoassay, which demonstrated good correlation with liquid chromatography-tandem mass spectrometry, determined the 25(OH)D cutoff value for manifest VDD to be 37.5 nmol/L (15.0 ng/mL), with a sensitivity and specificity of 81% and 97%, respectively. Twenty percent (19/94) of participants with 25(OH)D ≤ 37.5 nmol/L were asymptomatic. In cases with 25(OH)D ≤ 37.5 nmol/L, a low urinary calcium-to-creatinine ratio was a risk factor for manifest VDD. In conclusion, the 25(OH)D cutoff value leading to manifest VDD for children in Japan was 37.5 nmol/L.
25-羟维生素D[25(OH)D]水平和临床症状用于诊断维生素D缺乏症(VDD)。目前的25(OH)D临界值是基于生化指标，如甲状旁腺激素(PTH)水平升高，而非临床症状。然而，低25(OH)D水平不一定会产生临床症状。本研究提出了一个用于诊断明显VDD的25(OH)D临界值，明显VDD定义为基于临床症状（如佝偻病和/或低钙血症，有症状的VDD）或生化指标（如PTH和碱性磷酸酶水平升高，生化性VDD）可诊断的VDD。招募了180名年龄在0至15岁、疑似患有VDD的参与者，并进行了受试者工作特征曲线分析。分别有67名和10名患者患有有症状的和生化性VDD。一种与液相色谱-串联质谱法具有良好相关性的化学发光免疫分析法确定，明显VDD的25(OH)D临界值为37.5 nmol/L(15.0 ng/mL)，敏感性和特异性分别为81%和97%。25(OH)D≤37.5 nmol/L的参与者中有20%（19/94）无症状。在25(OH)D≤37.5 nmol/L的病例中，低尿钙肌酐比值是明显VDD的一个危险因素。总之，日本儿童明显VDD的25(OH)D临界值为37.5 nmol/L。
