住院患者维生素D缺乏症

Hypovitaminosis D in medical inpatients.

作者信息

Thomas M K, Lloyd-Jones D M, Thadhani R I, Shaw A C, Deraska D J, Kitch B T, Vamvakas E C, Dick I M, Prince R L, Finkelstein J S

机构信息

Endocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston 02114, USA.

出版信息

N Engl J Med. 1998 Mar 19;338(12):777-83. doi: 10.1056/NEJM199803193381201.

DOI:10.1056/NEJM199803193381201

PMID:9504937

Abstract

BACKGROUND

Vitamin D deficiency is a major risk factor for bone loss and fracture. Although hypovitaminosis D has been detected frequently in elderly and housebound people, the prevalence of vitamin D deficiency among patients hospitalized on a general medical service is unknown.

METHODS

We assessed vitamin D intake, ultraviolet-light exposure, and risk factors for hypovitaminosis D and measured serum 25-hydroxyvitamin D, parathyroid hormone, and ionized calcium in 290 consecutive patients on a general medical ward.

RESULTS

A total of 164 patients (57 percent) were considered vitamin D-deficient (serum concentration of 25-hydroxyvitamin D, < or = 15 ng per milliliter), of whom 65 (22 percent) were considered severely vitamin D-deficient (serum concentration of 25-hydroxyvitamin D, <8 ng per milliliter). Serum 25-hydroxyvitamin D concentrations were related inversely to parathyroid hormone concentrations. Lower vitamin D intake, less exposure to ultraviolet light, anticonvulsant-drug therapy, renal dialysis, nephrotic syndrome, hypertension, diabetes mellitus, winter season, higher serum concentrations of parathyroid hormone and alkaline phosphatase, and lower serum concentrations of ionized calcium and albumin were significant univariate predictors of hypovitaminosis D. Sixty-nine percent of the patients who consumed less than the recommended daily allowance of vitamin D and 43 percent of the patients with vitamin D intakes above the recommended daily allowance were vitamin D-deficient. Inadequate vitamin D intake, winter season, and housebound status were independent predictors of hypovitaminosis D in a multivariate model. In a subgroup of 77 patients less than 65 years of age without known risk factors for hypovitaminosis D, the prevalence of vitamin D deficiency was 42 percent.

CONCLUSIONS

Hypovitaminosis D is common in general medical inpatients, including those with vitamin D intakes exceeding the recommended daily allowance and those without apparent risk factors for vitamin D deficiency.

摘要

背景

维生素D缺乏是骨质流失和骨折的主要危险因素。虽然在老年人和居家人群中经常检测到维生素D缺乏，但普通内科住院患者中维生素D缺乏的患病率尚不清楚。

方法

我们评估了290名普通内科病房的连续患者的维生素D摄入量、紫外线暴露情况以及维生素D缺乏的危险因素，并测量了血清25-羟维生素D、甲状旁腺激素和离子钙。

结果

共有164例患者（57%）被认为维生素D缺乏（血清25-羟维生素D浓度≤15 ng/ml），其中65例（22%）被认为严重维生素D缺乏（血清25-羟维生素D浓度<8 ng/ml）。血清25-羟维生素D浓度与甲状旁腺激素浓度呈负相关。维生素D摄入量较低、紫外线暴露较少、抗惊厥药物治疗、肾透析、肾病综合征、高血压、糖尿病、冬季、甲状旁腺激素和碱性磷酸酶血清浓度较高以及离子钙和白蛋白血清浓度较低是维生素D缺乏的显著单因素预测指标。维生素D摄入量低于推荐每日摄入量的患者中有69%以及维生素D摄入量高于推荐每日摄入量的患者中有43%维生素D缺乏。在多变量模型中，维生素D摄入不足、冬季和居家状态是维生素D缺乏的独立预测指标。在一个77例年龄小于65岁且无已知维生素D缺乏危险因素的亚组中，维生素D缺乏的患病率为42%。