60万单位维生素D_3单次口服治疗维生素D缺乏  

Effect of a bolus oral dose of 600000 U of vitamin D_3 on patients with vitamin D deficiency:a prospective intervention study

作　　者：宁志伟[1] 苗莉[1] 刘佳[1] 胡延晋[1] 高霞[1] 潘永华[1] 孙红[1] 徐援[1] 刘丽宏[2] 

机构地区：[1]首都医科大学附属北京朝阳医院内分泌科,北京100020 [2]首都医科大学附属北京朝阳医院药事部,北京100020

出　　处：《中华骨质疏松和骨矿盐疾病杂志》2014年第4期320-324,共5页Chinese Journal Of Osteoporosis And Bone Mineral Research

摘　　要：目的寻找治疗维生素D缺乏有效且依从性良好的治疗方案,为寻找治疗维生素D缺乏症的理想治疗方案提供依据。方法采用前瞻性干预方法,给予62例维生素D缺乏症患者单次口服60万单位负荷剂量维生素D3,观察用药第4、30、60和90天血钙、磷、尿钙和血清25OHD和甲状旁腺素(PTH)水平。结果患者血清25OHD水平基线值为(8.9±2.9)ng/m L,用药第4天为(58.9±11.1)ng/m L,第90天为(30.3±9.6)ng/m L,差异均有统计学意义(均P<0.001);PTH基线值水平为(66.6±30.2)pg/m L,用药第4天降至(32.7±21.6)pg/m L,第90天为(38.8±18.3)pg/m L,差异均有统计学意义(均P<0.001);用药后不同时点血钙与和血磷均较基线水平升高,但在正常值范围内;尿钙水平在用药第4天显著升高,但高尿钙患者未见明显增多。所有受试者均未出现泌尿系结石。结论单次口服60万单位负荷剂量维生素D3,可快速纠正维生素D缺乏,维持血清25OHD理想水平并持续3个月,该治疗方案可有效逆转继发性甲状旁腺功能亢进,且未增加发生高钙血症和高尿钙的危险。Objective We evaluated the effect of a single high dose of vitamin D3 on serum level of 25-hydroxyvitamin,parathyroid hormone,and serum calcium and phosphorus level and urine calcium excretion at 4,30,60 and 90 d,compared to baseline. Methods Sixty-two subjects with vitamin D deficiency participated in this prospective intervention study. A single bolus oral dose of 600,000 IU of vitamin D3 was administered to each subject.Serum changes of 25-hydroxyvitamin D（ 25OHD）,PTH,calcium,and phosphorus level and urine calcium excretion induced by a single load of vitamin D3 were evaluated. Results The 25 OHD level was（ 8. 9 ± 2. 9） ng / m L at baseline and became（ 58. 9 ± 11. 1） ng / m L at 4 d（ P〈0. 001） and（ 30. 3 ± 9. 6） ng / m L at 90 d（ P〈0. 001）. PTH levels concomitantly decreased from（ 66. 6 ± 30. 2） pg / m L to（ 32. 7 ± 21. 6） pg / m L at 4 d and to（ 38. 8 ± 18. 3） pg / m L at90 d（ P〈0. 001 for both）. Mean serum Ca and P significantly increased compared to baseline,but all were still in normal range. No increased hypercalcemia patients were found. Conclusion A single bolus oral dose of 600 000 U of vitamin D3 rapidly corrects vitamin D deficiency and serum 25（ OH） D keeps ideal level lasting for 3 months. Secondary hyperparathyroidism concomitant with vitamin D deficiency were effectively reversed. No increased risk of hypercalcemia and hypercalciuria were found for the treatment. It＇s a promising treatment regimen in the management of vitamin D deficiency.

关 键 词：维生素D缺乏症 维生素D3 治疗 25-羟基维生素D 甲状旁腺激素 

分 类 号：R681[医药卫生—骨科学]