CAJ | 학술논문

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／mL，用药第4天为（58.9±11.1） ng／mL，第90天为（30.3±9.6） ng／mL，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／mL，用药第4天降至（32.7±21.6） pg／mL，第90天为（38.8±18.3） pg／mL，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。
목적：심조치료유생소D결핍유효차의종성량호적치료방안，위심조치료유생소D결핍증적이상치료방안제공의거。방법채용전첨성간예방법，급여62례유생소D결핍증환자단차구복60만단위부하제량유생소D3，관찰용약제4、30、60화90천혈개、린、뇨개화혈청25OHD화갑상방선소（ PTH）수평。결과환자혈청25OHD수평기선치위（8.9±2.9） ng／mL，용약제4천위（58.9±11.1） ng／mL，제90천위（30.3±9.6） ng／mL，차이균유통계학의의（균P＜0.001）； PTH기선치수평위（66.6±30.2） pg／mL，용약제4천강지（32.7±21.6） pg／mL，제90천위（38.8±18.3） pg／mL，차이균유통계학의의（균P＜0.001）；용약후불동시점혈개여화혈린균교기선수평승고，단재정상치범위내；뇨개수평재용약제4천현저승고，단고뇨개환자미견명현증다。소유수시자균미출현비뇨계결석。결론단차구복60만단위부하제량유생소D3，가쾌속규정유생소D결핍，유지혈청25OHD이상수평병지속3개월，해치료방안가유효역전계발성갑상방선공능항진，차미증가발생고개혈증화고뇨개적위험。
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 pro-spective 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 25OHD level was (8.9 ±2.9) ng/mL at baseline and became (58.9 ±11.1) ng/mL at 4 d (P<0.001) and (30.3 ±9.6) ng/mL at 90 d (P<0.001).PTH lev-els concomitantly decreased from (66.6 ±30.2) pg/mL to (32.7 ±21.6) pg/mL at 4 d and to (38.8 ±18.3) pg/mL at 90 d (P<0.001 for both).Mean serum Ca and P significantly increased compared to baseline , but all were still in nor-mal range.No increased hypercalcemia patients were found .Conclusion A single bolus oral dose of 600 000 U of vita-min D3 rapidly corrects vitamin D deficiency and serum 25 ( OH) D keeps ideal level lasting for 3 months.Secondary hy-perparathyroidism 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 .