总维生素D检测的重要性及临床意义

1血清总25OH维生素D检测的重要性及临床应用TheImportanceandClinicalApplicationofTotal25OH-D维生素D营养状况的评判标准聊城地区育龄女性VD状况统计成人共636人•VD1026341.35%•10≤VD2031349.21%•20≤VD30375.82%•VD≥30233.62%•聊城地区儿童VD状况儿童统计364人•VD10113.02%•10≤VD206517.86%•20≤VD3013035.71%•VD≥3015843.41%5维生素D的内分泌、旁分泌和自分泌功能维生素D在钙平衡中的作用维生素D可减低自身免疫性疾病发病率–VitaminDsupplementationisassociatedwithalowerriskofautoimmunediseases.–InaFinnishbirthcohortstudyof10,821children,supplementationwithvitaminDat2000IU/dreducedtheriskoftype1diabetesbyapproximately78%,whereaschildrenwhowereatriskforricketshada3-foldhigherriskfortype1diabetes.–Inacase-controlstudyof7millionUSmilitarypersonnel,highcirculatinglevelsofvitaminDwereassociatedwithalowerriskofmultiplesclerosis.–SimilarassociationshavealsobeendescribedforvitaminDlevelsandrheumatoidarthritis.维持充足的维生素D水平可以减低多种自身免疫病的发病风险•AprospectivecohortstudyofchildrenborninFinlandduringtheyear1966andfollowedforthirtyyearsfoundthatthosewhoreceivedsupplementalvitaminDduringthefirstyearoflifehadasignificantlylowerriskofdevelopingIDDM•Arecentcase-controlstudyinU.S.militarypersonnel,including257casesofdiagnosedMS,foundthatwhitesubjectsinthehighestquintileofserum25-hydroxyvitaminD(99.1nmol/L)hada62%lowerriskofdevelopingMS.•postmenopausalwomenwiththehighesttotalvitaminDintakeswereatsignificantlylowerriskofdevelopingRAafter11yearsoffollow-upthanthosewiththelowestintakes多发性硬化症与纬度的关系PeoplelivingclosertotheequatorareatdecreasedriskofdevelopingMSSimilartrends:cancer,hypertension促进细胞分化、抑制增殖---维生素D降低肿瘤发生率TheactiveformofvitaminD,1,25-dihydroxyvitaminD,inhibitsproliferationandstimulatesthedifferentiationofcells.HolickMF.VitaminD:importanceinthepreventionofcancers,type1diabetes,heartdisease,andosteoporosis.AmJClinNutr.2004;79(3):362-371.促进细胞分化、抑制增殖---维生素D降低肿瘤发生率12VitDandDisease•Brain：——精神分裂症schizophrenia——抑郁症depression•Lung：——哮喘Asthma•Circulation：——高血压Hypertension——冠心病CHD——中风Stroke•Immunosystem:——I型糖尿病DM——多发性硬化症MS——风湿性关节炎RH——可降低结核、流感活其他感染性疾病的临床症状TBetc.infectiondisease•肿瘤Tumor：——乳腺癌(breast)——前列腺癌(prostate)——结肠癌(colon)——卵巢癌(ovary)•骨骼与肌肉Musculoskeletone:——骨软化(osteomalacia）——代谢性骨病(MetabolicBoneDisease)——肌无力(myasthenia)•孕妇及胎儿、新生儿维生素D:每个人、人生的每个阶段都要关注15维生素D检测的临床应用•儿科：佝偻病、骨软化症、儿童骨骼发育不良、骨折、小儿精神抑郁、自闭症，疗效监测、预防维生素D中毒•产科:孕期和哺乳期维生素D检测，预防产科并发症和新生儿维生素D缺乏；预防产后骨质疏松症和抑郁症-中华儿科学会推荐：妊娠3个月查25OHD，确定维生素D的补充剂量维生素D营养状况的评判标准维生素D达到什么水平才能受益18总结•维生素D缺乏是很普遍的•补充维生素D，不仅促进骨健康，且有益全身健康•维生素D理想水平是30-100ng/ml•补充维生素D应在检测指导下补充•检测的指标是总25-OH-D•实验室应选用合适的检测平台