Management of Nutritional Rickets in Indian Children: A Randomized Controlled Trial
Management of Nutritional Rickets in Indian Children: A Randomized Controlled Trial
复制标题
DOI：
10.1093/tropej/fms058
复制
发表时间：
2013-04-01
影响因子：
2
通讯作者：
Aneja, Satinder
中科院分区：
文献类型：
--
作者：
Aggarwal, Varun;Seth, Anju;Aneja, Satinder
导言：软骨病通常被归因于维生素D缺乏。然而，最近的研究表明，饮食中缺钙与其病因有关。目的：研究钙、维生素D或两者合用对婴幼儿营养性软骨病愈合的影响。设计：随机对照试验。方法：将67例6个月~5岁的营养性软骨病患者随机分为维生素D(60万IU单次肌肉注射)、钙(75 mg/kg/d)或两者合用治疗12周。对所有患者的人口学参数、营养状况、膳食钙和植酸盐摄入量进行了评估。分别于治疗前、治疗6周和治疗12周对患者的腕部和膝部X线片和生化指标(血钙、无机磷、碱性磷酸酶、25-羟基胆钙素和甲状旁腺激素)进行评估。结果：所有患者的平均膳食钙摄入量均较低(204+/-129 mg/d)。血清25-羟基胆钙素D平均水平为15.9+/-12.4 ng/ml，82.1%的患者血清维生素D水平为20 ng/ml，提示维生素D缺乏。经过6周和12周的治疗后，所有治疗组的放射学和生化证据都显示软骨病痊愈，尽管程度不同。联合治疗12周后血清碱性磷酸酶正常和放射学完全愈合的联合终点为50%，而单纯维生素D组和单纯钙组分别为15.7%和11.7%。结论：软骨病患儿血清维生素D水平低，膳食钙摄入量低。与单独使用维生素D和钙相比，联合使用维生素D和钙的疗效最好。试验注册号：CTRI2010/091/000448。
Introduction: Rickets is usually attributed to vitamin D deficiency. However, recent studies have implicated dietary calcium deficiency in its etiology. Information on relative efficacy of calcium, vitamin D or both together in healing of rickets is limited.Objective: To study effect of treatment with calcium, vitamin D or a combination of these two on healing of nutritional rickets in young children.Design: Randomized controlled trial.Methods: Sixty-seven cases of nutritional rickets in the age group of 6 months to 5 years were randomly allocated to receive vitamin D (600 000 IU single intramuscular dose), calcium (75 mg/kg/day elemental calcium orally) or a combination of the above two for a period of 12 weeks. The demographic parameters, nutritional status, dietary calcium and phytate intake were assessed for all. Radiographs (wrist and knee) and biochemical parameters (serum calcium, inorganic phosphate, alkaline phosphatase, 25-hydroxycholecalciferol and parathyroid hormone) were evaluated at baseline, 6 and 12 weeks for evidence of healing.Results: Mean dietary intake of calcium in all cases was low (204 +/- 129 mg/day). Mean serum 25-hydroxycholecalciferol D level was 15.9 +/- 12.4 ng/ml, and 82.1% of patients had serum vitamin D levels < 20 ng/ml, indicative of vitamin D deficiency. After 6 and 12 weeks of treatment, radiological and biochemical evidence of healing rickets was observed in all treatment groups, albeit to a variable extent. The combined end point of normal serum alkaline phosphatase and complete radiological healing at 12 weeks was observed in 50% subjects on combination therapy as compared with 15.7% subjects on vitamin D alone and 11.7% on calcium alone.Conclusions: Children with rickets had a low serum vitamin D level and a low dietary calcium intake. The best therapeutic response was seen with a combination of vitamin D and calcium than either of them given alone.Trial registration number: CTRI/2010/091/000448.