The When, What & How of Measuring Vitamin D Metabolism in Clinical Medicine.
The When, What & How of Measuring Vitamin D Metabolism in Clinical Medicine.
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DOI：
10.3390/nu10040482
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发表时间：
2018-04-13
期刊：
影响因子：
5.9
通讯作者：
Heijboer AC
中科院分区：
文献类型：
--
作者：
Dirks NF;Ackermans MT;Lips P;de Jongh RT;Vervloet MG;de Jonge R;Heijboer AC
我们现在有能力用非常精确的方法测量许多不同的维生素D代谢物。最丰富的维生素D代谢物，25-羟基维生素D，目前是整体维生素D状态的最佳标志，因此在临床医学中最常被测量。测量25-羟基维生素D以外的代谢物的附加价值，如1,25-和24,25-二羟基维生素D，并没有得到广泛的重视。然而，在一些更复杂的病例中，这些代谢物可能只是提供合理诊断所需的信息。目前的问题是，知道什么时候测量，测量什么以及如何测量。对于25-羟基维生素D，最常用的自动免疫测定法不符合当今某些患者群体的标准要求，液相色谱-串联质谱法是这些个体的理想选择方法。较少测量的1,25-二羟基维生素D代谢物使我们能够识别许多疾病，包括1α-羟化酶缺乏症，遗传性维生素D抗性佝偻病和一些肉芽肿疾病或淋巴细胞增生性疾病伴高钙血症。此外，它区分fgf23介导和非fgf23介导的低磷综合征。24,25-二羟基维生素D代谢物已被证明在诊断特发性婴儿高钙血症方面具有价值，并且在识别其他疾病方面具有潜在价值。对于这两种代谢物，对测定法之间差异的起源的理解是有限的，需要进一步关注。然而，无论如何，临床实验室中维生素D代谢的适当测量主要取决于对不同代谢物的价值的理解，以及方法选择的重要性。
We now have the ability to measure a number of different vitamin D metabolites with very accurate methods. The most abundant vitamin D metabolite, 25-hydroxyvitamin D, is currently the best marker for overall vitamin D status and is therefore most commonly measured in clinical medicine. The added value of measuring metabolites beyond 25-hydroxyvitamin D, like 1,25-, and 24,25-dihydroxyvitamin D is not broadly appreciated. Yet, in some more complicated cases, these metabolites may provide just the information needed for a legitimate diagnosis. The problem at present, is knowing when to measure, what to measure and how to measure. For 25-hydroxyvitamin D, the most frequently used automated immunoassays do not meet the requirements of today’s standards for certain patient groups and liquid chromatography-tandem mass spectrometry is the desired method of choice in these individuals. The less frequently measured 1,25-dihydroxyvitamin D metabolite enables us to identify a number of conditions, including 1α-hydroxylase deficiency, hereditary vitamin D-resistant rickets and a number of granulomatous diseases or lymphoproliferative diseases accompanied by hypercalcaemia. Furthermore, it discriminates between the FGF23-mediated and non-FGF23-mediated hypophosphatemic syndromes. The 24,25-dihydroxyvitamin D metabolite has proven its value in the diagnosis of idiopathic infantile hypercalcaemia and has the potential of having value in identifying other diseases. For both metabolites, the understanding of the origin of differences between assays is limited and requires further attention. Nonetheless, in every way, appropriate measurement of vitamin D metabolism in the clinical laboratory hinges eminently on the comprehension of the value of the different metabolites, and the importance of the choice of method.
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影响因子：
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作者：
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DOI：
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