CORRELATION OF SYMPTOMS WITH VITAMIN D DEFICIENCY AND SYMPTOM RESPONSE TO CHOLECALCIFEROL TREATMENT: A RANDOMIZED CONTROLLED TRIAL
CORRELATION OF SYMPTOMS WITH VITAMIN D DEFICIENCY AND SYMPTOM RESPONSE TO CHOLECALCIFEROL TREATMENT: A RANDOMIZED CONTROLLED TRIAL
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DOI：
10.4158/ep.15.3.203
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发表时间：
2009-04-01
影响因子：
4.2
通讯作者：
Sjoberg, Robert J.
中科院分区：
文献类型：
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作者：
Arvold, David S.;Odean, Marilyn J.;Sjoberg, Robert J.
目的：在一项随机、双盲、安慰剂对照试验中，研究症状与维生素D缺乏的关系以及对胆骨化醇治疗的症状反应。方法：2007年2月，明尼苏达州德卢斯的成人初级保健患者进行了维生素D缺乏症筛查。参与者完成了关于各种症状、维生素D摄入量和选定医疗条件的问卷调查。轻至中度维生素D缺乏症（25-羟基维生素D [25(OH) D], 10-25 ng/mL）患者参与维生素D替代及其对症状影响的随机对照试验（RCT）。参与者被随机分配接受每周50000单位的胆钙化醇（维生素D(3)）或安慰剂，持续8周。重度维生素D缺乏症（25[OH]D < 10 ng/mL）患者采用非盲法治疗，治疗后重新评估症状。结果：共有610名患者接受了初步筛查，100名轻度至中度维生素D缺乏症患者参加了RCT。38名严重缺陷患者采用非盲法治疗。在最初的筛查中，46.2%的参与者缺乏维生素D。自我报告的维生素D补充、牛奶摄入量、乳糜泻、胃旁路手术和慢性胰腺炎可预测维生素D状况。严重缺乏的参与者报告肌肉骨骼症状增加，抑郁（包括季节性），纤维肌痛评估问卷得分更高（更差）。在随机对照试验中，治疗组在纤维肌痛评估评分上有显著改善（P = 0.03），而安慰剂组没有。严重缺乏患者在8周的试验期间或1年后的随访中没有表现出症状改善。结论：与安慰剂组相比，治疗组患者在纤维肌痛总体影响评分方面表现出轻度的短期改善，但在日常生活活动中的大多数肌肉骨骼症状没有显着改善。（执业医师，2009;15:20 03-212）
Objective: To examine the association of symptoms with vitamin D deficiency and symptom response to cholecalciferol treatment in a randomized, double-blind, placebo-controlled trial.Methods: Adult primary care patients in Duluth, Minnesota, were screened for vitamin D deficiency in February 2007. Participants completed questionnaires pertaining to a variety of symptoms, vitamin D intake, and selected medical conditions. Patients with mild to moderate vitamin D deficiency (25-hydroxyvitamin D [25(OH) D], 10-25 ng/mL) participated in a randomized controlled trial (RCT) of vitamin D replacement and its effect on symptoms. Participants were randomly assigned to receive 50000 units of cholecalciferol (vitamin D(3)) weekly or placebo for 8 weeks. Patients with severe vitamin D deficiency (25[OH]D < 10 ng/mL) were treated in an unblinded fashion, and symptoms were reevaluated post treatment.Results: A total of 610 patients underwent initial screening, and 100 patients with mild to moderate vitamin D deficiency participated in the RCT. Thirty-eight severely deficient patients were treated in an unblinded fashion. On initial screening, 46.2% of participants were deficient in vitamin D. Self-reported vitamin D Supplementation, milk intake, celiac disease, gastric bypass, and chronic pancreatitis were predictive of vitamin D status. Severely deficient participants reported increased musculoskeletal symptoms, depression (including seasonal), and higher (worse) scores on a fibromyalgia assessment questionnaire. In the RCT, the treated group showed significant improvement in fibromyalgia assessment scores (P = 0.03), whereas the placebotreated participants did not. Severely deficient patients did not show symptom improvement over the 8-week trial period or when followed up 1 year later.Conclusions: Compared with participants in the placebo group, patients in the treatment group showed mild short-term improvement in the overall fibromyalgia impact score, but did not show significant improvement in most musculoskeletal symptoms of in activities of daily living. (Endocr Pract. 2009;15:203-212)