Effects of 25-hydroxycholecalciferol on bone lesions of children with terminal renal failure.
Effects of 25-hydroxycholecalciferol on bone lesions of children with terminal renal failure.
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25-羟基胆钙化醇对终末期肾功能衰竭儿童骨病变的影响。
DOI：
10.1038/ki.1976.125
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发表时间：
1976
影响因子：
19.6
通讯作者：
Sonia Balsan
中科院分区：
文献类型：
--
作者：
Giulia Witmer;Alina Margolis;Olivier Fontaine;Janine Fritsch;Gérard Lenoir;Michel Broyer;Sonia Balsan
对14例终末期肾功能衰竭患儿的髂嵴活检进行定量组织学分析。一项关于维生素D2和25-羟基胆钙化醇[25-（OH）D3]在5名骨软化和/或纤维性骨炎严重病变患者中的比较作用的长期研究表明，25-（OH）D3的有效性为25 - 200 μ g/天，而维生素D2的治疗作用为345 - 685 μ g/天。在9例X线片正常或骨骼改变最小的受试者中，在间歇性血液透析开始时进行的首次活检显示矿化缺陷和/或吸收病变的证据。其中4名儿童接受了25-（OH）D3（25 - 50 μ g/天）和口服钙补充剂（0.5 - 1.5 g/天）治疗; 5名儿童单独口服钙（0.5 - 0.75 g/天）。在仅接受钙补充剂治疗的患者中，观察到间歇性血液透析期间骨病变加重。在给予25-（OH）D3的受试者中，矿化改善，骨髓纤维化消失。然而，由于两组患者的组成和治疗方式不同，很难说明观察到的有益作用是否仅归因于25-（OH）D3给药。25-（OH）D3治疗引起2例患者严重中毒。在另外两名患者中观察到血浆钙浓度升高至11.0至11.5 mg/100 ml。结论是：a）药理学剂量的25-（OH）D3在治愈患有终末期肾衰竭的儿童的骨损伤方面是高度有效的; B）这种治疗需要严格的临床监测，因为即使在无肾患者中也可能发生25-（OH）D3中毒。
Quantitative histology was performed on serial iliac crest biopsies obtained from 14 children with terminal renal failure. A long-term study on the comparative effects of vitamin D2 and 25-hydroxycholecalciferol [25-(OH)D3], in five patients with severe lesions of osteomalacia and/or osteitis fibrosa, demonstrated the efficiency of 25 to 200 mug/day of 25-(OH)D3 and the lack of therapeutic action of 345 to 685 mug/day of vitamin D2. In nine subjects with normal roentgenograms or minimal skeletal alterations, the first biopsy taken at the beginning of intermittent hemodialysis showed evidence of defective mineralization and/or lesions of resorption. Four of these children were treated with 25-(OH)D3 (25 to 50 mug/day) and calcium supplementation orally (0.5 to 1.5 g/day); five children received calcium orally (0.5 to 0.75 g/day) alone. Aggravation of bone lesions during intermittent hemodialysis was observed in patients treated with calcium supplements alone. In subjects who were given 25-(OH)D3, mineralization improved and marrow fibrosis disappeared. However, as the two groups of patients were different in composition and in the manner in which they were treated, it is difficult to state whether the beneficial effects observed were solely attributable to 25-(OH)D3 administration. 25-(OH)D3 therapy induced severe intoxication in two patients. A rise in plasma calcium concentration to 11.0 to 11.5 mg/100 ml was observed in two other patients. It is concluded that: a) pharmacologic doses of 25-(OH)D3 are highly effective in healing bone lesions of children with terminal renal failure; b) such treatment requires strict clinical surveillance as 25-(OH)D3 intoxication may occur even in anephric patients.