Low serum concentrations of 25-hydroxyvitamin D in children and adolescents with systemic lupus erythematosus

We evaluated the concentrations of 25-hydroxyvitamin D [25(OH)D] in children and adolescents with juvenile systemic lupus erythematosus (JSLE) and associated them with disease duration and activity, use of medication (chloroquine and glucocorticoids), vitamin D intake, calcium and alkaline phosphatase levels, and bone mineral density. Thirty patients with JSLE were evaluated and compared to 30 healthy individuals, who were age and gender matched. Assessment was performed of clinical status, disease activity, anthropometry, laboratory markers, and bone mineral density. The 30 patients included 25 (83.3%) females and 16 (53.3%) Caucasians, with a mean age of 13.7 years. The mean age at diagnosis was 10.5 years and mean disease duration was 3.4 years. Mean levels of calcium, albumin, and alkaline phosphatase were significantly lower in patients with JSLE compared with controls (P<0.001, P=0.006, and P<0.001, respectively). Twenty-nine patients (97%) and 23 controls (77%) had 25(OH)D concentrations lower than 32 ng/mL, with significant differences between them (P<0.001). Fifteen patients (50%) had vitamin D levels <20 ng/mL and 14 had vitamin D levels between 20 and 32 ng/mL. However, these values were not associated with greater disease activity, higher levels of parathormone, medication intake, or bone mineral density. Vitamin D concentrations were similar with regard to ethnic group, body mass index, height for age, and pubertal stage. Significantly more frequently than in controls, we observed insufficient serum concentrations of 25(OH)D in patients with JSLE; however, we did not observe any association with disease activity, higher levels of parathormone, lower levels of alkaline phosphatase, use of medications, or bone mineral density alterations.

本研究检测了幼年系统性红斑狼疮（juvenile systemic lupus erythematosus, JSLE）患儿及青少年体内的25-羟维生素D [25(OH)D]浓度，并分析其与疾病病程、疾病活动度、用药情况（氯喹（chloroquine）与糖皮质激素（glucocorticoids））、维生素D摄入、血钙与碱性磷酸酶（alkaline phosphatase）水平以及骨密度（bone mineral density）的相关性。本研究共纳入30例JSLE患者，并与30例年龄、性别匹配的健康对照者进行对比。研究人员对所有受试者的临床状态、疾病活动度、人体测量学（anthropometry）指标、实验室标志物及骨密度进行了评估。30例JSLE患者中，25例（83.3%）为女性，16例（53.3%）为高加索裔，受试者平均年龄为13.7岁；患者确诊时的平均年龄为10.5岁，平均病程为3.4年。与健康对照者相比，JSLE患者的血钙、白蛋白及碱性磷酸酶平均水平均显著降低（分别为P<0.001、P=0.006、P<0.001）。29例JSLE患者（97%）与23例健康对照者（77%）的25-羟维生素D [25(OH)D]浓度低于32 ng/mL，两组间差异具有统计学意义（P<0.001）。其中15例患者（50%）的维生素D水平低于20 ng/mL，14例患者的维生素D水平介于20~32 ng/mL之间。然而，上述维生素D水平与更高的疾病活动度、更高的甲状旁腺激素（parathormone）水平、用药情况或骨密度均无显著相关性。不同种族、体质量指数（body mass index）、年龄别身高以及青春期分期的受试者，其维生素D浓度均无显著差异。与健康对照者相比，JSLE患者血清25-羟维生素D [25(OH)D]浓度不足的检出率显著更高，但本研究未观察到该指标与疾病活动度、更高水平的甲状旁腺激素、更低的碱性磷酸酶水平、用药情况或骨密度改变存在关联。