目的观察维生素D2对妊娠中期至围产期妇女骨密度及骨代谢指标的影响情况。方法选取2012年6月至2016年6月于我院产科就诊和产前健康检查的100例孕龄≥20周的孕妇,采用随机数字表法均分为治疗组(n=50)及对照组(n=50)。全部患者给予口服钙剂及日常生活指导治疗,治疗组同时还按体质量给予维生素D2(5 000IU/kg)肌注,每2周1次,至产后6个月止。比较两组孕妇均治疗前和产后6个月时的骨密度及骨代谢指标。结果有9例孕妇脱落,实际有效病例为对照组48例,治疗组43例。两组孕妇的基线值均为25-羟基维生素D[25-(OH)D]含量低、维生素D高度缺乏状态。治疗结束时,治疗组25-(OH)D水平(65.71μmol/L)、骨密度(3.78 g/m^2)、血清钙水平(2.67 mmol/L)均高于对照组(依次是53.68μmol/L、1.96 g/m^2、2.21 mmol/L),其骨钙素(BGP,3.02 ng/ml)、碱性磷酸酶(60.29 ng/ml)、尿钙/肌酐(Ca/Cr,0.34mmol)水平及维生素D缺乏率(16.00%)低于对照组(依次是4.21 ng/ml、75.73 ng/ml、0.68 mmol、48.00%)。且以上差异均有统计学意义(均P <0.05)。但是治疗组血清磷为(1.02±0.20)mmol/L,对照组为(1.16±0.05)mmol/L,差异无统计学意义(P> 0.05);两组孕妇均无严重不良反应。结论妊娠中期至围产期孕妇肌肉注射维生素D2,可改善其25-(OH)D营养状况,延缓骨质疏松的发展,并能改善孕妇骨代谢结局,安全性良好。
Objective To observe the effect of vitamin D2 on bone mineral density and bone metabolism in women from mid-pregnancy to perinatal period. Methods One hundred pregnant volunteers(≥20 weeks) who were admitted to our hospital from June 2012 to June 2016 were randomly divided into treatment group(n=50) and control group(n=50)according to the random number table. Both groups were given oral calcium supplementation and life guidance. Meanwhile,patients in treatment group were additionally given intramuscular injection of vitamin D2(5 000 IU/kg) once every 2 weeks until 6 months after delivery. Bone density and bone metabolism indicators were measured before treatment and at 6 months postpartum for comparison. Results A total of 9 subjects were lost to follow-up. There were 48 cases in control group and43 cases in treatment group who completed the whole study. In both groups the baseline values of 25-(OH)vitamin D were low and vitamin D were highly deficient. After treatment, the levels of 25-(OH)vitamin D(65.71 μmol/L), bone mineral density(3.78 g/m^2) and serum calcium(2.67 mmol/L) in the treatment group were higher than those of the control group(53.68 μmol/L, 1.96 g/m2, 2.21 mmol/L, respectively), and the BGP(3.02 ng/ml), alkaline phosphatase(60.29 ng/ml),urine calcium/creatinine levels(0.34 mmol) and vitamin D deficiency rates(16.00%) were lower than those of the control group(4.21 ng/ml, 75.73 ng/ml, 0.68 mmol, 48.00%, respectively). The differences mentioned above all had statistical significance(P<0.05). The level of serum phosphorus in two groups after treatment was(1.02±0.20) mmol/L and(1.16±0.05)mmol/L, respectively, which had no significant difference(P>0.05). There were no serious adverse reactions in either group. Conclusions Intramuscular injection of vitamin D2 in pregnant women from mid-pregnancy to perinatal period can improve the nutritional status of 25-(OH)vitamin D, delay the development of osteoporosis, and improve the bone metabolism, which had good safety.
WORLD CLINICAL DRUGS
bone mineral density
bone metabolism index