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Rickets can be suspected below 36 ng of vitamin D – Oct 2012

Role of serum 25-hydroxyvitamin D in the diagnosis of vitamin D deficiency rickets

Zhongguo Dang Dai Er Ke Za Zhi. 2012 Oct;14(10):767-70.
Article in Chinese
Wang XY, Jin CH, Wu JX, Liu Z, Li M, Li N.
Department of Health Care, Capital Institute of Pediatrics, Beijing 100020, China.

OBJECTIVE: To study the role of serum 25-hydroxyvitamin D in the early diagnosis of vitamin D deficiency rickets.

METHODS: Concentrations of serum 25(OH)D, calcium, phosphorus and alkaline phosphatase were measured in normal control (n=73), suspected rickets (n=45) and confirmed rickets groups (n=65). Receiver operating characteristic (ROC) curve was used to evaluate the diagnostic value of serum 25(OH)D for rickets.

RESULTS: Serum 25(OH)D levels in the suspected and confirmed rickets groups were 83±30 and 72±31 nmol/L respectively, which was lower than in the normal control group (112±37 nmol/L) (P<0.01). There was no significant difference between the suspected and confirmed rickets groups (P>0.05). Vitamin D deficiency rates in the suspected and confirmed rickets groups were higher than in the control group (P<0.01). The ROC curve area of serum 25(OH)D for the diagnosis of rickets was 0.760 (95%CI 0.692-0.820, P<0.01), and the optimal operating point was 90.70 nmol/L (sensitivity 68.49%, specificity 72.73%). There was no significant difference in levels of calcium, phosphorus and alkaline phosphatase between the three groups (P>0.05).

CONCLUSIONS: Serum 25(OH)D levels in infants with suspected and confirmed rickets are significantly reduced and this may reflect vitamin D deficiency . Therefore, it may be useful to check serum 25(OH)D levels in screening for rickets.

PMID: 23092570


Chinese PDF is attached at the bottom of this page

Image

Groupnmolng
Suspected Rickets83 nmol 33ng
Confirmed Rickets72 nmol29 ng
Not rickets 112 nmol45 ng
Optimal operating point 90.7 nmol36 ng

See also VitaminDWiki


CLICK HERE for the Chinese text extracted from the PDF


The following is the text translated to English
Chinese Journal of Contemporary Pediatrics, Volume 14, Issue 10, October 2012
Serum 25 - hydroxyvitamin D value in the diagnosis of rickets
Wang Xiaoyan Jin Chunhua Wu Jianxin Zhuo Li Mei Li Na
(Children's Hospital, Health Care, Capital Institute of Pediatrics, Beijing 100020, China; 2. Biochemical Research Center of the Capital Institute of Pediatrics, Beijing 100020, China)
[[[Abstract] Objective To investigate the significance of serum 25 - hydroxyvitamin D [25 (OH) D] in the early diagnosis of vitamin D deficiency rickets. Detected by the control group (73 cases), suspicious group (45 cases) and rickets group (n = 65) serum 25 (OH) D, calcium, phosphorus, alkaline phosphatase, and the ROC curve for serum 25 (OH) the diagnostic value of D for evaluation. Results of the control group, the suspicious group and rickets in the serum 25 (OH) D levels were 112 ± 37,83 ± 30 and 72 ± 31 nmol / L, after both significantly lower than the control group (F = 26 174, P <0 01), suspicious group and rickets group difference was not statistically significant (> 0.05), respectively. Suspicious group and rickets group of vitamin D deficiency rate was significantly higher than that in the control group (;! 2 = 33.346, 8 <0 01). The area under the ROC curve of serum 25 (OH) D 760 (95% C /: 0.692 to 820, P <0 01), the best critical point to 90.7 nmol / L, the sensitivity of 68.49%, The specificity of 72.73%; suspicious group and rickets group of serum calcium, phosphorus, alkaline phosphatase, and the control group, the difference was not statistically significant (> 0.05). Conclusions Serum 25 (OH) D levels in children with suspected and confirmed rickets in a significant reduction may reflect the nutritional status of vitamin D, suitable for early screening of rickets. Chinese Journal of Contemporary Pediatrics, 2012,14 (10): 767 - 770]

[[[CLC] R591.44 [Document code] A [Article ID] 1008-8830 (2012) 10 -0 767 -04
In recent years, 25 - hydroxyvitamin D [25-hydroxyvitamin D, 25 (OH) D] and vitamin D deficiency rickets (rickets of vitamin D deficiency, referred to as rickets) to clinicians a hot topic again. Rickets is not only caused by osteoporosis, severe lower limb bow, fractures and other bone lesions, resulting in growth retardation in children [1], but also affects the respiratory, nervous, muscle, hematopoietic and immune group
[Received Date] 2012-03-16; Revised Date] 2012 - 04 -17
[Author] Wang Xiaoyan, female, master, the attending physician. [Communication] Jin Chunhua, chief physician.
Weaving organ function J. The rickets diagnosis based on dimensional
Lack of vitamin D intake history and clinical manifestations, and further confirmed by the carpal bone X-ray and blood biochemical tests. The early clinical manifestations and laboratory examinations are the lack of specificity and sensitivity. The pathogenesis of rickets is vitamin D deficiency caused by calcium and phosphorus metabolism disorders, leading to a series of pathological changes. So, whether through the monitoring of vitamin D

Level of early diagnosis is worth studying. In addition a large number of $ clinical findings have been confirmed by clinical manifestations and wrist X-ray rickets in children
Serum 25 (OH) D levels were normal. Thus serum 25 (OH) D testing
For the rickets diagnosis still make sense, need to be further explored.
In this study, the analysis of serum 25 (OH) D concentration, to explore its significance in the early diagnosis of rickets and problems of, and access to the critical point of the diagnostic value of clinical application of the indicators to carry out the diagnosis and treatment of rickets provide the basis for .
1 Materials and Methods
1.1 The study
Select from March 2009 to May 2010 at the Capital Institute of Pediatrics Children's Hospital, Health Care, 183 infants medical as research subjects, aged 1 month to 1 year old, is divided into the the rickets group of suspicious group and control group 3. (1) rickets group: meet the diagnostic criteria of "infant rickets prevention and treatment programs (Ministry of Health 1986) [5], both non-specific neuropsychiatric symptoms such as night terrors, sweating, irritability and other signs of bone changes, X-ray shows abnormal changes. (2) the suspicious group: (1) the presence of vitamin D deficiency risk factors (2008 vitamin D deficiency rickets prevention and treatment recommendations "[6]) or clinical symptoms such as night terrors, sweating, irritability; ② X line no abnormal changes . (3) control group: (1) normal physical examination of the baby; ② no vitamin D deficiency
Risk factors or clinical manifestations.
Exclusion criteria: (1) past suffered from rickets in children; (2) the recent suffering from infectious diseases; (3) past suffered from liver, kidney, thyroid disease or family history; (4) presence of congenital malformations and inherited metabolic disease. 1.2 Research Methods
A case-control study. History and body by hand
Gender
Group number of cases -
Male Female
Control group 73 44 (60) 29 (4 the (suspicious group 4522 (49) 23 (5: the rickets group of 65 29 (45) 36 (5; X2 value 3.596 P value _> 0.05
Comparison (Table 23 general
Group number of cases Age (months)
Weight (kg)
Height (cm) BMI

The control group 73 6.9 ± 2.8
8.5 ± 1.7
69 ± 5 1 .6 ± 2.0

Suspicious group 45 6.6 ± 2.5
8.3 ± 1.3
68 ± 4 1 of 1.7 ± 1.5

Many have suggested hunchback disease group 65 6.7 ± 2.8
8.5 ± 1.7
69 ± 5 1 a .7 ± 1.8

Value
Value
Cells inspector to collect clinical data. All of the subjects fasting acquisition vein
2 mL of blood anticoagulant vacuum blood collection tube, centrifuged 5 min at room temperature, the speed of 4000 r / min, serum was collected for serum 25 (OH) D, calcium, phosphorus, alkaline phosphatase detection. Serum 25 (OH) D was measured by enzyme-linked immunosorbent assay (ELISA). The coefficient of variation (CV) of 5.1%, inter-assay
Coefficient (CV) of 6.4%. All serum samples measured by the Capital Institute of Pediatrics Biochemical Research. 25 - hydroxyvitamin D assay kit provided by the British IDS. 1.3 Statistical Analysis
Application of E / iData 3 software for data entry,
SPSS 13.0 software for statistical analysis, MedCalc 12.1.1 software to draw the ROC curve. The measurement data were expressed as mean ± standard deviation (± s), multi-group analysis of variance between groups compared using LSD method; count data to form than the groups were compared using the chi-square test. P <0.05 was considered statistically significant.

2 Results

2.1 - normally

Control group, 73 patients aged 1.1 to 12. 3 months, 4, 5 to 12.5 kg body weight, 55 -78 cm of height, BMI 13.7-23.0. Suspicious group of 45 patients, aged 3.1-12.7, 6.0-11.2 kg body weight, height 61 -77 cm, BMI 15.0 to 21.0. The rickets group of 65 patients, aged 1.5-11.4 months, weighing 5.2-13.5 kg, height 57 -78 cm, a BMI of 15.1 to 24.7. Suspicious group, the rickets group sex, treatment season, age, weight, height and BMI compared with the control group, the difference was not statistically significant (> 0.05); suspicious group, rickets group of breastfeeding was significantly higher (8 <0.001), see
Table 1-2.
Feeding patterns
Breastfeeding mixed feeding artificial feeding

2.2 3 serum 25 (OH) D, calcium, phosphorus, alkaline phosphatase levels.

Suspicious group, rickets group serum 25 (OH) D water were significantly lower than the control group (<0.001), no statistically significant difference between the suspicious group and rickets group (> 0.05). Suspicious group and rickets group
The Table 13 general comparison (a) [[[Example
Treatment season winter and summer and Serum calcium, phosphorus, alkaline phosphatase levels compared with the control group no difference between the system
Considered significant (> 0.05), and all within the normal range, as shown in Table 3% Table 33 serum 25 (OH) D, calcium, phosphorus and alkaline phosphatase levels than
Relatively
25 (OH
The group number of cases,
) D calcium phosphorus L) (mmol / L) (mmol / L
Alkaline phosphatase) (U / L)

The control group 73 112 ±
37 2.64 ± 0.13 2.05 ± 0.2
0 235 ± 87

Suspicious group of 45 83 ± 3
0a 2.70 ± 0.09 2.02 ± 0.1
6 240 ± 66

Rickets group 65 72 ± 3
1a 2.66 ± 0.09 1.97 ± 0. 1
9 244 ± 90

Value of 26.17
4 3.005 1.622
0.105

P values ​​<0.0
01> 0.05> 0.05
> 0.05

a: Compared with control group, P
<0.001

2.3 3-group vitamins I

) Comparative nutritional status


Suspicious group and rickets vitamin D deficiency rates were 31% and 11% in the control group, no cases of vitamin D deficiency, the difference was statistically significant (<0.001), as shown in Table 4.
Table 43 vitamin D nutritional status of patients (%)]
,. , Adequate vitamin D deficiency vitamin D insufficiency vitamin D
Group number of cases
(<Of 50 nmoZL) (50 -75 nmoZL) (> 75 nmoZL) control group 73 0 (0) 15 (21) 58 (80)
Suspicious group 455 (11) 16 (36) 24 (53)
The rickets group of 65 20 (31) 14 (22) 31 (48)
X1 33.346 <0.001

2.4 serum 25 (OH) D diagnostic value of evaluation and best critical point

Serum 25 (OH) D level was no significant difference between the groups suspicious group and rickets, so the former satisfied rickets group analysis. The area under the curve (AUC) 0 760 (95% C /: 0 692 -0.820,8 <0.001), and the diagnostic accuracy Medium. Calculate the likely cut-off point of sensitivity and specificity, 90.7 nmoZL critical point on the ROC curve, the corresponding sensitivity of 68.49% and a specificity of 72.73%, as shown in Figure 1.
o Hi .. ■ ............. ■ ■ ■.
020406080100
1 B {0 / '\
Figure 1 serum 25 (OH) D levels ROC curve
3 Discussion
Rickets diagnosis of multiple serum markers as calcium, phosphorus and alkaline phosphatase, but the lack of specificity and sensitivity [7-8], this study also confirmed this point. This may be related to the role of parathyroid hormone and calcitonin, the latter two collaborative vitamin D to maintain the body's calcium and phosphorus balance. 25 (OH) D has the features of high concentration, stability and long half-life, is considered an important indicator to reflect the body's vitamin D metabolism [9], serum 25 (OH) D detection diagnostic value of rickets more and more attention . The this study rickets serum 25 (OH) D level of 72 ± 31 nmollL higher than that of vitamin D deficiency (<50nmol / L) of the diagnostic criteria. Combined with the object of study of medical history, consider primarily related to health care workers and parents of rickets prevention knowledge to understand fully and actively its taking vitamin D supplements related to the baby after birth. Confirmed in the regular, long-term medical environment to add vitamin D, rickets in children with serum 25 (OH) D7 level also increased. Nevertheless, rickets serum 25 (OH) D levels are still significantly lower than the control group, indicating that serum 25 (OH) D levels decreased still prompt the baby may occur rickets a more reliable indicator. ROC curve can be used as a diagnostic method in clinical epidemiology accuracy evaluation index. AUC - like the diagnostic value lower than 0.9 means that a higher diagnostic value between 0.5-0.7. The results of this study serum 25 (OH) D AUC = 0.760, showed that serum 25 (OH) D detection of some diagnostic value. It is noteworthy that the suspicious group and rickets serum 25 (OH) D level was no significant difference, suggesting in typical rickets before, already exists in children, even vitamin D deficiency may be a long time. Further illustrate the serum 25 (OH) D levels decreased for the early detection of rickets significant. At this point, even better than the classic X line. Because the latter can be displayed only when the bone mass loss of 30% to 50% decrease in bone mineral content [W].
Researchers refer to the majority of expert consensus as vitamin D nutritional status evaluation criteria [1115]: serum 25 (OH) D levels <50 nmoZL vitamin D deficiency, 50 -75 nmoZL lack of vitamin D, 75 nmoZL sufficient. 2011, published by the American College of Endocrinology vitamin D deficiency assessment, treatment, and prevention of clinical practice guidelines recommend serum 25 (OH) D levels <50 nmoZL diagnosis of vitamin D deficiency [16]. In fact, no such study in children serum 25 (OH) D the normal uniform standards. Due to the experimental method, latitude, season and vitamin D intake persons and other factors, countries, different children around the serum 25 (OH) D level [17-23]. Which is the limit of the check in the pediatric clinical wider application of one of the factors. Diagnosed rickets in children in this study only 31% (20/65) consistent with vitamin D deficiency, to

Diagnosis and treatment of great distress. Therefore, if the application of the above subscript
Baby vitamin D nutritional status of prospective evaluation of the area to be combined with the history and clinical performance into account, to avoid missed diagnosis of vitamin D deficiency cases, delaying treatment. ROC curve select the best critical point for a detection means to achieve maximum sensitivity and specificity, while reducing the rate of misdiagnosis and missed diagnosis rate. In this study, 90 7 nmoZL as the diagnostic value of the critical point of view from a sensitivity of 68.49% and 72.73% specificity, there are certain clinical value. Both as soon as possible to prevent and detect the occurrence of rickets, it will not increase the psychological and economic burden of the parents. Due to a limited number of the observed object, needed more time large-scale & randomized, controlled trials testing. Recent Liangguan Yu et al [24] proposed Nanjing 0-10 age group children, serum 25 'OH) D level 50 -60 nmoZL may be the optimal concentration to maintain normal bone metabolism, in addition to still rare in the open literature reports of national laboratories establish its own reference range.
In summary, with the prevention of health literacy, domestic severe rickets is rare, early or atypical rickets is more common. Serum 25 (OH) D level of testing for the detection of early rickets and
When clinical treatment is even more significant. In view of the more influential factors still exist in the current children's serum 25 (OH) D, under the premise of the normal range has not yet been determined, it is recommended that the serum 25 (OH) D testing as a screening Koh
Means of disease hunchback. Lily Chow, Guoqing Mei serum 25-hydroxyvitamin D determination of significance in the prevention of rickets [J]. Eugenics and Heredity, 1996,4 (3) :35-36. Malan, microelement, Tian Yue, Li Jing, Lu Fang, Hou security deposit. infant serum 25-hydroxyvitamin D levels and rickets relationship [J]. Applied Clinical Pediatrics, 2007,22
Diagnostic the Tanghai single photon technology [M] / / honest osteoporosis, Beijing: Science Press, 1998: 59-84.
Wu Kangmin vitamin D deficiency rickets [M] / / Liu Xiangyun, Chen Ronghua, Zheng-Yan Zhao child health science. 4th edition. Nanjing: Jiangsu Science and Technology Press, 2011:

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Ma Xiuli, Zhen Yanfen children with asthma serum 25 - Immunoglobulin E changes [[J] Chinese Journal of Contemporary Pediatrics, and immune
Liang Xiaohong, let Yang, Shu-Ping, Wu Hongyuan children aged .0-2 VD levels of nutrition and related factors [J] Chinese Primary Health Care, 2004, 18 (7): 74-75. Moli Ya Lai original Revising Contributions Chien-Liang Liu, Liu Jianlong infant serum 25-hydroxyvitamin D levels in the diagnosis of rickets [J] Practical Preventive Medicine, 2008,
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Children's Health Study Group of Chinese Medical Sciences Branch of the National rickets Prevention Research Group. Vitamin D deficiency rickets prevention and treatment recommendations [J] Journal of Pediatrics, Jia Chunmei, Liu Shuyuan, Wang Dongmei rickets serum 25-hydroxyvitamin D3 and serum calcium Determination of Baotou Medical College [J]., 1997, 13 (4): 33-35. Liangguan Yu, Qin Rui, Li Jing, Lu Jingxia Gegao Xia Hu Youfang, 010-year-old children in Nanjing serum 25 - (OH) D optimal level of [J] Chinese Journal of Pediatrics, 2009, 17 (6): 624-626.
(This article: WANG Qing)


See also VitaminDWiki


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