研究维生素D水平增加的动态以及计算胆骨化醇摄入所需持续时间的方法

V. V. Krivosheev, I. V. Kozlovsky, L. Yu. Nikitina, A. V. Fedorov
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引用次数: 0

摘要

流行性维生素d病席卷全球。在北半球的居民中,大约45%的人缺乏维生素D, 32%的人血清维生素D水平不足。在俄罗斯,情况更加紧张:56.4%的人口缺乏营养,27.87%的公民缺乏营养。维持血清中维生素D的最佳浓度可以降低自身免疫性疾病、心血管疾病、多种癌症、痴呆、1型和2型糖尿病、呼吸道感染的风险和严重程度,改善牙齿和口腔健康,提高身体表现。怀孕期间普遍缺乏维生素D的问题需要特别注意,这不仅对母亲,而且对儿童以后的生活也有严重后果。对规范维生素D补充剂摄入的文件的审查表明,说明中存在一些不确定性,这导致对患者的医疗建议在选择药物类型、剂量和维生素D摄入持续时间方面存在很大差异。在我们看来,关于维生素D补充所需持续时间的建议是最脆弱和不充分的,因此,在这项工作中,在国际临床实践的基础上,对维生素D水平增加的动态进行了研究,并开发了一种计算目前最常见的维生素D3制剂所需持续时间的方法。通过对国内外提高血清维生素D水平的实践分析,以及所进行的统计研究,可以谨慎地得出以下结论。当服用维生素D3制剂时,25(OH)D水平随时间的增加可以用指数方程非常正确地描述。随着服用维生素D3制剂时间的增加,血清中25(OH)D水平的增加速率降低。在渐近人群中服用维生素D3制剂时,当前的钙化二醇水平与每日药物剂量呈幂律依赖关系,并随着剂量的增加而增加。大量临床试验结果表明,在不同条件下,25(OH)D水平的升高主要发生在30-90天内。我们得到的多元回归方程表明,维生素D3血清饱和时间与药物日剂量、患者年龄、血清25(OH)D初始水平呈负相关。作者开发的方法可以估计在服用维生素D3制剂时患者血清中25(OH)D水平增加的动态,并确定药物摄入所需的持续时间。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Study of the dynamics of the vitamin D level increase and the development of a method for calculating the required duration of cholecalciferol intake
Pandemic D-avitaminosis swept the planet. Among the inhabitants of the northern hemisphere, about 45 % are deficient, and 32 % have insufficient vitamin D serum levels. In Russia, the situation is even more tense: the level of deficiency was registered in 56.4 % of the population, and insufficiency in 27.87 % of our fellow citizens. Maintaining an optimal concentration of vitamin D in the blood serum reduces the risk and severity of autoimmune, cardiovascular diseases, many types of cancer, dementia, type 1 and 2 diabetes, respiratory tract infections, improves dental and oral health, and increases physical performance. The problem of the increased prevalence of vitamin D deficiency during pregnancy, which has serious consequences not only for the mother, but also for the child throughout later life, requires special attention. A review of the documents regulating the intake of vitamin D supplements suggests that there is some uncertainty in the instructions, which leads to a wide variability in medical recommendations to patients on the choice of the type of drug, its dosage and the duration of vitamin D intake. Recommendations on the required duration of vitamin D supplementation, in our opinion, look the most vulnerable and insufficiently substantiated, therefore, in this work, on the basis of international clinical practice, studies of the dynamics of the increment in the level of vitamin D were carried out and a method was developed for calculating the required duration of taking the most common vitamin D3 preparations at present. The analysis of domestic and foreign practice of increasing the level of vitamin D in the blood serum, as well as the conducted statistical studies, allow, with some caution, to draw the following conclusions. When taking vitamin D3 preparations, the increase in the level of 25(OH)D over time is quite correctly described by an exponential equation. As the duration of taking vitamin D3 preparations increases, the rate of increase in the level of 25(OH)D in the blood serum decreases. The current calcifediol level when taking in vitamin D3 preparations in asymptotical persons, is associated with a power-law dependence on the daily drug dose and increases as it increases. As shown by numerous results of clinical trials, the main increase in the level of 25(OH)D occurs within 30–90 days under different conditions. The multiple regression equation we obtained indicates that the time of blood serum saturation with vitamin D3 is inversely related to the daily dose of the drug, the patient’s age, and the initial level of 25(OH)D in the blood serum. The method developed by the authors makes it possible to estimate the dynamics of the increase in the level of 25(OH)D in the patient’s blood serum as vitamin D3 preparations are taken and to determine the required duration of the drug intake.
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