연속된 두 검체의 비타민 D분류 상태의 변화에 따른 혈청 부갑상선호르몬과 골대사 산물의 변화
Changes in the Serum Levels of Parathyroid Hormone and Bone Metabolites in Two Serial Samples with Different Vitamin D Status
1
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
배경: 비타민 D는 장에서 칼슘을 흡수하여 혈중 농도를 증가시키는 역할을 한다. 비타민 D의 혈중 감소는 부갑상선호르몬(parathyroid hormone, PTH)을 증가시키고 골대사와 관련된 골합성 대 사산물, 골파괴 대사물질의 혈중 농도를 증가시킨다. 일반적으로 비타민 D 혈중 상태는 25(OH) vitamin D (25(OH)VD)의 혈중 농도에 따라 뼈 건강 유지를 위한 기준인 부족증, 연조직 질환의 예방을 위한 불충분증과 적정상태의 3가지 상태로 분류한다. 우리는 같은 사람에서 2회 측정한 검사 결과에서 비타민 D 혈중 상태의 변화에 따른 혈청 PTH와 골대사산물의 변화를 관찰하였다. 방법: 6개월 이상 간격을 두고 혈청 PTH, osteocalcin (OST), carboxyterminal-telopeptide of type I collagen (CTX)과 25(OH)VD를 2회 측정한 857명의 환자에서 비타민 D 혈중 상태의 변화에 따른 PTH, OST, CTX의 차이를 각각 쌍을 이룬 t 검정으로 비교하였다. 비타민 D 혈중 상태는 25(OH)VD 농도 30 ng/mL은 적정 상태로 분류하였다. 결과: 비타민 D 혈중 상태의 변화가 없는 군에서는 PTH, OST, CTX는 통계적으로 유의한 농도 변화는 없었다. 부족과 불충분에서 적정 상태로 비타민 D 혈중 상태가 호전된 군에서는 PTH, OST, CTX는 통계적으로 유의하게 감소하였다. 그러나 적정에서 불충분으로 비타민 D 혈중 상태가 악화된 군에서는 PTH, OST, CTX는 통계적으로 유의한 농도 변화를 보이지 않았다. 결론: 비타민 D의 상태가 “부족”에서 뿐 아니라 “불충분”에서 “적정”으로의 변화를 보일 때도 골 대사에 대한 영향을 주므로 불충분 상태보다 적정 상태를 유지하는 것이 다른 연조직 질환의 예방 뿐 아니라 골건강에도 도움을 줄 것으로 생각되었다.
Abstract
Background: Vitamin D increases serum calcium levels by promoting calcium absorption in intestines. Vitamin D deficiency raises the serum levels of parathyroid hormone (PTH) and bone metabolites. Generally, vitamin D status is classified into three groups named deficiency, insufficiency, and adequacy by its level. Deficient level affect bone health, while insufficient level influence the soft tissue disease. We observed the effect of changes in vitamin D status on serum PTH and bone metabolite levels using two different samples taken from the same individual. Methods: Serum PTH, osteocalcin (OST), carboxy-terminal telopeptide of type I collagen (CTX), and 25(OH) vitamin D was evaluated in 857 patients. The levels were measured again after six months or later. The changes in the levels of each biomarker based on the change in vitamin D status in two serial samples were estimated through paired t-test. Vitamin D status was classified into three groups: deficiency (30 ng/mL). Results: No statistically significant changes in PTH, OST and, CTX levels were found in the group without altered vitamin D status. The same bio markers were decreased in the group where vitamin D status improved from deficiency or insufficiency to adequacy. Conclusions: Maintaining vitamin D at the adequate level was not only helpful in preventing soft tissue disease but also seemed to promote bone health as indicated by the change in PTH and bone metabolites levels during the transition of vitamin D status from both deficient and insufficient states to the adequate state.
참고문헌 (22)
- Dusso AS, "Vitamin D", Am J Physiol Renal Physiol, 289, pp.F8~F28 (2005)
- Binkley N, "Low Vitamin D Status : Definition, Prevalence, Consequences and Correction", Endocrinol Metab Clin North Am, 39, pp.287~301 (2010)
- Björkman M, "Vitamin D supplementation has minor effects on parathyroid hormone and bone turnover markers in vitamin D-deficient bedridden older patients", Age Ageing, 37, pp.25~31 (2008)
- Wamberg L, "The effect of high-dose vitamin D supplementation on calciotropic hormones and bone mineral density in obese subjects with low levels of circulating 25-hydroxyvitamin D : results from a randomized controlled study", Calcif Tissue Int, 93, pp.69~77 (2013)
- Zittermann A, "Vitamin D supplementation and bone turnover in advanced heart failure : the EVITA trial", Osteoporos Int, 29, pp.579~586 (2018)
- "Statulator: An online statistical calculator (2014). Sample Size Calculator for Comparing Two Paired Means"[URL]
- Peacock M, "Vitamin D: Chemical, Biochemical and Clinical Update", pp.569~570 (1985), Walter de Gruyter
- Malabanan A, "Redefining vitamin D insufficiency", Lancet, 351, pp.805~806 (1998)
- Dawson-Hughes B, "Estimates of optimal vitamin D status", Osteoporos Int, 16, pp.713~716 (2005)
- Bischoff-Ferrari HA, "Estimation of optimal serum concentrations of 25-hydroxyvitamin D for multiple health outcomes", Am J Clin Nutr, 84, pp.18~28 (2006)
- Souberbielle JC, "Vitamin D and musculoskeletal health, cardiovascular disease, autoimmunity and cancer : Recommendations for clinical practice", Autoimmun Rev, 9, pp.709~715 (2010)
- Holick MF, "Endocrine Society. Evaluation, Treatment, and Prevention of Vitamin D Deficiency : An Endocrine Society Clinical Practice Guideline", J Clin Endocrinol Metab, 96, pp.1911~1930 (2011)
- Institute of Medicine, "Dietary Reference Intakes for Calcium and Vitamin D" (2011), National Academies Press
- "Vitamin D and Bone Health: A Practical Clinical Guideline for Patient Management"[URL]
- National Kidney Foundation, "K", DOQI clinical practice guidelines for bone metabolism and disease in chronic kidney disease, 2003, pp.42(4 Suppl 3), S1~S201
- 박현아, "비타민 D에 대한 최신지견", 대한의사협회지, 56(4), pp.310~318 (2013), 대한의사협회
- 나은희, "한국인에서 비타민 D: 성별, 연령, 거주지, 계절에 따른 상태 및 결핍의 유병률", Laboratory Medicine Online, 5(2), pp.84~91 (2015), 대한진단검사의학회
- Park IK, "Concentration of serum hormone and substances related with bone metabolism according to the new classification of vitamin D concentration", Ann Lab Med, 32(Suppl), pp.S98~ (2012)
- Hemmingway A, "Interactions between Vitamin D Status, Calcium Intake and Parathyroid Hormone Concentrations in Healthy White-Skinned Pregnant Women at Northern Latitude", Nutrients, 10, pp.916~ (2018)
- 김길선, "Relationship between Vitamin D, Parathyroid Hormone, and Bone Mineral Density in Elderly Koreans", Journal of Korean Medical Science, 27(6), pp.636~643 (2012), 대한의학회[DOI]
- McKee A, "Screening for Vitamin D Deficiency in Black Americans : Comparison of Total, Free, Bioavailable 25 Hydroxy Vitamin D Levels with Parathyroid Hormone Levels and Bone Mineral Density", Nutr Health Aging, 22, pp.1045~1050 (2018)
- Gannagé-Yared MH, "Effects of a short-term calcium and vitamin D treatment on serum cytokines, bone markers, insulin and lipid concentrations in healthy post-menopausal women", J Endocrinol Invest, 26, pp.748~753 (2003)