外来リハ患者におけるビタミンD欠乏の割合

外来リハ患者におけるビタミンD欠乏の有病割合の論文を紹介します。

Pellicane, AJ. et al: Prevalence of 25-Hydroxyvitamin D Deficiency in the Outpatient Rehabilitation Population. American Journal of Physical Medicine & Rehabilitation: November 2010 - Volume 89 - Issue 11 - pp 899-904

後ろ向きの症例集積の論文ですが、ビタミンDを内服していない患者群で血中ビタミンD濃度が正常だったのは33％、不十分Insufficientだったのは53.2％、欠乏Deficientしていたのは13.8％でした。当然ですがビタミンDを内服していた群では、血中ビタミンD濃度が有意に高いという結果でした。

外来リハ患者でさえこれだけビタミンDが不足している患者が多いということは、入院リハ患者ではさらにビタミンD不足患者が多いことが推測されます。ビタミンDが欠乏していればビタミンD内服の適応になりますが、今の日本の保険医療制度ではビタミンDの測定が難しいことが難点です。低栄養患者ではビタミンD不足を常に疑えということになりますでしょうか。

Objective: To assess the prevalence of 25-hydroxyvitamin D insufficiency and deficiency in the outpatient rehabilitation setting and to identify patient characteristics associated with low serum 25-hydroxyvitamin D levels.

Design: 25-Hydroxyvitamin D levels from 136 rehabilitation outpatients at an academic rehabilitation facility obtained from April 2007 to December 2008 for patient care purposes were captured via retrospective electronic medical record review.

Results: Considering only those subjects not receiving 25-hydroxyvitamin D supplementation at time of evaluation, 33.0% were 25-hydroxyvitamin D Sufficient while 53.2% were Insufficient and 13.8% Deficient. Those outpatient subjects receiving supplementation at time of evaluation had significantly higher 25-hydroxyvitamin D levels compared with those not receiving supplementation (34.1 ± 14.2 ng/ml vs. 25.9 ± 15.2 ng/ml; P = 0.005). Blacks had significantly lower 25-hydroxyvitamin D levels compared with whites (18.0 ± 10.6 ng/ml vs. 31.3 ± 14.3 ng/ml; P < 0.001). Subjects not on vitamin D supplementation assigned to diagnostic groups, Spinal Cord Injury, Brain Injury, and Hereditary Musculoskeletal, all had average 25-hydroxyvitamin D levels well below the lower limit of Sufficiency.

Conclusions: Sixty-seven percent of rehabilitation outpatients are 25-hydroxyvitamin D Insufficient or Deficient. Supplementation significantly affects 25-hydroxyvitamin D levels in the outpatient rehabilitation population. Non-white race and history of Spinal Cord Injury, Brain Injury, or Hereditary Musculoskeletal diagnosis seem to be associated with lower 25-hydroxyvitamin D levels.