Роль витамина D для профилактики и лечения рахита у детей

Пигарова Е.А., Поваляева А.А., Дзеранова Л.К., Рожинская Л.Я. Роль витамина D для профилактики и лечения рахита
у детей. Педиатрия. Consilium Medicum. 2019; 3: 40–45.
DOI: 10.26442/26586630.2019.3.190582

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Pigarova E.A., Povalyaeva A.A., Dzeranova L.K., Rozhinskaya L.Ya. The role of vitamin D in the prevention and treatment of rickets in children. Pediatrics. Consilium Medicum. 2019; 3: 40–45. DOI: 10.26442/26586630.2019.3.190582

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Аннотация

Настоящий обзор литературы посвящен проблеме профилактики и лечения рахита – заболевания детей грудного и раннего возраста с расстройством костеобразования и недостаточностью минерализации костей, ведущим патогенетическим звеном которого является дефицит витамина D. Понимание гистопатологии рахита, успехи в биохимическом и радиологическом тестировании в XIX в., выявление антирахитических свойств рыбьего жира и ультрафиолетового света в XX в. – все это было причиной победы над рахитом как болезнью. При этом заболевание, возникшее с изменением особенностей питания в ходе сельскохозяйственной революции и переселения людей в города, после открытия витамина D стало редким состоянием благодаря массовой профилактике, но теперь в XXI в. вновь вызывает обеспокоенность. Наиболее выраженные костные изменения рахит оставляет в период развития костей у детей, как правило, они неизлечимы и сохраняются на всю жизнь, предрасполагают к множественным неблагоприятным последствиям для здоровья, таким как развитие артрозов, нарушение статики позвоночника с выраженным болевым синдромом, деформации костей малого таза, что у девочек в будущем может привести к невозможности естественного родоразрешения, деминерализация эмали зубов, снижение плотности костной ткани, а это во взрослом возрасте приведет к раннему развитию остеопороза. В обзоре приводятся рекомендации по первичной и вторичной профилактике недостаточности витамина D.
Ключевые слова: рахит, витамин D, 25(OH)D, профилактика, кость, минеральная плотность кости, пик костной массы, кариес, эмаль, таз, колекальциферол, дефицит, недостаточность.

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The present review is devoted to the problem of prevention and treatment of rickets – a disease of infants and young children with disturbed bone formation and mineralization, due to vitamin D deficiency. Understanding the histopathology of rickets, advances in biochemical and radiological testing in the 19th century, identification antirachitic properties of fish oil and ultraviolet light in the 20th century – all thesis was the reason for the victory over rickets as a disease. At the same time, the disease that arose with a change in nutritional characteristics during the agricultural revolution and the resettlement of people in cities, after the discovery of vitamin D became a rare condition due to mass prevention, but now, in the 21st century, it again causes a big concern. Rickets leaves the most pronounced bone changes during the period of bone development in children, which are usually incurable and predispose to multiple adverse health effects, such as the development of arthrosis, disturbed statics of the spine with severe pain, pelvic bone deformities, which in girls can lead to the impossibility of natural delivery in the future, demineralization of tooth enamel, a decrease in bone density, which in adulthood will lead to early development of osteoporosis. The review provides recommendations for the primary and secondary prevention of vitamin D deficiency with cholecalciferol preparations.
Key words: rickets, vitamin D, 25 (OH) D, prophylaxis, bone, bone mineral density, peak bone mass, caries, enamel, pelvis, cholecalciferol, deficiency, insufficiency.

Список литературы

1. Rowe PS. The wrickkened pathways of FGF23, MEPE and PHEX. Crit Rev Oral Biol Med 2004; 15 (5): 264–81.
2. Rajakumar K. Vitamin D, cod-liver oil, sunlight, and rickets: a historical perspective. Pediatrics 2003; 112 (2): e132–e135.
3. Dunn PM. Francis Glisson (1597–1677) and the "discovery" of rickets. Arch Dis Child Fetal Neonatal Ed 1998; 78 (2): F154–F155.
4. Foster BL, Nociti FH, Somerman MJ. The Rachitic Tooth. Endocrine Rev 2014; 35: 1–34. Issue 1. DOI: https://doi.org/10.1210/er.2013-1009
5. Rajakumar K. Vitamin D, cod-liver oil, sunlight, and rickets: a historical perspective. Pediatrics 2003; 112 (2): e132–5.
6. Dunn PM. Professor Armand Trousseau (1801–67) and the treatment of rickets. Arch Dis Child Fetal Neonatal Ed 1999; 80: F155–F157.
7. Wharton B, Bishop N. Rickets. Lancet 2003; 362 (9393): 1389–400.
8. Berdal A. Vitamin D action on tooth development and biomineralization. In: Feldman D, Glorieux FH, Pike JW, eds. Vitamin D. 1st ed. New York, NY: Academic Press, 1997; p. 423–36.
9. Christakos S, DeLuca HF. Vitamin D: is there a role in extraskeletal health? Endocrinology 2011; 152: 2930–6.
10. Girgis CM, Clifton-Bligh RJ, Hamrick MW et al. The Roles of Vitamin D in Skeletal Muscle: Form, Function, and Metabolism. Endocrine Rev 2013; 34: 33–83. Issue 1. DOI: https://doi.org/10.1210/er.2012-1012
11. Russell JA. Osteomalacic myopathy. Muscle Nerve 1994; 17: 578–80.
12. Ahmad N, Mohamed Sobaihi M, Al-Jabri M et al. Acute respiratory failure and generalized hypotonia secondary to vitamin D dependent rickets type 1A. Int J Pediatr Adolesc Med 2018; 5 (2): 78–81. DOI: 10.1016/j.ijpam.2018.05.001
13. Cooper C, Curtis EM, Moon RJ et al. Chapter 40. Consequences of perinatal vitamin D deficiency on later bone health. In Vitamin D, Volume 1: Biochemistry, Physiology and Diagnostics, Fourth Edition. 2018. Elsevier Inc; p. 709–30. DOI: https://doi.org/10.1016/B978-0-12-809965-0.00040-9
14. Dawodu A, Tsang RC. Maternal vitamin D status: effect on milk vitamin D content and vitamin D status of breastfeeding infants. Adv Nutr 2012; 3: 353–61.
15. Pigarova EA, Rozhinskaya LY, Belaya JE et al. Russian Association of Endocrinologists recommendations for diagnosis, treatment and prevention of vitamin D deficiency in adults. Problems Endocrinol 2016; 62 (4): 60–84. DOI: 10.14341/probl201662460-84
16. Orbak Z, Karacan M, Doneray H, Karakelleoglu C. Congenital rickets presenting with hypocalcaemic seizures. West Indian Med J 2007; 56: 364–7.
17. Javaid MK, Crozier SR, Harvey NC et al. Maternal vitamin D status during pregnancy and childhood bone mass at age 9 years: a longitudinal study. Lancet 2006; 367: 36–43.
18. Harvey NC, Holroyd C, Ntani G et al. Vitamin D supplementation in pregnancy: a systematic review. Health Technol Assess 2014; 18: 1–190.
19. Ioannou C, Javaid MK, Mahon P et al. The effect of maternal vitamin D concentration on fetal bone. J Clin Endocrinol Metab 2012; 97: E2070–7.
20. Mahon P, Harvey N, Crozier S et al. Low maternal vitamin D status and fetal bone development: cohort study. J Bone Miner Res 2010; 25: 14–9.
21. Brooke OG, Brown IR, Bone CD et al. Vitamin D supplements in pregnant Asian women: effects on calcium status and fetal growth. Br Med J 1980; 280: 751–4. JID – 0372673.
22. Zhu K, Whitehouse AJ, Hart P et al. Maternal vitamin D status during pregnancy and bone mass in offspring at 20 Years of age: a prospective cohort study. J Bone Miner Res 2014; 29 (5): 1088–95.
23. Wood AJ, Oakey RJ. Genomic imprinting in mammals: emerging themes and established theories. PLoS Genet 2006; 2 (11): e147. DOI: 10.1371/journal.pgen.002014
24. Grossniklaus U, Kelly WG, Ferguson-Smith AC et al. Transgenerational epigenetic inheritance: how important is it? Nat Rev Genet 2013; 14: 228–35.
25. Carlberg C, Molnár F. The epigenome. Mechanisms of gene regulation. 2nd ed. Springer 2016; p. 159–72.
26. Weydert JA. Vitamin D in children's health. Children 2014; 1: 208–26. https://doi.org/10.3390/children1020208
27. Пигарова Е.А., Петрушкина А.А. Неклассические эффекты витамина D. Остеопороз и остеопатии. 2017; 3: 90–101.
[Pigarova E.A., Petrushkina A.A. Neklassicheskie effekty vitamina D. Osteoporoz i osteopatii. 2017; 3: 90–101 (in Russian).]
28. Национальная программа «Недостаточность витамина D у детей и подростков Российской Федерации: современные подходы к коррекции». Союз педиатров России и др. М.: ПедиатрЪ, 2018.
[National program "Vitamin D deficiency in children and adolescents of the Russian Federation: modern approaches to correction". Soiuz pediatrov Rossii et al. Moscow: Pediatr, 2018 (in Russian).]
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30. Плещева А.В., Пигарова Е.А., Дзеранова Л.К. Витамин D и метаболизм: факты, мифы и предубеждения. Ожирение и метаболизм. 2012; 9 (2): 33–42.
[Pleshcheva A.V., Pigarova E.A., Dzeranova L.K. Vitamin D i metabolizm: fakty, mify i predubezhdeniia. Ozhirenie i metabolizm. 2012; 9 (2): 33–42 (in Russian).]

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1. Rowe PS. The wrickkened pathways of FGF23, MEPE and PHEX. Crit Rev Oral Biol Med 2004; 15 (5): 264–81.
2. Rajakumar K. Vitamin D, cod-liver oil, sunlight, and rickets: a historical perspective. Pediatrics 2003; 112 (2): e132–e135.
3. Dunn PM. Francis Glisson (1597–1677) and the "discovery" of rickets. Arch Dis Child Fetal Neonatal Ed 1998; 78 (2): F154–F155.
4. Foster BL, Nociti FH, Somerman MJ. The Rachitic Tooth. Endocrine Rev 2014; 35: 1–34. Issue 1. DOI: https://doi.org/10.1210/er.2013-1009
5. Rajakumar K. Vitamin D, cod-liver oil, sunlight, and rickets: a historical perspective. Pediatrics 2003; 112 (2): e132–5.
6. Dunn PM. Professor Armand Trousseau (1801–67) and the treatment of rickets. Arch Dis Child Fetal Neonatal Ed 1999; 80: F155–F157.
7. Wharton B, Bishop N. Rickets. Lancet 2003; 362 (9393): 1389–400.
8. Berdal A. Vitamin D action on tooth development and biomineralization. In: Feldman D, Glorieux FH, Pike JW, eds. Vitamin D. 1st ed. New York, NY: Academic Press, 1997; p. 423–36.
9. Christakos S, DeLuca HF. Vitamin D: is there a role in extraskeletal health? Endocrinology 2011; 152: 2930–6.
10. Girgis CM, Clifton-Bligh RJ, Hamrick MW et al. The Roles of Vitamin D in Skeletal Muscle: Form, Function, and Metabolism. Endocrine Rev 2013; 34: 33–83. Issue 1. DOI: https://doi.org/10.1210/er.2012-1012
11. Russell JA. Osteomalacic myopathy. Muscle Nerve 1994; 17: 578–80.
12. Ahmad N, Mohamed Sobaihi M, Al-Jabri M et al. Acute respiratory failure and generalized hypotonia secondary to vitamin D dependent rickets type 1A. Int J Pediatr Adolesc Med 2018; 5 (2): 78–81. DOI: 10.1016/j.ijpam.2018.05.001
13. Cooper C, Curtis EM, Moon RJ et al. Chapter 40. Consequences of perinatal vitamin D deficiency on later bone health. In Vitamin D, Volume 1: Biochemistry, Physiology and Diagnostics, Fourth Edition. 2018. Elsevier Inc; p. 709–30. DOI: https://doi.org/10.1016/B978-0-12-809965-0.00040-9
14. Dawodu A, Tsang RC. Maternal vitamin D status: effect on milk vitamin D content and vitamin D status of breastfeeding infants. Adv Nutr 2012; 3: 353–61.
15. Pigarova EA, Rozhinskaya LY, Belaya JE et al. Russian Association of Endocrinologists recommendations for diagnosis, treatment and prevention of vitamin D deficiency in adults. Problems Endocrinol 2016; 62 (4): 60–84. DOI: 10.14341/probl201662460-84
16. Orbak Z, Karacan M, Doneray H, Karakelleoglu C. Congenital rickets presenting with hypocalcaemic seizures. West Indian Med J 2007; 56: 364–7.
17. Javaid MK, Crozier SR, Harvey NC et al. Maternal vitamin D status during pregnancy and childhood bone mass at age 9 years: a longitudinal study. Lancet 2006; 367: 36–43.
18. Harvey NC, Holroyd C, Ntani G et al. Vitamin D supplementation in pregnancy: a systematic review. Health Technol Assess 2014; 18: 1–190.
19. Ioannou C, Javaid MK, Mahon P et al. The effect of maternal vitamin D concentration on fetal bone. J Clin Endocrinol Metab 2012; 97: E2070–7.
20. Mahon P, Harvey N, Crozier S et al. Low maternal vitamin D status and fetal bone development: cohort study. J Bone Miner Res 2010; 25: 14–9.
21. Brooke OG, Brown IR, Bone CD et al. Vitamin D supplements in pregnant Asian women: effects on calcium status and fetal growth. Br Med J 1980; 280: 751–4. JID – 0372673.
22. Zhu K, Whitehouse AJ, Hart P et al. Maternal vitamin D status during pregnancy and bone mass in offspring at 20 Years of age: a prospective cohort study. J Bone Miner Res 2014; 29 (5): 1088–95.
23. Wood AJ, Oakey RJ. Genomic imprinting in mammals: emerging themes and established theories. PLoS Genet 2006; 2 (11): e147. DOI: 10.1371/journal.pgen.002014
24. Grossniklaus U, Kelly WG, Ferguson-Smith AC et al. Transgenerational epigenetic inheritance: how important is it? Nat Rev Genet 2013; 14: 228–35.
25. Carlberg C, Molnár F. The epigenome. Mechanisms of gene regulation. 2nd ed. Springer 2016; p. 159–72.
26. Weydert JA. Vitamin D in children's health. Children 2014; 1: 208–26. https://doi.org/10.3390/children1020208
27. Pigarova E.A., Petrushkina A.A. Neklassicheskie effekty vitamina D. Osteoporoz i osteopatii. 2017; 3: 90–101 (in Russian).
28. National program "Vitamin D deficiency in children and adolescents of the Russian Federation: modern approaches to correction". Soiuz pediatrov Rossii et al. Moscow: Pediatr, 2018 (in Russian).
29. Misra M, Pacaud D, Petryk A et al. Drug and therapeutics committee of the Lawson Wilkins pediatric endocrine society. Vitamin D deficiency in children and its management: review of current knowledge and recommendations. Pediatrics 2008; 122: 398–417.
30. Pleshcheva A.V., Pigarova E.A., Dzeranova L.K. Vitamin D i metabolizm: fakty, mify i predubezhdeniia. Ozhirenie i metabolizm. 2012; 9 (2): 33–42 (in Russian).

Авторы

Е.А. Пигарова*, А.А. Поваляева, Л.К. Дзеранова, Л.Я. Рожинская

ФГБУ «Национальный медицинский исследовательский центр эндокринологии» Минздрава России, Москва, Россия
*kpigarova@gmail.com

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Ekaterina A. Pigarova*, Alexandra A. Povalyaeva, Larisa K. Dzeranova, Liudmila Ya. Rozhinskaya

Endocrinology Research Centre, Moscow, Russia
*kpigarova@gmail.com

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