高剂量维生素D在儿童短肠综合征合并维生素D不足/缺乏中的应用

doi:10.3969/j.issn.1674-8115.2026.01.006

上海交通大学学报（医学版） ›› 2026, Vol. 46 ›› Issue (1): 54-59.doi: 10.3969/j.issn.1674-8115.2026.01.006

高剂量维生素D在儿童短肠综合征合并维生素D不足/缺乏中的应用

吴青青¹, 曹毅¹, 陆丽娜¹, 陶怡菁¹, 冯海霞¹, 颜伟慧¹^,², 王莹¹^,²()

^1.上海交通大学医学院附属新华医院儿消化营养科，上海 200092
^2.上海市小儿消化与营养重点实验室，上海 200092

收稿日期:2025-05-05 接受日期:2025-12-05 出版日期:2026-01-28 发布日期:2026-01-30
通讯作者: 王　莹，主任医师，博士；电子信箱：wangying_ssmu@126.com。
作者简介:第一联系人：吴青青和曹毅设计了本研究，王莹参与了本研究的构思与设计，颜伟慧、陆丽娜、陶怡菁、冯海霞参与了数据收集和分析，吴青青撰写了论文初稿，王莹和颜伟慧对论文进行了修订。所有作者均阅读并同意了最终稿件的提交。
基金资助:
国家重点研发计划(2023YFC2706505);国家自然科学基金(82370525);上海市东方英才计划拔尖项目(BJWS2024033);上海市“医苑新星”杰出青年医学人才项目(20234Z0004);上海交通大学医学院“双百人”项目(2024-009)

High-dose vitamin D for pediatric short bowel syndrome with vitamin D insufficiency/deficiency

Wu Qingqing¹, Cao Yi¹, Lu Lina¹, Tao Yijing¹, Feng Haixia¹, Yan Weihui¹^,², Wang Ying¹^,²()

^1.Division of Pediatric Gastroenterology and Nutrition, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
^2.Shanghai Key Laboratory of Pediatric Gastroenterology and Nutrition, Shanghai 200092, China

Received:2025-05-05 Accepted:2025-12-05 Online:2026-01-28 Published:2026-01-30
Contact: Wang Ying, E-mail: wangying_ssmu@126.com.
About author:First author contact:Wu Qingqing and Cao Yi designed the study. Wang Ying contributed to the conception and design of the research. Yan Weihui, Lu Lina, Tao Yijing, and Feng Haixia contributed to collection and analysis of the data. Wu Qingqing drafted the manuscript. Wang Yin and Yan Weihui revised the manuscript for important intellectual content. All authors have read the last version of paper and consented to submission.
Supported by:
National Key Research and Development Program of China(2023YFC2706505);National Natural Science Foundation of China(82370525);Top-notch Project of Shanghai Oriental Talent Plan(BJWS2024033);Shanghai “Medical New Star” Outstanding Young Medical Talents Project(20234Z0004);“Two-hundred Talents”Program of Shanghai Jiao Tong University School of Medicine(2024-009)

摘要/Abstract

摘要：

目的·探讨单次高剂量肌内注射途径补充维生素D对儿童短肠综合征（short bowel syndrome，SBS）合并维生素D不足/缺乏的安全性和有效性。方法·回顾性纳入32例SBS合并维生素D不足/缺乏的儿童。当患儿血清25-羟维生素D［25-hydroxyvitamin D，25-（OH）D］浓度低于50 nmol/L时，通过肌内注射途径补充200 000 IU的维生素D2。收集患儿的临床资料（性别、年龄、原发疾病、小肠剩余长度、是否保留回盲瓣以及结肠是否完整等），记录肌内注射部位皮肤情况，以及维生素D补充前和补充后1个月的血清25-（OH）D、钙、磷和碱性磷酸酶水平状况。结果·SBS患儿入组时的中位年龄为5.0（3.0，7.0）个月。小肠闭锁和坏死性小肠结肠炎是导致SBS的主要原因（分别占28.13%和21.88%），剩余小肠平均长度为（57.27±24.55）cm。在补充维生素D之前，65.63%（21/32）的患儿存在维生素D缺乏，34.38%（11/32）的患儿存在维生素D不足。在补充维生素D之后，患儿25-（OH）D水平由28.87 nmol/L显著升高至53.10 nmol/L（P<0.001）；在维生素D不足的患儿中，25-（OH）D水平从37.30 nmol/L显著升高至58.51 nmol/L（P=0.010）；而在维生素D缺乏的患儿中，该水平从26.91 nmol/L显著升高至44.82 nmol/L（P<0.001）；62.50%（20/32）的患儿25-（OH）D浓度达到正常水平。所有患儿在研究期间均未出现维生素D中毒、高钙血症、皮肤硬结或局部感染等并发症。结论·单次、高剂量（200 000 IU）肌内注射途径补充维生素D，可以安全、有效地改善SBS合并维生素D不足/缺乏婴儿的维生素D水平。

关键词: 短肠综合征, 儿童, 高剂量, 维生素D

Abstract:

Objective ·To explore the safety and efficacy of a single high-dose intramuscular injection of vitamin D in children with short bowel syndrome (SBS) complicated by vitamin D insufficiency/deficiency. Methods ·The retrospective study included 32 children with SBS complicated by vitamin D insufficiency/deficiency. When the serum 25-hydroxyvitamin D [25-(OH)D] concentration was lower than 50 nmol/L, a single intramuscular injection of 200 000 IU vitamin D2 was administered. Clinical data, including gender, age, primary disease, remaining length of the small intestine, presence of the ileocecal valve, and colonic integrity, were collected. Skin conditions at the intramuscular injection site and the levels of serum 25-(OH)D, calcium, phosphorus, and alkaline phosphatase before and one month after vitamin D supplementation were recorded. Results ·The median age at enrollment was 5.0 (3.0, 7.0) months. Intestinal atresia and necrotizing enterocolitis were the main causes of SBS, accounting for 28.13% and 21.88%, respectively. The average length of the remaining small intestine was (57.27±24.55) cm. Before vitamin D supplementation, 65.63% (21/32) of children had vitamin D deficiency and 34.38% (11/32) had vitamin D insufficiency. After supplementation, serum 25-(OH)D levels increased significantly compared with baseline (53.10 nmol/L vs. 28.87 nmol/L, P<0.001). In children with vitamin D insufficiency, the serum 25-(OH)D levels increased from 37.30 nmol/L to 58.51 nmol/L (P=0.010), while in those with vitamin D deficiency, the levels increased from 26.91 nmol/L to 44.82 nmol/L (P<0.001). Overall, 62.50% (20/32) of children achieved normal serum 25-(OH)D levels. Moreover, no complications, including vitamin D toxicity, hypercalcemia, skin induration, or local infection, were observed in any of the children. Conclusion ·A single high-dose (200 000 IU) intramuscular injection of vitamin D can safely and effectively improve the vitamin D level in children with SBS complicated by vitamin D insufficiency/deficiency.

Key words: short bowel syndrome (SBS), child, high-dose, vitamin D

中图分类号:

R574

吴青青, 曹毅, 陆丽娜, 陶怡菁, 冯海霞, 颜伟慧, 王莹. 高剂量维生素D在儿童短肠综合征合并维生素D不足/缺乏中的应用[J]. 上海交通大学学报（医学版）, 2026, 46(1): 54-59.

Wu Qingqing, Cao Yi, Lu Lina, Tao Yijing, Feng Haixia, Yan Weihui, Wang Ying. High-dose vitamin D for pediatric short bowel syndrome with vitamin D insufficiency/deficiency[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2026, 46(1): 54-59.

图/表 5

参考文献 33

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Brand	Vitamin D/ (×10^-2 µg·mL^-1)	Vitamin D/ (×10^-2 IU·mL^-1)
Alfare	1.01	40.4
Pepti Junior	1.30	52.0
Neocate	1.20	48.0
Alfamino	1.00	40.0
Alfamino Junior	2.00	80.0
Peptamen	1.43	57.2

Brand	Vitamin D/ (×10^-2 µg·mL^-1)	Vitamin D/ (×10^-2 IU·mL^-1)
Alfare	1.01	40.4
Pepti Junior	1.30	52.0
Neocate	1.20	48.0
Alfamino	1.00	40.0
Alfamino Junior	2.00	80.0
Peptamen	1.43	57.2

Item	Total (n=32)	Vitamin D deficiency group (n=21)	Vitamin D insufficiency group (n=11)	P value
Male/n(%)	18 (56.25)	12 (57.14)	6 (54.55)	0.673^①
GA/week	35.83±3.71	36.58±2.56	34.37±5.11	0.202^②
Birth weight/g	2625.17±782.83	2801.90±632.90	2287.73±952.79	0.077^②
Weight/kg	4.20 (3.19, 5.88)	4.20 (3.10, 5.75)	4.20 (3.45, 7.20)	0.696^③
Age/month	5.0 (3.0, 7.0)	3.0 (2.5, 5.5)	7.0 (5.0, 11.0)	0.016^③
Weight-for-age Z score	-3.55±2.25	-3.35±2.19	-3.95±2.43	0.484^②
Remnant small-bowel length/cm	57.27±24.55	53.0±19.10	64.10±31.33	0.270^②
Presence of the entire terminal ileum/n(%)	4 (12.50)	3 (14.29)	1 (9.09)	0.678^①
Presence of the ileocecal valve/n(%)	7 (21.88)	5 (23.81)	2 (18.18)	0.719^①
Presence of the entire colon/n(%)	8 (25.00)	6 (28.57)	2 (18.18)	0.526^①
Primary disease/n(%)				‒
Intestinal atresia	9 (28.13)	5 (23.81)	4 (36.36)
NEC	7 (21.88)	5 (23.81)	2 (18.18)
CSBS	3 (9.38)	2 (9.52)	1 (9.09)
Volvulus	3 (9.38)	1 (4.76)	2 (18.18)
Others	10 (31.25)	8 (38.10)	2 (18.18)

Item	Total (n=32)	Vitamin D deficiency group (n=21)	Vitamin D insufficiency group (n=11)	P value
Male/n(%)	18 (56.25)	12 (57.14)	6 (54.55)	0.673^①
GA/week	35.83±3.71	36.58±2.56	34.37±5.11	0.202^②
Birth weight/g	2625.17±782.83	2801.90±632.90	2287.73±952.79	0.077^②
Weight/kg	4.20 (3.19, 5.88)	4.20 (3.10, 5.75)	4.20 (3.45, 7.20)	0.696^③
Age/month	5.0 (3.0, 7.0)	3.0 (2.5, 5.5)	7.0 (5.0, 11.0)	0.016^③
Weight-for-age Z score	-3.55±2.25	-3.35±2.19	-3.95±2.43	0.484^②
Remnant small-bowel length/cm	57.27±24.55	53.0±19.10	64.10±31.33	0.270^②
Presence of the entire terminal ileum/n(%)	4 (12.50)	3 (14.29)	1 (9.09)	0.678^①
Presence of the ileocecal valve/n(%)	7 (21.88)	5 (23.81)	2 (18.18)	0.719^①
Presence of the entire colon/n(%)	8 (25.00)	6 (28.57)	2 (18.18)	0.526^①
Primary disease/n(%)				‒
Intestinal atresia	9 (28.13)	5 (23.81)	4 (36.36)
NEC	7 (21.88)	5 (23.81)	2 (18.18)
CSBS	3 (9.38)	2 (9.52)	1 (9.09)
Volvulus	3 (9.38)	1 (4.76)	2 (18.18)
Others	10 (31.25)	8 (38.10)	2 (18.18)

Route	Frequency	Total dose/μg
Vitamin D from intramuscular injection	Once	5 000.00
Vitamin D via PN	Daily	66.00 (52.69, 85.88)
Vitamin D via EN	Daily	75.27±38.35

高剂量维生素D在儿童短肠综合征合并维生素D不足/缺乏中的应用

High-dose vitamin D for pediatric short bowel syndrome with vitamin D insufficiency/deficiency

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Metrics

Item	Normal range	Before	After	P value
25-(OH)D/(nmol·L^-1)	50‒250	28.87±7.78	53.10±19.24	<0.001^②
Ca/(mmol·L^-1)	2.0‒2.8	2.37 (2.30, 2.51)	2.40 (2.35, 2.48)	0.545^①
P/(mmol·L^-1)	1.48‒2.20	1.60±0.36	1.71±0.30	0.185^②
Ca*P/(mg·dL^-1)	‒	50.61 (38.53, 56.06)	51.57 (45.11,55.48)	0.393^①
AKP/(U·L^-1)	106‒420	415.50 (316.00, 621.00)	429.00 (318.00, 538.00)	0.422^①

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