2021 USPSTF建议:成人维生素D缺乏症的筛查

2021-04-15 MedSci原创 MedSci原创

维生素D是脂溶性维生素,在钙稳态和骨骼代谢中起重要作用,并且还影响骨骼系统以外的许多其他细胞调节功能。维生素D的要求可能因人而异,目前并没有统一的共识。

维生素D是脂溶性维生素,在钙稳态和骨骼代谢中起重要作用,并且还影响骨骼系统以外的许多其他细胞调节功能。维生素D的要求可能因人而异,目前并没有统一的共识

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近日,美国预防服务工作组(USPSTF)对维生素D缺乏症的筛查进行系统的审查,包括筛查和早期治疗的利弊。此建议适用于没有维生素D缺乏体征或症状(例如骨痛或肌肉无力)或建议使用维生素D治疗的人群,包括非怀孕成年人。

风险评估

尽管没有足够的证据推荐或反对筛查维生素D缺乏症,但以下因素与维生素D含量较低有关:1)饮食中维生素D摄入量较低可能与25OHD含量降低有关;2)很少或根本没有日晒,以及年龄较大有关导致维生素D含量较低。

从血清阈值来看,非西班牙裔黑人中维生素D缺乏症的患病率比非西班牙裔白人中高210倍,这可能与皮肤色素沉着的差异有关。然而,上面提到的危险因素并不能解释个体中25OHD水平的差异,有研究显示,这些危险因素似乎仅占25OHD水平变异的20%至30%。

治疗和干预

维生素D缺乏症通常可以通过口服维生素D来治疗。维生素D2种常见形式包括胆固醇钙化醇和麦角钙化醇。两者都可以作为处方药或非处方饮食补品。

维生素D缺乏症的患病率取决于缺乏症的定义。根据2011年至2014年国家健康与营养检查调查(National Health and Nutrition Examination Survey)的数据,该调查使用液相色谱-串联质谱测定法测量25OHD水平,1岁或以上人群中,5%的个体25OHD水平(<12 ng / mL)极低,18%介于1219 ng / mL之间。

成人维生素D缺乏症的筛查.

在一些观察性研究中,较低的维生素D水平与骨折,跌倒,功能受限,某些类型的癌症,糖尿病血管疾病,抑郁和死亡的风险有关。然而,这些关联的观察不一致。这种不一致可能是由于不同的研究使用不同的临界值来定义低维生素D水平,或者是因为维生素D的需求量不同。尽管非西班牙裔黑人的维生素D水平低于白人,但其骨折发生率较低。此外,尚不清楚这些关联是否与因果关系相关。

筛查维生素D缺乏症的目的是在相关的不良临床结果发生之前进行识别和治疗。总25OHD水平目前被认为是维生素D状态的最佳标志。多种测定法可用于测量25OHd的水平,然而测定法可能会低估或高估25OHD的水平,可能难以准确测。此外,目前的证据不足以确定无症状的低25OHD水平的筛查和治疗是否能改善居住在社区的成年人的临床结局。

潜在危害

由于缺乏统一的维生素D的临界值,在筛查过程中,可能会将维生素D缺乏者分类错误。分类错误可能会导致诊断过度(导致缺乏能力的人接受不必要的治疗)或诊断不足(导致缺乏能力的人没有接受治疗)。

维生素D治疗存在潜在毒性,具有明显的高钙血症以及高磷酸盐血症和高钙尿症。但是,与25OHD水平(通常> 150 ng / mL)相关毒性远远高于目前的认知。

因此,USPSTF再次得出结论,证据不足以评估筛查无症状成人维生素D缺乏症的利弊之间的平衡。

原始出处

US Preventive Services Task Force.Screening for Vitamin D Deficiency in Adults US Preventive Services Task Force Recommendation Statement.JAMA. 2021;325(14):1436-1442. doi:10.1001/jama.2021.3069

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    2021-04-15 七安

    #梅斯医学科研互助群# 欢迎您的加入,添加【梅斯医学科研助手WeChat:medsci_2021】邀您进群! 【社群简介】👉 梅斯医学目前已建立覆盖肿瘤、心血管、神经、消化、内分泌、呼吸等30个科室的学习交流社群。 【入群福利】👉 群内可实时交流病例,提问同行,跨群讨论,每天更新前沿医学资讯和指南共识,每周推出至少1场专业直播,不时共享科研干货,入群即可获得100份SCI写作攻略!

    0

  4. 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【社群简介】👉 梅斯医学目前已建立覆盖肿瘤、心血管、神经、消化、内分泌、呼吸等30个科室的学习交流社群。 【入群福利】👉 群内可实时交流病例,提问同行,跨群讨论,每天更新前沿医学资讯和指南共识,每周推出至少1场专业直播,不时共享科研干货,入群即可获得100份SCI写作攻略!, beContent=null, objectType=article, channel=null, level=null, likeNumber=76, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=104233, encryptionId=d55f104233bd, topicName=梅斯医学科研互助群)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210413/a7082efd72134f339011deffae56d660/9f9bdab2a00341ce92bf6fd196c67f81.png, createdBy=4e205474392, createdName=七安, createdTime=Thu Apr 15 16:23:05 CST 2021, time=2021-04-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=958279, encodeId=85d79582e9d3, content=taught!+2, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20201214/b3170121d995432ea306ae3a7809cc05/2cfb236f361b4d3c80ef8fdef4301832.jpg, createdBy=8ad35400531, createdName=ZJYYY7, createdTime=Mon Apr 19 11:57:13 CST 2021, time=2021-04-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=958278, encodeId=397c9582e896, content=学习了谢谢了🙏🏻, beContent=null, objectType=article, channel=null, level=null, likeNumber=66, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20201214/b3170121d995432ea306ae3a7809cc05/2cfb236f361b4d3c80ef8fdef4301832.jpg, createdBy=8ad35400531, createdName=ZJYYY7, createdTime=Mon Apr 19 11:57:02 CST 2021, time=2021-04-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=958277, encodeId=dcaf9582e78c, content=多晒太阳哈, beContent=null, objectType=article, channel=null, level=null, likeNumber=66, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20201214/b3170121d995432ea306ae3a7809cc05/2cfb236f361b4d3c80ef8fdef4301832.jpg, createdBy=8ad35400531, createdName=ZJYYY7, createdTime=Mon Apr 19 11:56:52 CST 2021, time=2021-04-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1537039, encodeId=6d7d153e03966, content=<a href='/topic/show?id=7b6e18196cf' target=_blank style='color:#2F92EE;'>#USPSTF#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=18196, encryptionId=7b6e18196cf, topicName=USPSTF)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=315112772198, createdName=lingqf, createdTime=Sat Apr 17 07:15:50 CST 2021, time=2021-04-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=957377, encodeId=cec695e377f1, content=好文章, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a2fd1620398, createdName=dengyazhou, createdTime=Thu Apr 15 19:39:21 CST 2021, time=2021-04-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=957364, encodeId=833495e36473, content=好文章!, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160806/IMG57A5698BDB0244113.jpg, createdBy=32a91358059, createdName=jyzxjiangqin, createdTime=Thu Apr 15 18:12:47 CST 2021, time=2021-04-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=957337, encodeId=0de695e33770, content=额……, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdqq.qlogo.cn/qqapp/1103841572/19A78ACCA514A62ED89322FF8BE440FD/100, createdBy=3fd82549592, createdName=一叶,一菩提, createdTime=Thu Apr 15 16:56:11 CST 2021, time=2021-04-15, status=1, ipAttribution=)]
    2021-04-19 ZJYYY7

    taught!+2

    0

  5. 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【社群简介】👉 梅斯医学目前已建立覆盖肿瘤、心血管、神经、消化、内分泌、呼吸等30个科室的学习交流社群。 【入群福利】👉 群内可实时交流病例,提问同行,跨群讨论,每天更新前沿医学资讯和指南共识,每周推出至少1场专业直播,不时共享科研干货,入群即可获得100份SCI写作攻略!, beContent=null, objectType=article, channel=null, level=null, likeNumber=76, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=104233, encryptionId=d55f104233bd, topicName=梅斯医学科研互助群)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210413/a7082efd72134f339011deffae56d660/9f9bdab2a00341ce92bf6fd196c67f81.png, createdBy=4e205474392, createdName=七安, createdTime=Thu Apr 15 16:23:05 CST 2021, time=2021-04-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=958279, encodeId=85d79582e9d3, content=taught!+2, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20201214/b3170121d995432ea306ae3a7809cc05/2cfb236f361b4d3c80ef8fdef4301832.jpg, createdBy=8ad35400531, createdName=ZJYYY7, createdTime=Mon Apr 19 11:57:13 CST 2021, time=2021-04-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=958278, encodeId=397c9582e896, content=学习了谢谢了🙏🏻, beContent=null, objectType=article, channel=null, level=null, likeNumber=66, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20201214/b3170121d995432ea306ae3a7809cc05/2cfb236f361b4d3c80ef8fdef4301832.jpg, createdBy=8ad35400531, createdName=ZJYYY7, createdTime=Mon Apr 19 11:57:02 CST 2021, time=2021-04-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=958277, encodeId=dcaf9582e78c, content=多晒太阳哈, beContent=null, objectType=article, channel=null, level=null, likeNumber=66, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20201214/b3170121d995432ea306ae3a7809cc05/2cfb236f361b4d3c80ef8fdef4301832.jpg, createdBy=8ad35400531, createdName=ZJYYY7, createdTime=Mon Apr 19 11:56:52 CST 2021, time=2021-04-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1537039, encodeId=6d7d153e03966, content=<a href='/topic/show?id=7b6e18196cf' target=_blank style='color:#2F92EE;'>#USPSTF#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=18196, encryptionId=7b6e18196cf, topicName=USPSTF)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=315112772198, createdName=lingqf, createdTime=Sat Apr 17 07:15:50 CST 2021, time=2021-04-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=957377, encodeId=cec695e377f1, content=好文章, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a2fd1620398, createdName=dengyazhou, createdTime=Thu Apr 15 19:39:21 CST 2021, time=2021-04-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=957364, encodeId=833495e36473, content=好文章!, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160806/IMG57A5698BDB0244113.jpg, createdBy=32a91358059, createdName=jyzxjiangqin, createdTime=Thu Apr 15 18:12:47 CST 2021, time=2021-04-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=957337, encodeId=0de695e33770, content=额……, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdqq.qlogo.cn/qqapp/1103841572/19A78ACCA514A62ED89322FF8BE440FD/100, createdBy=3fd82549592, createdName=一叶,一菩提, createdTime=Thu Apr 15 16:56:11 CST 2021, time=2021-04-15, status=1, ipAttribution=)]
    2021-04-19 ZJYYY7

    学习了谢谢了🙏🏻

    0

  6. 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【社群简介】👉 梅斯医学目前已建立覆盖肿瘤、心血管、神经、消化、内分泌、呼吸等30个科室的学习交流社群。 【入群福利】👉 群内可实时交流病例,提问同行,跨群讨论,每天更新前沿医学资讯和指南共识,每周推出至少1场专业直播,不时共享科研干货,入群即可获得100份SCI写作攻略!, beContent=null, objectType=article, channel=null, level=null, likeNumber=76, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=104233, encryptionId=d55f104233bd, topicName=梅斯医学科研互助群)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210413/a7082efd72134f339011deffae56d660/9f9bdab2a00341ce92bf6fd196c67f81.png, createdBy=4e205474392, createdName=七安, createdTime=Thu Apr 15 16:23:05 CST 2021, time=2021-04-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=958279, encodeId=85d79582e9d3, content=taught!+2, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20201214/b3170121d995432ea306ae3a7809cc05/2cfb236f361b4d3c80ef8fdef4301832.jpg, createdBy=8ad35400531, createdName=ZJYYY7, createdTime=Mon Apr 19 11:57:13 CST 2021, time=2021-04-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=958278, encodeId=397c9582e896, content=学习了谢谢了🙏🏻, beContent=null, objectType=article, channel=null, level=null, likeNumber=66, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20201214/b3170121d995432ea306ae3a7809cc05/2cfb236f361b4d3c80ef8fdef4301832.jpg, createdBy=8ad35400531, createdName=ZJYYY7, createdTime=Mon Apr 19 11:57:02 CST 2021, time=2021-04-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=958277, encodeId=dcaf9582e78c, content=多晒太阳哈, beContent=null, objectType=article, channel=null, level=null, likeNumber=66, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20201214/b3170121d995432ea306ae3a7809cc05/2cfb236f361b4d3c80ef8fdef4301832.jpg, createdBy=8ad35400531, createdName=ZJYYY7, createdTime=Mon Apr 19 11:56:52 CST 2021, time=2021-04-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1537039, encodeId=6d7d153e03966, content=<a href='/topic/show?id=7b6e18196cf' target=_blank style='color:#2F92EE;'>#USPSTF#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=18196, encryptionId=7b6e18196cf, topicName=USPSTF)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=315112772198, createdName=lingqf, createdTime=Sat Apr 17 07:15:50 CST 2021, time=2021-04-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=957377, encodeId=cec695e377f1, content=好文章, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a2fd1620398, createdName=dengyazhou, createdTime=Thu Apr 15 19:39:21 CST 2021, time=2021-04-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=957364, encodeId=833495e36473, content=好文章!, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160806/IMG57A5698BDB0244113.jpg, createdBy=32a91358059, createdName=jyzxjiangqin, createdTime=Thu Apr 15 18:12:47 CST 2021, time=2021-04-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=957337, encodeId=0de695e33770, content=额……, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdqq.qlogo.cn/qqapp/1103841572/19A78ACCA514A62ED89322FF8BE440FD/100, createdBy=3fd82549592, createdName=一叶,一菩提, createdTime=Thu Apr 15 16:56:11 CST 2021, time=2021-04-15, status=1, ipAttribution=)]
    2021-04-19 ZJYYY7

    多晒太阳哈

    0

  7. 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    2021-04-17 lingqf
  8. 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    2021-04-15 dengyazhou

    好文章

    0

  9. 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    2021-04-15 jyzxjiangqin

    好文章!

    0

  10. 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    2021-04-15 一叶,一菩提

    额……

    0

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J Invest Dermatol:骨化三醇改善了大疱性表皮松解症小鼠模型的炎症和水泡症状。

近期,维生素D缺乏症和自身免疫性大疱病的发展之间的联系已被提出,但是目前尚没有具体的实验详细阐述过这种联系。本研究探索了维生素D在大疱性表皮松解症(EBA,一种抗Ⅶ型胶原的自身抗体引起的起泡性皮肤疾病)中所扮演的角色。