JCEM:SARS-CoV-2感染住院患者的维生素D水平

2022-01-21 从医路漫漫 MedSci原创

有几条证据可能支持维生素D状态在SARS-CoV-2感染中的作用。

背景:有几条证据可能支持维生素D状态在SARS-CoV-2感染中的作用。首先,维生素D缺乏是世界各地的一种常见情况,血清25-羟基维生素D(25-OHD)水平与季节和地域有关。西班牙位于北半球温带,但维生素D缺乏率较高,SARS-CoV-2的感染率和致死率非常高。其次,维生素D是一种类固醇激素,参与调节先天和后天免疫系统,也参与抗菌素的产生,如长春花素和人β-防御素-2,以及参与病原体细胞内破坏的基因的表达)。第三,血清25OHD水平经常出现在老年人或患有慢性病的人中,如高血压、糖尿病、癌症或心血管疾病,这些疾病也与新冠肺炎的不良预后因素。最后,SARS-CoV-2对ACE2的下调导致肾素-血管紧张素系统(RAS)的失调,这导致了以严重的COVID19为特征的急性呼吸窘迫综合征(ARDS)之前的“细胞因子风暴”。从这个意义上说,维生素D可以抑制人单核/巨噬细胞的促炎细胞因子的产生,而慢性维生素D缺乏可能会诱导RAS激活,导致纤维化因子的产生,从而导致肺损伤。

考虑到上述因素,我们旨在评估COVID-19住院患者血清25OHD水平,并与基于人群的对照组进行比较。还分析了血清25OHD浓度与COVID-19严重程度和死亡率之间可能的相关性。

目的:评估COVID-19住院患者血清25-羟基维生素D (25-OHD)水平,分析维生素D水平对疾病严重程度的可能影响。

方法:对216例COVID-19患者和197例正常人群进行回顾性病例对照研究。测定两组血清25-OHD水平。还评估了血清25-OHD水平与COVID-19严重程度(入院重症监护病房、机械通气需求或死亡率)的关系。

结果:216例患者中,19例服用维生素D补充剂,并分别进行分析。在COVID-19患者中,25-OHD水平的平均值±标准差为13.8±7.2 ng/mL,而对照组为20.9±7.4 ng/mL (P < 0.0001)。男性25-OHD值低于女性。82.2%的COVID-19病例和47.2%的正常人群对照组发现维生素D缺乏(P <0 .0001)。25-OHD与血清铁蛋白(P =0 .013)和D -二聚体水平(P = 0.027)呈负相关。与血清25-OHD≥20 ng/mL患者相比,缺乏维生素D的COVID-19患者高血压、心血管疾病患病率更高,血清铁蛋白和肌钙蛋白水平升高,住院时间更长。作为综合终点或作为单独成分,维生素D缺乏和COVID-19严重程度之间没有发现因果关系。

表1 根据维生素D缺乏的状况评估新冠肺炎患者的主要特征

表2 新冠肺炎患者入院时口服与不口服维生素D补充剂的主要特征

图1 根据性别,服用和不服用活性口服维生素D补充剂的住院新冠肺炎患者和基于人群的对照患者的血清维生素D水平。灰色线条代表男性,白色线条代表女性。

图2 新冠肺炎患者(不包括入院时服用维生素D的患者)和对照组按血清25OHD水平的不同时段进行比较。

图3 血清25OHD与炎症标志物(A 铁蛋白、B D-二聚体、C C-反应蛋白)的相关性。

结论:住院的COVID-19患者的25-OHD水平低于以人群为基础的对照组,这些患者的维生素D缺乏患病率更高。我们没有发现维生素D水平或维生素缺乏与疾病的严重程度之间有任何关系。

原文出处: Hernández JL,  Nan D,  Fernandez-Ayala M,et al.Vitamin D Status in Hospitalized Patients with SARS-CoV-2 Infection.J Clin Endocrinol Metab 2021 Oct 08;106(3)

 

 

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    2022-10-11 achengzhao
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    2022-10-17 仁者大医
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    2022-04-08 hukaixun
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    2022-01-21 查查佳佳

    统性红斑狼疮(Systemic lupus erythematosus, SLE)是一种慢性自身免

    0

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    2022-01-20 小刀医生

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从轻度至中度SARS-CoV-2感染中恢复的受试者表现出与肺脏、心脏、血栓形成和肾功能相关的亚临床多器官病变迹象,而没有结构性脑损伤、神经认知或生活质量受损的迹象。

Nat Med:孕妇COVID-19疫苗接种与SARS-CoV-2感染

解决孕妇疫苗接种率低的问题对于在持续的COVID-19大流行期间保护妇女和婴儿的健康至关重要。