Clinical Nutrition: 重症COVID-19出现急性呼吸窘迫综合征(ARDS) 后维生素D缺乏症较为普遍

2022-06-21 xuyihan MedSci原创

维生素D(简称VD)是一种脂溶性维生素,乃环戊烷多氢菲类化合物,一组结构上与固醇有关,功能上可防止佝偻病的维生素,最主要的是维生素D3与D2。

维生素D有多种作用效果,其作用远远超出其在矿物质稳态中的经典作用。人体组织可以通过两次酶促反应将维生素D转化为25-羟基维生素D和1,25-二羟基维生素D。但是维生素 D 缺乏症在所有年龄组和国家都非常普遍。有研究显示补充维生素 D 可降低急性呼吸道感染的风险。英国的一项横断面研究表明,充足的维生素D水平与降低呼吸道感染风险之间存在线性关系。本项研究旨在探究患有COVID-19而诱发急性呼吸窘迫综合征(ARDS)的患者中维生素D的缺乏情况。

这是一项针对确诊 SARS-CoV-2 感染和存在COVID-19感染而出现ARDS接受重症监护的患者的单中心回顾性研究。研究人员在患者入院时和第10-15天测量25-羟基维生素 D 和 1,25-二羟基维生素D血清水平、促炎和抗炎细胞因子和免疫细胞亚群。

研究结果显示共有39名 COVID-19 ARDS 患者符合条件,其中 26 名被纳入本研究,96% 的人患有严重的 COVID-19 ARDS。所有之前未补充维生素D的患者 (n = 22) 血清 25-羟基维生素D水平不足。补充维生素D导致血清25-羟基维生素D水平升高,但第10天时25-羟基维生素D水平并未增加。 第15天时25-羟基维生素D水平充足或不足的患者之间的临床参数没有差异。只有循环浆母细胞在 25-羟基维生素 D 水平≥30 ng/ml 的患者中较高(p=0.029)。1,25-二羟基维生素 D 水平低于 20 pg/ml 的患者需要更长的机械通气时间(p=0.045),慢性健康评估 (APACHE) II 评分较差 (p=0.048)。

本项研究证实绝大多数COVID-19 ARDS 患者存在维生素 D 缺乏症。25-羟基维生素D状态与临床过程的变化无关,而 1,25-二羟基维生素 D 水平低与机械通气时间延长和 APACHE II 评分较差有关。

原始出处:

QuirinNotz. Et al. Vitamin D deficiency in critically ill COVID-19 ARDS patients. Clinical Nutrition.2022.

 

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    2023-05-18 drwjr
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    2022-06-21 zll0628
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