慢性阻塞性肺疾病患者下呼吸道感染与25-羟基维生素D的关系研究

目的研究慢性阻塞性肺疾病(COPD)患者25-羟基维生素D浓度与下呼吸道感染的关系,为临床治疗提供参考依据。方法收集2011年1月-2012年12月COPD患者126例,分为吸烟组76例、非吸烟组50例,并测定夏季和冬季的25-羟基维生素D浓度,同期选取50名健康人员为对照组,测定25-羟基维生素D浓度,采用SPSS13.0进行统计分析。结果 COPD患者夏季25-羟基维生素D浓度为(24.4±5.7)ng/ml,健康对照者夏季25-羟基维生素D浓度为(35.2±9.4)ng/ml;同季节吸烟组与非吸烟组25-羟基维生素D浓度差异无统计学意义,冬季COPD下呼吸道感染发生率高于夏季,同季节吸烟组下呼吸道感染发生率高于非吸烟组(P<0.05)。结论 25-羟基维生素D浓度与慢性阻塞性肺疾病下呼吸道感染有一定关系,但其确切的关系有待深入研究。     

慢性阻塞性肺疾病稳定期患者血清25-羟维生素D水平与CAT评分的相关性研究

目的了解慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)稳定期患者血清25-羟维生素D水平,探讨维生素D缺乏对其生活质量的影响。方法选取2011年10月—2012年3月在莒县人民医院呼吸内科就诊及随访的COPD稳定期患者56例,另选择健康对照组30例,采用ELISA法测定两组患者血清25-羟维生素D水平,并计算维生素D缺乏的患病率。同时对COPD稳定期患者进行COPD评估测试(COPD assessment test,CAT)评分,按照CAT评分将COPD稳定期患者分为4组,即轻微影响组、中等影响组、严重影响组、非常严重影响组,比较4组的血清25-羟维生素D水平与维生素D缺乏患病率。计量资料组间两两比较采用LSD-t检验,计数资料采用χ2检验,相关分析采用Pearson相关分析,P0.05为差异有统计学意义。结果 COPD组的血清25-羟维生素D明显低于健康对照组[(28.41±18.34)、(65.43±33.62)ng/ml],差异有统计学意义(P0.05),COPD组血清25-羟维生素D缺乏的患病率为33.9%,明显高于对照组的10%,差异有统计学意义(P0.05);COPD稳定期患者的血清25-羟维生素D水平与CAT评分呈负相关(P0.05)。轻微影响组、中等影响组、严重影响组、非常严重影响组维生素D水平[(47.78±19.43)、(31.98±18.73)、(17.95±7.86)、(12.88±9.91)ng/ml],维生素D缺乏者比例(20%、25%、42.9%、54.5%)比较,差异均有统计学意义(均P0.05)。结论血清维生素D缺乏在COPD稳定期患者中有较高的患病率,可能对COPD稳定期患者的生活质量产生负面影响。     

维生素D与儿童支气管哮喘

越来越多的研究表明维生素D与支气管哮喘发病有关, 机制包括维生素D和遗传、环境危险因素等共同作用导致免疫系统的失衡, 以及维生素D对胚胎肺发育的影响等。如果维生素D参与儿童哮喘发病机制, 将对哮喘治疗产生重大影响。本文对维生素D水平与儿童哮喘的发病与防治关系的相关研究做一综述。     

维生素D与糖尿病肾病的研究进展

糖尿病肾病是糖尿病常见的并发症之一,流行病学研究显示维生素D缺乏与糖尿病肾病的发生有关,维生素D可能是影响糖尿病肾病的重要因素。目前,维生素D缺乏与糖尿病肾病发病的关系及补充维生素D改善糖尿病肾病患者的状态成为研究的热点。此文总结近年国内外的相关研究,系统全面地从维生素D与糖尿病肾病关系、维生素D对糖尿病肾病保护作用机制以及维生素D在糖尿病肾病患者中的应用等方面介绍维生素D与糖尿病肾病之间关系的研究进展,重点介绍维生素D与糖尿病肾病相互关系的生理学机制,并从维生素D受体信号通路及基因多态性方面解释人群实验中补充维生素D对糖尿病肾病防治效果差异性产生的原因。未来,随着维生素D在糖尿病肾病发病机制中作用的进一步揭示,将为糖尿病肾病患者的治疗及并发症的预防提供更好的指导。     

维生素D对自然流产的免疫调节

维生素D的经典功能在于调节钙吸收和骨代谢,但目前的研究强调了维生素D的非经典作用,尤其是对子宫和胎盘的重要性。子宫和胎盘局部合成分泌的维生素D对植入、细胞因子的合成和感染过程的免疫调节,对维持成功妊娠、预防治疗自然性流产有重要的意义。该文就维生素D代谢和维生素D在胎盘滋养层、蜕膜和子宫内膜的调节作用进行综述。     

COPD患者外周血25(OH)D与肺功能及炎症指标的相关性

目的探讨慢性阻塞性肺疾病(COPD)患者外周血25-二羟维生素D [25(OH)D]与肺功能及炎症指标的相关性。方法选取2018年1月至12月本院门诊随诊的COPD稳定期患者60例(COPD稳定期组)和住院COPD急性加重期患者68例(COPD急性加重期组);收集同期在本院健康体检的志愿者54例为健康对照组。肺功能检测仪测定第1秒用力呼气容积(FEV1),用力肺活量(FVC);电化学发光法测定血清25(OH)D水平,酶联免疫吸附法测定人干扰素-γ(INF-γ)和肿瘤坏死因子-α(TNF-α)水平,流式细胞术测定白细胞介素(IL)-2、IL-4、IL-6、IL-10水平。根据25(OH)D水平将受试者分为维生素D缺乏(20 ng/ml)和维生素D不缺乏(≥20 ng/ml)。结果健康对照组、COPD稳定期组及COPD急性加重期组的FEV1/FVC分别为70.52±5.08、55.80±3.25、36.72±2.48;COPD急性加重期组患者FEV1/FVC明显低于COPD稳定期组和健康对照组,差异均有统计学意义(均P0.05)。3组受试者维生素D缺乏率差异有统计学意义(P0.01);其中COPD急性加重期组与COPD稳定期组维生素D缺乏率明显高于健康对照组,COPD急性加重期组维生素D缺乏率明显高于COPD稳定期组,差异均有统计学意义(均P0.05)。Pearson相关性分析显示,COPD稳定期组患者血清25(OH)D水平与FEV1/FVC水平呈正相关(P0.05)。COPD稳定期组和COPD急性加重期组血清IL-2、IL-6及INF-γ水平明显高于健康对照组,COPD急性加重期组血清IL-6和INF-γ水平明显高于COPD稳定期组,差异均有统计学意义(均P0.05)。Pearson相关性分析显示,血清25(OH)D水平与IL-2、IL-4、IL-6、IL-10、TNF-α及INF-γ水平间均无明显相关性(均P0.05)。结论 COPD患者维生素D缺乏率明显高于健康人群;维生素D水平与FEV1/FVC呈正相关,但患者血清25(OH)D水平与血清炎症指标无明显相关性。     

维生素D在抗肿瘤发生发展中的作用

维生素D作为人体的一种必需营养素,可广泛调节机体各种生理过程。近来年,越来越多的流行病学研究,前期临床试验和细胞试验表明维生素D除了在骨代谢中发挥传统的作用外,还可能在许多除骨科疾病以外的疾病如癌症的预防和治疗中发挥着关键作用。维生素D的代谢和功能在许多类型的癌症中都是紊乱的,从而促进了癌症的发生和发展,这也表明维生素D具有一定的抗肿瘤作用。因此,了解维生素D的抗肿瘤作用对于制定以维生素D为基础的抗癌治疗方案将是至关重要的。     

维生素D3类似物治疗白癜风分子生物学机制及临床应用现状

维生素 D3 活性代谢产物 1,25（OH）2D3 及其类似物通过维生素 D 受体 （VDR） 发挥对表皮黑素单位的保护作用.近年来研究表明,维生素 D3 类似物单独或联合应用紫外线或皮质类固醇激素可以提高白癜风皮损的复色.因此,进一步了解维生素 D3 类似物在白癜风复色中的作用机制,研制新的、高效的维生素 D3 类似物,对白癜风的治疗具有重要意义.     

009 维生素K与骨质疏松

维生素K不仅与凝血功能有关,而且与骨代谢有关,对骨质疏松有预防和治疗作用.本文着重从维生素K对骨质疏松的预防作用、维生素K对各种原因引起的骨质疏松的治疗作用和维生素K、维生素D及钙对骨质疏松的联合作用3方面介绍近几年来维生素K与骨质疏松关系方面研究的一些新进展.     

维生素D与儿童感染性疾病相关性及其抗感染机制研究

维生素D是类固醇类激素超家族中的一员,除调节钙磷代谢,维持儿童骨骼健康的经典作用外,维生素D还具有重要的免疫调节作用。近年来多项研究表明,维生素D低水平与儿童多种感染性疾病的发生、进展相关,维生素D增补被用于治疗与预防多种儿童感染性疾病。本文就维生素D营养状况与儿童感染性疾病的相关性及其抗感染机制进行简要综述。     

Dietary influences on chronic obstructive lung disease and asthma: a review of the epidemiological evidence.

The epidemiological evidence for a relationship between diet and indicators of asthma and chronic obstructive pulmonary disease (COPD) is evaluated. The review focuses on the intake of Na, n-3 fatty acids, and antioxidant vitamins as well as fruit and vegetables. Experimental studies suggest that a high-Na diet has a small adverse effect on airway reactivity in asthma patients. However, observational studies provide no clear evidence that high Na intake has adverse effects on airway reactivity or asthma symptoms in open populations. n-3 Polyunsaturated fatty acids, which are present in fish oils, are metabolized into less broncho-constricting and inflammatory mediators than n-6 polyunsaturated fatty acids. Studies in the general adult population suggest that a high fish intake has a beneficial effect on lung function, but the relationship with respiratory symptoms and clinically-manifest asthma or COPD is less evident. Also, experimental studies in asthma patients have not demonstrated an improvement in asthma severity after supplementations with fish oil. Several studies showed a beneficial association between fruit and vegetable intake and lung function, but the relationship with respiratory symptoms and the clinically-manifest disease was less convincing. A similar pattern was found for vitamin C in relation to indicators of asthma and COPD, but there are still conflicting results with respect to vitamin E and beta-carotene. In conclusion, the epidemiological evidence for a beneficial effect on indicators of asthma and COPD of eating fish, fruit and vegetables is increasing. However, the effectiveness of dietary supplementation in open-population samples is often not demonstrated. Several unresolved questions are raised, which should be addressed in future studies on the relationship between diet and respiratory disease.     

The effect of vitamin D prophylaxis on radiation induced pulmonary damage

Vitamin D has a selective radio and chemosensitizing effect on tumor cells. In vitro and in vivo studies have shown that vitamin D inhibits collagen gel construction, induces type II pneumocyte proliferation and surfactant synthesis in the lungs, and decreases vascular permeability caused by radiation. The aim of this experimental study was to determine if vitamin D has a protective effect against radiation-induced pulmonary damage. Adult Wistar rats were divided into 4 groups. Group 1 was comprised of control animals. Group 2, which was administered 0.25 μg/kg/day of vitamin D3 for 8 weeks, was the vitamin D control group. Rats in groups 3 and 4 were given 20 Gy right hemithorax radiotherapy, and in addition group 4 was given vitamin D3 treatment, which began the day before the radiotherapy and continued for 8 weeks. At the 8(th) and the 12(th) weeks of the study 4 rats from each group were sacrificed. Right lungs were dissected for light and electron microscopic study. The electron microscopy examinations revealed statistically significant differences between group 3 and 4, and in group 4 there was less interstitial inflammation and collagen deposition, and the alveolar structure and the cells lining the alveolar walls were protected. These results confirm that vitamin D has a protective effect against radiation-induced pulmonary toxicity. These findings should be evaluated with further clinical studies.     

支气管哮喘相关基因ADAM33的研究进展

支气管哮喘和慢性阻塞性肺疾病均是慢性气道炎症性疾病，尽管从发病机制到临床表现两者各有不同，但越来越多的研究表明两者在病因、发病机制和临床表现等诸多方面均有许多相似之处。解整合素-金属蛋白酶（adisintegrinandmetalloprotease，ADAM）33基因作为首次通过定位克隆技术确定的哮喘易感基因，近几年的研究证实该基因与慢性阻塞性肺疾病的发生发展也有关联。ADAM33基因是否能架起哮喘和慢性阻塞性肺疾病共同发病机制的桥梁，笔者对近年来该基因的研究进展进行综述。     

Vitamin E and vitamin C supplementation in patients with chronic obstructive pulmonary disease

The purpose of this study was to determine whether vitamin E or vitamin C supplementation alters the DNA damage of whole blood white blood cells (WBC) in patients with chronic obstructive pulmonary disease (COPD). Thirty-five patients with stable COPD were recruited in this randomized and placebo-controlled study. Patients were randomly assigned to placebo (n = 8), 400 mg/day vitamin E (E400, n = 9), 200 mg/day vitamin E (E200, n = 9), or 250 mg/day vitamin C (C250, n = 9) for 12 weeks. The results showed that vitamin E or C supplementation did not significantly change the mean level of endogenous DNA breakages. Whereas, after 12 weeks of vitamin supplementation, the H2O2-induced DNA breakages were significantly suppressed by 45%, 59%, and 52%, respectively, in E400, E250 and C250 groups (p < 0.05). In addition, neither the level of thiobarbituric acid-reactive substances (TBARS) nor spirometric parameters were significantly changed after 12 weeks of supplementation. In conclusion, vitamin E or C supplementation for 12 weeks may improve the resistance of DNA in whole blood WBC against oxidative challenge, although more research is needed to demonstrate the beneficial effect on slowing the decline of lung function in patients with COPD.     

Vitamin D and the occurrence of depression: causal association or circumstantial evidence?

While recent laboratory-based studies have substantially advanced our understanding of the action of vitamin D in the brain, much is still unknown concerning how vitamin D relates to mood. The few epidemiological studies of vitamin D and depression have produced inconsistent results and generally have had substantial methodological limitations. Recent findings from a randomized trial suggest that high doses of supplemental vitamin D may improve mild depressive symptoms, but important questions persist concerning how vitamin D may affect monoamine function and hypothalamic-pituitary-adrenal axis response to stress, whether vitamin D supplementation can improve mood in individuals with moderate-to-severe depression, and whether vitamin D sufficiency is protective against incident depression and recurrence. At this time, it is premature to conclude that vitamin D status is related to the occurrence of depression. Additional prospective studies of this relationship are essential.     

Vitamin D and chronic lung disease: a review of molecular mechanisms and clinical studies

Vitamin D is classically recognized for its role in calcium homeostasis and skeletal metabolism. Over the last few decades, vitamin D deficiency has increased in prevalence in adults and children. Potential extraskeletal effects of vitamin D have been under investigation for several diseases. Several cross-sectional studies have associated lower vitamin D status with decreased lung function. This finding has prompted investigators to examine the association of vitamin D deficiency with several chronic lung diseases. One major focus has been the link between maternal vitamin D status and childhood asthma. Vitamin D deficiency has also been associated with increased risk of respiratory infection from influenza A and Mycobacterium tuberculosis. Other chronic respiratory diseases associated with vitamin D deficiency include cystic fibrosis, interstitial lung disease, and chronic obstructive pulmonary disease. This review will examine the current clinical literature and potential mechanisms of vitamin D in various pulmonary diseases.     

Vitamin D and blood pressure connection: update on epidemiologic, clinical, and mechanistic evidence

Hypertension is an important risk factor for cardiovascular and kidney disease. High blood pressure is a growing public health problem that is expected to affect 1.6 billion people worldwide by the year 2025. In light of emerging evidence of a widespread global problem of vitamin D deficiency, there has been increasing interest concerning the role of vitamin D in chronic disease. The recent publication of several studies, highlighted in this brief review, supports an association between vitamin D status and blood pressure. It remains to be determined what level of vitamin D status needs to be achieved in different subpopulations to assure the maximum benefit of vitamin D status on blood pressure.     

The Immunologic Profile of Vitamin D and Its Role in Different Immune-Mediated Diseases: An Expert Opinion

Historically, vitamin D is recognized as an essential component for the maintenance of the musculoskeletal system. The immunomodulatory role of vitamin D in health and disease has gained much interest in recent years due to the many pathologies that share underlying immunological features where vitamin D has been shown to exert a potential role. Evidence from pre-clinical studies show that vitamin D elicits biological effects on both the innate and adaptive immune systems. Furthermore, in vivo studies have shown that administration of vitamin D can lead to changes in or the development of a range of immune-related diseases. This encourages the hypothesis that data derived from clinical and epidemiological studies connect vitamin D with the incidence and severity of many immune-mediated disorders such as rheumatoid arthritis, diabetes, and infectious diseases. Since some other immune-mediated diseases share similar features to that of viral infection such as COVID-19, in this review, we examined these other areas and the role of vitamin D in these diseases.