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。     

维生素D在儿童感染性疾病中的应用

儿童感染性疾病严重危害儿童健康,是造成5岁以下儿童发病和死亡的重要原因。近年来研究发现维生素D除了维持钙和磷的稳态外,还能够影响儿童感染性疾病的发生与发展。此文就维生素D水平的变化在儿童常见感染性疾病中的预防及治疗作用进行综述。     

维生素A与维生素D辅助治疗儿童肺炎的研究进展

肺炎是儿童常见的感染性疾病,其主要病原为病毒、细菌、衣原体和支原体,严重影响儿童的健康。临床以抗生素治疗为主,但近年广谱抗生素的应用出现多种耐药菌株,导致治疗效果欠佳。随着临床及基础医学研究的深入,维生素A(Vit A)和维生素D(Vit D)在提高机体免疫方面起着较为重要的作用。因此,本文就Vit A和Vit D在辅助治疗儿童肺炎中所起到的作用及相关研究进展作一综述。     

维生素D与儿童反复呼吸道感染相关性研究进展

反复呼吸道感染严重影响儿童健康成长,机体免疫力低下是导致呼吸道感染的主要因素。维生素D可通过多种途径调节免疫功能,婴幼儿缺乏维生素D容易发生各种感染。从儿童呼吸道感染的发生、儿童维生素D缺乏发生原因、维生素D生物作用等方面阐述反复呼吸道感染与维生素D的关系,为减少儿童呼吸道感染的发病提供理论依据。     

维生素D缺乏与儿童感染性疾病

维生素D是维持人体健康必不可少的营养素,不仅参与钙磷代谢,维持骨健康,而且作为一种免疫调节剂,在感染性疾病中发挥着重要作用。维生素D主要通过促进抗菌肽的产生、影响免疫调节等功能发挥辅助抗感染作用。本文将对维生素D缺乏和其与感染性疾病的相关性做一简要综述。     

郑州地区健康儿童及感染性疾病儿童维生素D水平变化分析

目的 了解郑州地区0～14岁健康儿童维生素D水平现状,并比较分析同期同龄感染性疾病儿童维生素D水平变化。方法 选取2020-02-01-2022-08-31郑州市第一人民医院行健康体检的912名0～14岁健康儿童为研究对象(观察组),选取同院同期就诊的同龄142例感染性疾病儿童为对照(感染组)。以25-羟基维生素D代表维生素D水平,分析观察组健康儿童维生素D水平,并对感染组和观察组维生素D水平进行比较分析。结果 观察组912名健康儿童的维生素D平均水平为43.80(25.29,57.00) ng/mL,维生素D缺乏和不足占比为18.86%。观察组不同年龄组维生素D水平(H=516.676,P<0.001)和营养状态(χ²=475.034,P<0.001)差异有统计学意义。其中婴儿组和幼儿组维生素D水平最高,其次为学前组,学龄组最低。学龄组维生素D缺乏占比最高;学前组和学龄组维生素D不足占比高于婴儿组和幼儿组;婴儿组和幼儿组维生素D充足占比最高,其次是学前组,学龄组最低。观察组总体男女维生素D水平及营养状态差异无统计学意义,均P>0.05。婴儿组、...     

中国儿童维生素A、维生素D临床应用专家共识(2024)

<正>儿童中维生素A和维生素D缺乏很常见^[1],可能还存在较高比例的维生素A和维生素D同时缺乏的问题,这些将影响儿童的健康状况、增加对感染性疾病的易感性^[2-4]。中华预防医学会儿童保健分会于2021年组织国内相关专家撰写了《中国儿童维生素A、维生素D临床应用专家共识》(以下简称《共识》)^[5]。近年的调查结果显示,我国学龄前儿童维生素A缺乏和边缘缺乏率高,且有随年龄增长而增加的趋势;0～18岁儿童中维生素D缺乏和不足率较普遍^[6],儿童中维生素A和维生素D的缺乏存在相关性。     

感染患儿贫血维生素D和铁调素的变化及相关性

目的 探讨急性感染患儿的铁调素、维生素D与贫血之间的相互关系。方法 对88例儿科住院患者(男性和女性各44例)进行一项前瞻性研究,其中61例患者由于感染性疾病入院(30例患有贫血,31例无贫血),27例患者非感染性疾病住院的儿童。入院后72 h内获得IL-6、铁调素、铁代谢相关参数和维生素D的血样。结果 与对照组相比,感染合并贫血患儿的血清IL-6和铁调素浓度显著升高,而维生素D、血清铁和转铁蛋白显著降低。血清维生素D水平20 ng/ml的儿童患贫血的几率显著高于水平 20 ng/ml的儿童(OR=2. 53,95%CI:0. 80～7. 98),相关性分析发现铁调素和IL-6之间存在正相关(r=0. 23,P 0. 05),铁调素和维生素D之间存在负相关(r=-0. 24,P 0. 05)。结论 高水平的IL-6和低水平的维生素D可导致铁调素水平的升高,进而导致急性感染儿童的低铁血症和贫血。     

中国儿童维生素A、维生素D临床应用专家共识

维生素A和维生素D是与儿童健康密切相关的两种脂溶性维生素,充足的维生素A、维生素D营养对儿童早期发展及疾病的防治具有积极的作用,缺乏和不足均会影响儿童健康。针对儿童保健医生和儿童家长对维生素A、维生素D的营养现状、缺乏原因及危害、防治措施、安全性等方面所存在的一些疑虑,中华预防医学会儿童保健分会组织国内相关专家,就上述问题结合国内外相关研究展开了充分讨论,基于现有研究成果,达成如下共识,希望对我国儿童维生素A、维生素D的临床应用提供参考.     

维生素D在儿童注意力缺陷多动障碍中作用的研究进展

维生素D(Vit D)作为一种神经甾体,它在大脑增值、分化、神经营养、神经递质和神经可塑性等方面发挥了重要的作用,而最近有研究表明注意力缺陷多动障碍(ADHD)患儿维生素D水平低于健康儿童,可能与ADHD的发病机制有关,本文将对维生素D与儿童ADHD的作用机制进行了探讨。     

Vitamin D deficiency: a worldwide problem with health consequences

Vitamin D deficiency is now recognized as a pandemic. The major cause of vitamin D deficiency is the lack of appreciation that sun exposure in moderation is the major source of vitamin D for most humans. Very few foods naturally contain vitamin D, and foods that are fortified with vitamin D are often inadequate to satisfy either a child's or an adult's vitamin D requirement. Vitamin D deficiency causes rickets in children and will precipitate and exacerbate osteopenia, osteoporosis, and fractures in adults. Vitamin D deficiency has been associated with increased risk of common cancers, autoimmune diseases, hypertension, and infectious diseases. A circulating level of 25-hydroxyvitamin D of >75 nmol/L, or 30 ng/mL, is required to maximize vitamin D's beneficial effects for health. In the absence of adequate sun exposure, at least 800-1000 IU vitamin D3/d may be needed to achieve this in children and adults. Vitamin D2 may be equally effective for maintaining circulating concentrations of 25-hydroxyvitamin D when given in physiologic concentrations.     

儿童维生素A缺乏与感染性疾病的关系

[目的]了解儿童血清维生素A缺乏(vitamin A deficiency,VAD)与感染性疾病的关系. [方法]在避光条件下采集儿童指血、分离血清,以严格的质量控制,用微量荧光法检测血清维生素A(vitamin A,VA)浓度. [结果]两周内不同地区儿童发热率、急性呼吸道感染(ARI)、腹泻,发病率随血清VA缺乏率的增加而增加;儿童平均血清VA的含量随发热率、发病率的增加而下降. [结论]我国儿童血清VA含量低、缺乏率高的儿童不论个体或群体都表现为易于发生急性感染疾病,VAD是引起儿童易于发生急性感染性疾病的重要原因之一.     

Better newborn vitamin D status lowers RSV-associated bronchiolitis in infants

Each year 1.5 million children under the age of 5 years die from pneumonia. In the United States, respiratory syncytial virus (RSV) is the number one cause of bronchiolitis and pneumonia in children under 1 year of age. Low serum 25(OH)D is associated with an increased risk of lower respiratory tract infections (LRTI). Two recent studies have provided important information concerning the association between cord blood 25(OH)D and subsequent risk of developing respiratory infection in very young children. These findings support the need in future studies to determine the extent to which an intervention to change the vitamin D status of mothers during pregnancy can reduce the risk of RSV-associated LRTI in their offspring. An answer to this question would have significant worldwide public health importance given the high prevalence of low vitamin D status worldwide and the high mortality burden accompanying infectious lung diseases in young children.     

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.     

Vitamin D signaling in the bovine immune system: a model for understanding human vitamin D requirements

The endocrine physiology of vitamin D in cattle has been rigorously investigated and has yielded information on vitamin D requirements, endocrine function in health and disease, general metabolism, and maintenance of calcium homeostasis in cattle. These results are relevant to human vitamin D endocrinology. The current debate regarding vitamin D requirements is centered on the requirements for proper intracrine and paracrine vitamin D signaling. Studies in adult and young cattle can provide valuable insight for understanding vitamin D requirements as they relate to innate and adaptive immune responses during infectious disease. In cattle, toll-like receptor recognition activates intracrine and paracrine vitamin D signaling mechanism in the immune system that regulates innate and adaptive immune responses in the presence of adequate 25-hydroxyvitamin D. Furthermore, experiments with mastitis in dairy cattle have provided in vivo evidence for the intracrine vitamin D signaling mechanism in macrophages as well as vitamin D mediated suppression of infection. Epidemiological evidence indicates that circulating concentrations above 32 ng/mL of 25-hydroxyvitamin D are necessary for optimal vitamin D signaling in the immune system, but experimental evidence is lacking for that value. Experiments in cattle can provide that evidence as circulating 25-hydroxyvitamin D concentrations can be experimentally manipulated within ranges that are normal for humans and cattle. Additionally, young and adult cattle can be experimentally infected with bacteria and viruses associated with significant diseases in both cattle and humans. Utilizing the bovine model to further delineate the immunomodulatory role of vitamin D will provide potentially valuable insights into the vitamin D requirements of both humans and cattle, especially as they relate to immune response capacity and infectious disease resistance.     

对4个农村贫困县5岁以下儿童定期普服维生素A预防呼吸道感染和腹泻效果的前瞻性队列研究

目的:探讨定期普服维生素A对儿童感染性疾病患病率的影响。方法:分层抽样选取云南省4个县3669名5岁以下儿童,调查其两周患病情况,测量身高(身长)和体重,采用SPSS13.0软件进行统计分析。结果:①患病率及相对危险度(RR):支气管炎患儿服维生素A后患病率1.1%,RR=1.5,χ2=5.5,其他各疾病患病率服维生素A组明显低于对照组(服药前),RR均大于1,差异均有统计学意义。②归因危险度百分比(AR%):服维生素A后比服维生素A前各患病率降低19.2%～81.4%;人群归因危险度百分比(PAR%)为11.1%～69.2%。③平行对照:呼吸道、消化道感染及营养不良等患病率只有急性呼吸道感染和急性腹泻的相对危险度,对照组高于试验组;服维生素A双剂量优于单剂量。结论:普服维生素A对呼吸道和肠道感染有保护效应,双剂量效果更佳。     

Mechanisms Involved in the Relationship between Vitamin D and Insulin Resistance: Impact on Clinical Practice

Recent evidence has revealed anti-inflammatory properties of vitamin D as well as extra-skeletal activity. In this context, vitamin D seems to be involved in infections, autoimmune diseases, cardiometabolic diseases, and cancer development. In recent years, the relationship between vitamin D and insulin resistance has been a topic of growing interest. Low 25-hydroxyvitamin D (25(OH)D) levels appear to be associated with most of the insulin resistance disorders described to date. In fact, vitamin D deficiency may be one of the factors accelerating the development of insulin resistance. Vitamin D deficiency is a common problem in the population and may be associated with the pathogenesis of diseases related to insulin resistance, such as obesity, diabetes, metabolic syndrome (MS) and polycystic ovary syndrome (PCOS). An important question is the identification of 25(OH)D levels capable of generating an effect on insulin resistance, glucose metabolism and to decrease the risk of developing insulin resistance related disorders. The benefits of 25(OH)D supplementation/repletion on bone health are well known, and although there is a biological plausibility linking the status of vitamin D and insulin resistance supported by basic and clinical research findings, well-designed randomized clinical trials as well as basic research are necessary to know the molecular pathways involved in this association.     

维生素D在儿童抽动障碍中的神经生化与免疫机制研究进展

维生素D(VD)是一种营养素,也是一种激素,还是一类神经活性甾体,除调节钙磷代谢、维持牙齿和骨骼健康外,还对骨骼外系统发挥重要作用,如影响脑部正常发育和功能、调节免疫和影响代谢等。近年来的研究表明抽动障碍(TDs)患儿血液中VD水平低于健康儿童;VD缺乏通过影响神经系统皮质-基底神经节-丘脑-皮质(CBGTC)通路中神经递质的含量、各种神经递质的平衡性以及机体免疫功能等途径在儿童TDs中发挥作用,本文对TDs儿童的VD营养状况以及VD在儿童TDs中的神经生化和免疫机制进行总结。