维生素D在预防重症新型冠状病毒肺炎中的作用及价值

新型冠状病毒引起的全球卫生危机仍在继续,而且病毒不断发生变异,传播速度逐渐变快。既往研究表明,维生素D可以在调节免疫、抑制炎症、干预肾素-血管紧张素系统等方面发挥作用,而且低维生素D水平与新型冠状病毒肺炎(COVID-19)严重程度以及死亡率之间存在联系。因此维生素D在减轻COVID-19病情严重程度上具有一定价值。但是目前的临床研究还没有明确维生素D用于广泛人群预防重症新冠肺炎的最佳补充剂量,这仍需要进一步的基础和临床试验来探索。     

能否用维生素D防治新型冠状病毒肺炎?

维生素D有免疫调控和抗感染作用,低维生素D水平与新型冠状病毒肺炎(COVID-19)的患病风险和不良预后相关,这些线索提示补充维生素D可能起到预防和治疗COVID-19的作用。但是根据现有的临床试验结果,尚无足够证据支持常规应用大剂量维生素D来防控疫情。在更多临床试验数据公布前,我们仍然应当积极倡导日常规律补充维生素D制剂来纠正维生素D缺乏。     

能否用维生素D防治新型冠状病毒肺炎？

维生素D有免疫调控和抗感染作用,低维生素D水平与新型冠状病毒肺炎(COVID-19)的患病风险和不良预后相关,这些线索提示补充维生素D可能起到预防和治疗COVID-19的作用。但是根据现有的临床试验结果,尚无足够证据支持常规应用大剂量维生素D来防控疫情。在更多临床试验数据公布前,我们仍然应当积极倡导日常规律补充维生素D制剂来纠正维生素D缺乏。     

应重视对新型冠状病毒肺炎患者活性维生素D的应用

新型冠状病毒肺炎(COVID-19)在全球快速蔓延,人群普遍易感。目前认为病毒感染后诱发的免疫、炎性反应及其引起的\"细胞因子风暴\"是造成患者肺损伤,导致病情危重和死亡的重要原因。既往研究发现,肺感染患者往往存在维生素D不足和血钙降低。活性维生素D除调节钙、磷代谢外,还与机体的防御、炎性反应、免疫调节和修复等病理生理过程密切相关,在预防和治疗肺感染,特别是病毒感染中具有重要作用,且无糖皮质激素的不良反应,不增加病毒复制和继发细菌感染。活性维生素D还能预防和治疗COVID-19康复中可能出现的骨坏死和肺纤维化等并发症。因此,应重视活性维生素D在COVID-19临床诊治中的应用。     

胸部CT在新型冠状病毒肺炎患者诊断及治疗中的应用

自2019年12月,新型冠状病毒(COVID-19)疾病在全国及世界范围内迅速传播、爆发,其临床诊断及治疗方法仍存在很多争议。COVID-19肺炎患者的胸部CT影像表现具有一定的特征。一定时期内,湖北省通过胸部CT检查能够对COVID-19肺炎患者实现临床诊断。同时胸部CT检查在患者治疗后评价方面能够提供临床依据。本文介绍了轻型及普通型COVID-19肺炎患者CT影像学表现,同时初步总结了部分重型及危重型患者胸部CT表现,以期为临床进行准确的影像评价提供参考。     

老年人新型冠状病毒肺炎的中医药预防策略

我国新型冠状病毒肺炎疫情防控形势严峻,老年患者是新型冠状病毒疾病危重症患者的主要群体,因此做好老年人群的预防工作非常重要和紧迫。已有报道表明中医药治疗新型冠状病毒肺炎疗效显著,本文重点回顾了中医药治疗疫病的历史及对本次疫情的认识,针对老年人群具有的生理特殊性和疾病复杂性,提出了老年人新型冠状病毒肺炎的中医药预防要点和应对策略。     

52例重症新型冠状病毒肺炎患者临床特征分析

目的:探讨52例重症新型冠状病毒肺炎(COVID-19)患者临床特征.方法:采用回顾性研究方法,收集2020年2月3日至3月1日,华中科技大学同济医院中法新城院区隔离病房,收治的核酸阳性的重症COVID-19患者52例一般资料,分析其临床表现、实验室检查和影像学检查特点.结果:52例患者中,男性30例,女性22例,平均...     

冠状病毒及新型冠状病毒肺炎防控策略

随着科学技术的发展和医学研究不断取得新进步,人们认识到病毒引发的传染性疾病仍然对人类健康构成巨大威胁,据世界卫生组织(World Health Organization,WHO)宣布,地球上对人类危害最大的有九大病毒:(1)克里米亚-刚果出血热病毒(Crimean-Congo haemorrhagic fever virus,CCHFV);(2)埃博拉病毒(Ebola virus,EBOV);(3)马尔堡病毒(Marburg virus,MBV);(4)艾滋病病毒(Human immunodeficiency virus,HIV);(5)寨卡病毒(Zika virus,ZKV);(6)狂犬病毒(rabies virus,RBV);(7)流感病毒(influenza virus,FLV);(8)尼帕病毒和裂谷热病毒(Nipah virus and riftvelley fever virus,NV-RFV);(9)冠状病毒(coronavirus,CoV),其中包括中东呼吸综合征(Middle East respiratory syndrome,MERS)和重症急性呼吸综合征(severe acute respiratory syndrome,SARS)等。特别是EBOV和CoV传播较快,病死率高,造成了严重公共健康危机[1-3]。     

新型冠状病毒肺炎流行期间神经急诊流程专家建议

在新型冠状病毒肺炎(COVID-19)疫情防控的关键时期,神经急诊面临各种挑战,既负责着疫情防控的重任,又面临接诊急性脑血管病和神经疾病的压力,中国人体健康科技促进会神经急诊重症监护专业委员会会同有关专家在前期疫情防控经验的基础上,分别在神经急诊接诊、抢救、外出转运、绿色通道等工作流程给予专家建议,供广大同行参考并在实践中改进,旨在为全国各级医院神经急诊重症医师在做好防护工作的同时,坚持神经急诊患者的救治提供参考。     

Impact of the vitamin D deficiency on COVID-19 infection and mortality in Asian countries

Background and aimsCOVID-19 is a pandemic that has affected beyond 100 million and caused nearly 3 million deaths globally. Vitamin D is a known risk factor for COVID-19. Therefore, we aimed to investigate the association of prevalence of vitamin D deficiency and mean vitamin D level with COVID-19 infection and mortality in Asia, predicting with other confounding factors such as median age, obesity, and diabetes.MethodsCOVID-19 infections and mortalities among the Asian countries were retrieved from the Worldometer website. Information on prevalence of vitamin D deficiency and mean vitamin D values in each Asian country was retrieved through literature searching on PubMed® and Google scholar. The associations between COVID-19 infections and mortalities with prevalence of vitamin D deficiency and mean vitamin D level were explored with correlation coefficients. As a predictive analysis, multiple linear regression was carried out with all confounders.ResultsPositive correlations were observed for prevalence of vitamin D deficiency with COVID-19 infections (r = 0.55; p = 0.01; R² = 0.31) and mortalities (r = 0.50; p = 0.01; R² = 0.25). Moreover, the associations for the COVID-19 infections and mortalities improved to r = 0.76 (p = 0.002; R² = 0.58) and r = 0.65 (p = 0.03; R² = 0.42), respectively, after predicting with confounding factors. Similarly, mean vitamin D level had a significant negative correlation with COVID-19 infections (r = ?0.77; p = 0.04; R² = 0.59) and mortalities (r = ?0.80; p = 0.03; R² = 0.63) when combining with confounders.ConclusionPrevalence of vitamin D deficiency is significantly positively associated whereas the mean vitamin D level is significantly negatively associated with both infection and mortality rate of COVID-19 among Asian countries upon predicting with all confounders.     

BCG vaccination induced protection from COVID-19

There are worldwide urgency, efforts, and uncertainties for the discovery of a vaccine against SARS CoV2. If successful, it will take its own time till useful for the humans. Till the specific vaccine is available, there are evidences for repurposing existing other vaccines. It is observed that countries having a routine BCG vaccination programme, have shown to have lower incidence of COVID-19, suggesting some protective mechanisms of BCG against COVID-19 in such countries. In countries like India despite vast population density and other adversities, and growing numbers of COVID19 infections, the mortality rate and severity of COVID has been low in comparison to some TB non-endemic countries (like Europe and USA). In addition, there are evidences that BCG vaccination offers partial protection and survival in low-income countries where tuberculosis is prevalent. The nonspecific effects (NSEs) of immune responses induced by BCG vaccination protect against other infections seem to be due to its immunological memory eliciting lymphocytes response and trained immunity. The protective effect on other viral infection in humans are believed to be mediated by heterologous lymphocyte activation and the initiation of innate immune memory may be applicable to SARS CoV2. The BCG vaccination at birth does not have a protective effect beyond childhood against COVID-19. In adults, there might be other factors dampening the virulence and pathogenicity of COVID-19. In the TB endemic countries like India, with high population density, similar to BCG vaccination, the environmental Mycobacteria might be imparting some immune-protection from severity and deaths of COVID-19.     

维生素D对肺癌的抑制作用

维生素D作为一种脂溶性维生素,其活性形式1α,25(OH)2D3是调节许多细胞生物学行为的激素.1α,25(OH)2D3通过与维生素D受体结合形成特别的复合物与细胞核内的维生素D反应元件连接,从而完成对细胞活动的调节,其对细胞癌变及癌变细胞的转移都有抑制作用.目前的体内和体外实验都充分证实,维生素D对肺癌细胞的生长、增殖和转移具有明确的抑制作用.临床研究发现促进维持高维生素D水平的因素及增加维生素D受体活性的多态性基因型对肺癌患者的预后改善和正常人患肺癌的风险的降低有益.     

Serum vitamin D and colonic vitamin D receptor in inflammatory bowel disease

AIM: To determine serum vitamin D levels and colonic vitamin D receptor(VDR) expression in inflammatory bowel disease(IBD) and non-IBD patients and correlate these with histopathology.METHODS: Puerto Rican IBD(n = 10) and non-IBD(n = 10) patients ≥ 21 years old scheduled for colonoscopy were recruited. Each patient completed a questionnaire and provided a serum sample and a colonic biopsy of normal-appearing mucosa. For IBD patients, an additional biopsy was collected from visually diseased mucosa. Serum vitamin D levels were measured by ultra-performance liquid chromatography and mass spectrometry. Hematoxylin and eosin stained tissue sections from colonic biopsies were classified histologically as normal or colitis(active/inactive), and scored for the degree of inflammation present(0-3, inactive/absent to severe). Tissue sections from colonic biopsies were also stained by immunohistochemistry for VDR, for which representative diagnostic areas were photographed and scored for staining intensity using a 4-point scale.RESULTS: The IBD cohort was significantly younger(40.40 ± 5.27, P 0.05) than the non-IBD cohort(56.70 ± 1.64) with a higher prevalence of vitamin D deficiency(40% vs 20%, respectively) and insufficiency(70% vs 50%, respectively). Histologic inflammation was significantly higher in visually diseased mucosa from IBD patients(1.95 ± 0.25) than in normalappearing mucosa from control patients(0.25 ± 0.08, P 0.01) and from IBD patients(0.65 ± 0.36, P 0.05) and correlated inversely with VDR expression in visually diseased colonic tissue from IBD patients(r =-0.44, P 0.05) and from IBD patients with Crohn's disease(r =-0.69, P 0.05), but not in normal-appearing colonic tissue from control patients or IBD patients. Control and IBD patient serum vitamin D levels correlated positively with VDR expression in normal colon from control and IBD patients(r = 0.38, P 0.05) and with patient age(r = 0.54, P 0.01). CONCLUSION: Levels of serum vitamin D correlate positively with colonic VDR expression in visually normal mucosa whereas inflammation correlates negatively with colonic VDR expression in visually diseased mucosa in Puerto Rican patients.     

Non-classical effects of vitamin D: Non-bone effects of vitamin D

Our understanding of vitamin D has improved considerably in recent years. The role of vitamin D in preventing osteoporotic fractures is now well-established. However, an important controversy has emerged in the last decade concerning the effects of the active form of vitamin D (1,25-dihydroxy-vitamin D) on tissues other than bone (non-classical effects). The demonstration that the vitamin D receptor (VDR) is ubiquitously, expressed combined with increasing observational data supporting a relationship between the level of 25-hydroxy-vitamin D in the serum and chronic metabolic disorders, cardiovascular disease and neoplasms, have led to its redefinition as a steroid hormone and the proposal of its use in preventing and/or treating those diseases. This article is an update on the different non-bone or non-classical effects of “vitamin-hormone D”, and its potential preventive or therapeutic role in certain diseases, however, this review is not exhaustive. The different modalities of substitution or supplementation proposed in France by the Groupe de Recherche et d’Information sur les Ostéoporoses (GRIO) are also summarised.     

维生素D缺乏与系统性红斑狼疮的相关性研究

目的 探讨系统性红斑狼疮（SLE）患者维生素D缺乏现象与疾病活动性的相关性.方法 选取60例SLE患者及30例健康志愿者,收集研究对象临床资料;ELISA法检测血清25-羟基维生素D[25-（OH）D]水平;采用Pearson相关分析法分析血清25-（OH）D水平与SLE疾病活动指数（SLEDAI）、抗ds-DNA抗体滴度、补体C3、补体C4、尿蛋白定量、血清免疫球蛋白G（IgG）的相关性.结果 （1）SLE患者血清25-（OH）D水平[36.8（23.4,53.2）nmol/L]较健康志愿者[58.8（51.1,65.3） nmol/L]明显降低（P＜0.01）;（2）SLE患者中维生素D缺乏比例为53.3％,严重维生素D缺乏比例为15.0％,健康志愿者中维生素D缺乏比例为23.3％,严重维生素D缺乏比例为6.7％,两组比较差异具有统计学意义（P＜0.01）.（3）SLE患者血清25-（OH）D水平与SLEDAI（r=-0.35,P＜0.05）及抗ds-DNA抗体滴度（r=-0.42,P＜0.05）呈负相关,与补体C3（r=0.25,P＜0.05）、补体C4（r=0.28,P＜0.05）呈正相关,与尿蛋白定量、血清IgG水平无明显相关性（P＞0.05）.结论 SLE患者中维生素D缺乏现象普遍存在,血清维生素D水平与疾病活动性具有一定相关性.     

Theoretical basis of a beneficial role for vitamin D in viral hepatitis

Abnormal bone metabolism and dysfunction of the calcium-parathyroid hormone-vitamin D axis have been reported in patients with viral hepatitis. Some studies suggested a relationship between vitamin D and viral hepatitis. Genetic studies have provided an opportunity to identify the proteins that link vitamin D to the pathology of viral hepatitis (i.e., the major histocompatibility complex class Ⅱ molecules, the vitamin D receptor, cytochrome P 450 , the renin-angiotensin system, apolipoprotein E, liver X receptor, toll-like receptor, and the proteins regulated by the Sp1 promoter gene). Vitamin D also exerts its effects on viral hepatitis via non-genomic factors, i.e., matrix metalloproteinase, endothelial vascular growth factor, prostaglandins, cyclooxygenase-2, and oxidative stress. In conclusion, vitamin D could have a beneficial role in viral hepatitis. Calcitriol is best used for viral hepatitis because it is the active form of the vitamin D 3 metabolite.