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Clinical Nutrition: 出现急性呼吸窘迫综合征的重症COVID-19患者的维生素D缺乏更为严重

2022-05-20 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具有很强的免疫调节作用,并且有研究已证明补充维生素D可预防呼吸道感染。但是,维生素D缺乏症在所有年龄组和国家都非常普遍,而且尚未确定维生素 D 缺乏与多器官功能障碍之间的因果关系。因此,维生素 D 作为治疗危重患者的补充添加剂仍然存在争议。本项研究旨在分析维生素 D 水平对COVID-19引起的急性呼吸窘迫综合征(ARDS) 患者的临床和免疫学影响。

 

这是一项针对确诊COVID-19感染且存在急性呼吸窘迫综合症(ARDS)的接受重症监护的患者的单中心回顾性研究。在患者入院时和第10-15天测量其体内的 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。从患者数据管理系统中提取临床参数。维生素 D 的干预措施为通过肠内营养喂食维生素D3 。

 

共有39名 COVID-19 ARDS 患者符合纳排条件,其中 26 名被纳入本研究。研究结果显示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水平明显不足。补充维生素D可以使血清 25-羟基维生素 D 水平升高,但第10天的25-羟基维生素 D 水平并未增加。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)。

 

本项研究结果证实绝大多数 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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    2022-05-20 zll0628
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