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维生素D和慢性病:机制,临床影响和未来的前景
Hong Wang1,2,3, Tingting Yuan1,2,3, Weihua Wu1,2,3
1Department of Nephrology, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China.
Frontiers in medicine
|October 30, 2025
概括
维生素D缺乏在慢性病 (CKD) 中很常见. 用营养维生素D补充缺乏症,但活性维生素D受体激活剂应保留在特定的二次性甲状腺功能障碍症症状中,并进行仔细监测.
科学领域:
- 腎臟病學 (nephrology) 是一種醫學.
- 内分泌学 在内分泌学.
- 营养科学 营养科学
背景情况:
- 维生素D缺乏在慢性病 (CKD) 中很普遍.
- 维生素D/维生素D受体 (VDR) 信号影响炎症,氧化应激,纤维生成,氨酸-氨酸-阿尔多斯特系统 (RAAS) 和肠-轴,表明具有保护性潜力.
- 本综述探讨了维生素D在CKD中的多方面的作用.
研究的目的:
- 审查目前关于维生素D补充剂和CKD中VDR激活剂的证据.
- 评估维生素D对CKD患者代孕和硬性临床结果的影响.
- 为CKD中维生素D管理提供一个务实的方法.
主要方法:
- 从2000年1月到2025年8月,从主要科学数据库 (PubMed/MEDLINE,Embase,Web of Science,Cochrane图书馆) 中识别出来的文献进行叙事审查.
- 包括不同阶段 (非透析,透析,移植) 的成年CKD人群.
- 检查的结果包括生物标记 (蛋白尿,EGFR斜率) 和硬临床终点 (功能衰竭,心血管事件,骨折,死亡率).
主要成果:
- 营养维生素D有效地纠正缺乏并改善实验室参数.
- 维生素D受体激活剂 (VDRAs) 可以抑制二次性副甲状腺功能障碍症 (SHPT).
- 对硬结局的持续益处尚未被证明,可能是由于患者群体,疾病阶段,联合疗法和维生素D配方/剂量策略的异质性. 有关活性剂和高剂量疗法存在诸如高血症等安全问题.
结论:
- 一种务实的方法是用营养维生素D (在特定情况下最好是D3或二醇) 补充维生素D缺乏,避免高剂量玻尿酸治疗方案.
- 活跃的VDRA应该保留给明确的SHPT指示,并仔细监测,酸盐和副甲状腺激素 (PTH).
- 维生素D不应该被定位为非选择性CKD患者的疾病修饰疗法;未来的试验需要专注于特定的表型和事件驱动的结果.
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