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维生素D的合理使用是近年来国内外关注的热点问题,美国国立卫生研究院(NIH)食品补充剂办公室提供了在线维生素D相关情况说明,包括参考值范围、维生素D的食物来源以及基于循证研究的有关维生素D与健康的讨论等。最近,欧洲Pérez-Lópeza博士及其同事的一项最新研究发现,相关流行病学和前瞻性研究提示,维生素D缺乏不仅与骨质疏松症有关,也与心血管疾病、糖尿病、癌症、感染和神经退行性疾病等相关。对骨骼影响方面的证据充分,但非骨骼影响方面的大型前瞻性研究甚少。维生素D的主要天然来源是经日光照射后由皮肤合成,少量来源于动物类食物,如富含脂肪的鱼、鸡蛋和牛奶等。通过测定血清25(OH)D可了解维生素D的水平。最佳血清25(OH)D的水平应为30~90ng/mL(75-225nmol/L),但在国际上尚未达成一致。该数值受季节(冬季偏低)、纬度、高度、空气污染、皮肤色素沉着、使用防晒品和服装遮盖等因素的影响。造成血清25(OH)D水平低的危险因素还包括:肥胖、吸收不良综合征、使用药物(如抗惊厥药物,抗逆转录病毒药物)、皮肤老化、日晒少和处于家庭护理中的人群。强化食品不一定能提供足量的维生素D,而夏天中午有规律的日晒(不使用防晒用品),每周3-4次,每次15分钟可维持健康水平。维生素D的每日推荐量为600IU/天,71岁及以上的人为800IU/天;当需要补充维生素时,可适当使用维生素D2(麦角钙化醇)或维生素D3(胆钙化醇)。有肾脏疾病或其他并发症者,根据患者情况决定其用量。本文对该项研究的核心内容和结论进行了摘译,以便于我国临床医师及公众了解相关研究进展,并可作为合理使用维生素D的临床用药参考。
The rational use of vitamin D is a hot issue at home and abroad in recent years. The National Institutes of Health (NIH) Office of Food Supplement provides an online description of vitamin D, including the reference range, the food source of vitamin D, Study on vitamin D and health discussion. A recent study by Dr. Pérez-Lópeza and colleagues in Europe found that relevant epidemiological and prospective studies suggest that vitamin D deficiency is not only associated with osteoporosis but also with cardiovascular disease, diabetes, cancer, infection and Neurodegenerative diseases and other related. There is good evidence for bone effects, but large, prospective studies of non-skeletal effects are rare. The main natural source of vitamin D is sun-shine after the skin synthesis, a small amount of animal-derived foods, such as fat-rich fish, eggs and milk. By measuring the serum 25 (OH) D can understand the level of vitamin D. Best serum 25 (OH) D levels should be 30 ~ 90ng / mL (75-225nmol / L), but in the world has not yet reached an agreement. The values are influenced by factors such as season (low winter), latitude, altitude, air pollution, skin pigmentation, the use of sunscreens and clothing covering. Other risk factors for low serum 25 (OH) D levels include obesity, malabsorption syndrome, the use of medications (eg, anticonvulsants, antiretrovirals), skin aging, less sun exposure, and people in home care . Fortified foods may not be able to provide enough vitamin D, while regular sunburn summer (no sunscreen use), 3-4 times a week, every 15 minutes to maintain the health level. The recommended daily dose of vitamin D is 600 IU / day, and those aged 71 and over are 800 IU / day; vitamin D2 (ergocalciferol) or vitamin D3 (cholecalciferol) may be used when vitamin supplementation is required. Have kidney disease or other complications, according to the patient’s condition to decide its dosage. In this paper, the core contents and conclusions of the study were excerpted, so that our clinicians and the public to understand the progress of relevant research, and can be used as a reasonable reference for the clinical use of vitamin D.