Laboratoire de Physiologie, CHU Necker, Paris, France.
Autoimmun Rev. 2010 Sep;9(11):709-15. doi: 10.1016/j.autrev.2010.06.009. Epub 2010 Jul 1.
There is increasing evidence that, in addition to the well-known effects on musculoskeletal health, vitamin D status may be related to a number of non-skeletal diseases. An international expert panel formulated recommendations on vitamin D for clinical practice, taking into consideration the best evidence available based on published literature today. In addition, where data were limited to smaller clinical trials or epidemiologic studies, the panel made expert-opinion based recommendations.
Twenty-five experts from various disciplines (classical clinical applications, cardiology, autoimmunity, and cancer) established draft recommendations during a 2-day meeting. Thereafter, representatives of all disciplines refined the recommendations and related texts, subsequently reviewed by all panelists. For all recommendations, panelists expressed the extent of agreement using a 5-point scale.
Recommendations were restricted to clinical practice and concern adult patients with or at risk for fractures, falls, cardiovascular or autoimmune diseases, and cancer. The panel reached substantial agreement about the need for vitamin D supplementation in specific groups of patients in these clinical areas and the need for assessing their 25-hydroxyvitamin D (25(OH)D) serum levels for optimal clinical care. A target range of at least 30 to 40 ng/mL was recommended. As response to treatment varies by environmental factors and starting levels of 25(OH)D, testing may be warranted after at least 3 months of supplementation. An assay measuring both 25(OH)D(2) and 25(OH)D(3) is recommended. Dark-skinned or veiled individuals not exposed much to the sun, elderly and institutionalized individuals may be supplemented (800 IU/day) without baseline testing.
越来越多的证据表明，维生素 D 状态除了对骨骼肌肉健康有众所周知的影响外，还可能与许多非骨骼疾病有关。一个国际专家小组根据目前已发表的文献，就维生素 D 的临床应用制定了建议，同时考虑到现有最佳证据。此外，在数据仅限于较小的临床试验或流行病学研究的情况下，专家组根据专家意见提出了建议。
来自不同学科（经典临床应用、心脏病学、自身免疫和癌症）的 25 名专家在为期两天的会议上制定了建议草案。此后，所有学科的代表都对建议和相关文本进行了细化，随后由所有小组成员进行了审查。对于所有建议，小组成员都使用 5 分制来表示对共识的程度。
建议仅限于临床实践，涉及有或有骨折风险、跌倒、心血管或自身免疫性疾病以及癌症的成年患者。专家组在这些临床领域的特定患者群体中需要补充维生素 D 以及需要评估其 25-羟维生素 D（25（OH）D）血清水平以获得最佳临床治疗方面达成了实质性共识。建议目标范围至少为 30-40ng/ml。由于治疗反应因环境因素和 25（OH）D 的起始水平而异，因此在补充后至少 3 个月可能需要进行检测。建议使用同时测量 25（OH）D（2）和 25（OH）D（3）的检测方法。肤色较深或蒙住面纱、很少暴露在阳光下的个体、老年人和机构化个体可以在没有基线检测的情况下补充（每天 800IU）。
