Sen Deepali, Ranganathan Prabha
Division of Rheumatology, Department of Medicine, Washington University School of Medicine, 660 S Euclid Avenue, St Louis, Missouri 63110, USA.
Discov Med. 2012 Nov;14(78):311-9.
Vitamin D deficiency is highly prevalent in the general population including individuals with rheumatoid arthritis (RA). Autocrine regulation of vitamin D modulates important biologic processes including immune responses. Vitamin D deficiency has been implicated in the pathogenesis of several autoimmune diseases including RA. Vitamin D regulates both the innate and adaptive immune responses. Recent evidence indicates that vitamin D's effects on the innate immune system are predominantly through the toll-like receptors (TLR) and on the adaptive immune system through T cell differentiation, particularly the Th17 response. As Th17 cells are critical in the pathogenesis of RA, this has led to an interest in the effects of vitamin D deficiency in RA. Several studies have looked at the association of vitamin D deficiency with markers of disease activity in RA with somewhat mixed results. Based on these results, although the role of vitamin D in mediating various biological processes is well defined, this has not translated into meaningful clinical associations in RA. Herein, we review the immune-modulatory role of vitamin D and its effects on pathogenesis, disease activity, and cardiovascular risk in RA.
维生素D缺乏在包括类风湿关节炎（RA）患者在内的普通人群中极为普遍。维生素D的自分泌调节可调节包括免疫反应在内的重要生物学过程。维生素D缺乏与包括RA在内的多种自身免疫性疾病的发病机制有关。维生素D可调节先天性和适应性免疫反应。最近的证据表明，维生素D对先天性免疫系统的影响主要通过 Toll 样受体（TLR），对适应性免疫系统的影响则通过T细胞分化，特别是Th17反应。由于Th17细胞在RA发病机制中至关重要，这引发了人们对维生素D缺乏在RA中作用的兴趣。多项研究探讨了维生素D缺乏与RA疾病活动标志物之间的关联，结果不一。基于这些结果，尽管维生素D在介导各种生物学过程中的作用已得到明确界定，但在RA中尚未转化为有意义的临床关联。在此，我们综述维生素D的免疫调节作用及其对RA发病机制、疾病活动和心血管风险的影响。
