Department of Internal Medicine, St Antonius Hospital, , Nieuwegein, The Netherlands.
Thorax. 2013 Nov;68(11):990-6. doi: 10.1136/thoraxjnl-2013-203623. Epub 2013 Jul 26.
Vitamin D plays a role in host defence against infection. Vitamin D deficiency has been associated with an increased risk of respiratory tract infections in children and adults. This study aimed to examine whether vitamin D supplementation is associated with a lower pneumonia risk in adults.
Three independent case-control studies were performed including a total of 33 726 cases with pneumonia in different settings with respect to hospitalisation status and a total of 105 243 controls. Cases and controls were matched by year of birth, gender and index date. The major outcome measure was exposure to vitamin D supplementation at the time of pneumonia diagnosis. Conditional logistic regression was used to compute ORs for the association between vitamin D supplementation and occurrence of pneumonia.
Vitamin D supplementation was not associated with a lower risk of pneumonia. In studies 1 and 2, adjustment for confounding resulted in non-significant ORs of 1.814 (95% CI 0.865 to 3.803) and 1.007 (95% CI 0.888 to 1.142), respectively. In study 3, after adjustment for confounding, the risk of pneumonia remained significantly higher among vitamin D users (OR 1.496, 95% CI 1.208 to 1.853). Additional analyses showed significant modification of the association through co-use of corticosteroids and drugs that affect bone mineralisation. For patients using these drugs, ORs below one were found combined with higher ORs for patients not using these drugs.
This study showed no preventive association between vitamin D supplementation and the risk of pneumonia in adults.
维生素 D 在宿主抗感染防御中发挥作用。维生素 D 缺乏与儿童和成人呼吸道感染风险增加有关。本研究旨在探讨维生素 D 补充是否与成年人肺炎风险降低相关。
进行了三项独立的病例对照研究，共纳入了 33726 例在不同环境下因肺炎住院的病例和 105243 例对照，这些研究涉及到住院状态。病例和对照按出生年份、性别和索引日期进行匹配。主要结局指标为肺炎诊断时维生素 D 补充的暴露情况。采用条件逻辑回归计算维生素 D 补充与肺炎发生之间的关联的比值比（OR）。
维生素 D 补充与肺炎风险降低无关。在研究 1 和 2 中，调整混杂因素后，维生素 D 补充的非显著性 OR 分别为 1.814（95%CI 0.865 至 3.803）和 1.007（95%CI 0.888 至 1.142）。在研究 3 中，调整混杂因素后，维生素 D 使用者肺炎的风险仍然显著更高（OR 1.496，95%CI 1.208 至 1.853）。进一步分析表明，皮质类固醇和影响骨矿物质化的药物共同使用会改变这种关联。对于同时使用这些药物的患者，发现比值比低于 1，而对于未使用这些药物的患者，比值比则较高。
本研究表明，维生素 D 补充与成年人肺炎风险之间没有预防关联。
