García de Tena Jaime, El Hachem Debek Abdulkader, Hernández Gutiérrez Cristina, Izquierdo Alonso José Luis
Servicio de Medicina Interna, Hospital Universitario de Guadalajara, Guadalajara, España; Departamento de Medicina y Especialidades Médicas, Universidad de Alcalá, Alcalá de Henares, España.
Servicio de Neumología, Hospital Universitario de Guadalajara, Guadalajara, España.
Arch Bronconeumol. 2014 May;50(5):179-84. doi: 10.1016/j.arbres.2013.11.023. Epub 2014 Jan 18.
There has been growing interest in recent years in the extraosseous effects of vitamin D. In this article, we review the physiology of vitamin D, the physiopathological effects associated with vitamin D deficit and the available evidence on its etiopathogenic role in respiratory diseases. Given the pleiotropic actions of vitamin D, it is biologically plausible that the deficit of this vitamin could play a pathogenic role of in the development of various respiratory diseases. However, the many epidemiological studies that have shown an association between low vitamin D levels and a higher risk of developing various respiratory diseases or a poorer prognosis if they do appear, were unable to show causality. Post-hoc analyses of some clinical trials, particularly in chronic obstructive pulmonary disease (COPD) and asthma, appear to suggest that some patient subtypes may benefit from correction of a vitamin D deficit. In this respect, it would be interesting to determine if the interindividual differences found in the effect of vitamin D deficit and responses to correcting this deficit could be explained by the genetic variants involved in vitamin D metabolism. Ultimately, only appropriately designed clinical trials will determine whether 25-OHD supplements can prevent or improve the course of the various respiratory diseases in which an epidemiological association between prognosis and vitamin D deficit has been described.
近年来，人们对维生素D的骨外效应越来越感兴趣。在本文中，我们综述了维生素D的生理学、与维生素D缺乏相关的生理病理效应以及其在呼吸系统疾病发病机制中致病作用的现有证据。鉴于维生素D具有多效性作用，这种维生素的缺乏在各种呼吸系统疾病的发生发展中发挥致病作用在生物学上是合理的。然而，许多流行病学研究表明维生素D水平低与发生各种呼吸系统疾病的风险较高或如果发病则预后较差之间存在关联，但未能证明因果关系。一些临床试验的事后分析，特别是在慢性阻塞性肺疾病（COPD）和哮喘方面，似乎表明某些患者亚组可能受益于维生素D缺乏的纠正。在这方面，确定维生素D缺乏效应和纠正这种缺乏的反应中发现的个体差异是否可以由参与维生素D代谢的基因变异来解释将是很有意思的。最终，只有经过适当设计的临床试验才能确定25-羟维生素D补充剂是否可以预防或改善各种呼吸系统疾病的病程，在这些疾病中已经描述了预后与维生素D缺乏之间的流行病学关联。
