Calton E K, Keane K N, Newsholme P, Zhao Y, Soares M J
Food, Nutrition &Health, School of Public Health, Curtin Health Innovation Research Institute, Curtin University, Perth, WA, Australia.
School of Biomedical Sciences, Curtin Health Innovation Research Institute, Curtin University, Perth, WA, Australia.
Eur J Clin Nutr. 2017 Aug;71(8):931-943. doi: 10.1038/ejcn.2017.67. Epub 2017 May 10.
Causal links between vitamin D status [25(OH)D] and systemic inflammation were examined through a systematic review of randomized controlled trials (RCTs). Selected RCTs were ⩾12 weeks, conducted in adults free of acute inflammatory disease, and of high-quality (Jadad score ⩾3). Of 14 studies that met our criteria, 9 studies (15 study arms) permitted extraction of data. There was no effect on the weighted mean difference (WMD) of IL-6 (WMD (95% confidence interval)=0.1, (-0.166, 0.366) pg/ml, P=0.462) or C-reactive protein (CRP) (WMD=-0.324, (-1.007, 0.359) mg/l, P=0.352). Subgroup analyses of trials achieving ⩾80 nmol/l indicated a trend for lower CRP (WMD=-0.834, (-1.726, 0.058) mg/l, P=0.067), however heterogeneity was significant (I=66.7%, P=0.017). Studies employing a low dose (<1000 IU/d) showed increased CRP (WMD=0.615, (0.132, 1.098), P=0.013). In contrast, ⩾1000 IU/d had a favourable effect on CRP (WMD=-0.939, (-1.805, -0.073), P=0.034) but heterogeneity was significant (I=61.3%, P=0.017). Meta-regression indicated that older age predicted a significant decrease in IL-6 (β=-0.02, (-0.034, -0.006) pg/ml, P=0.013) and CRP (β=-0.06, (-0.103, -0.017), P=0.01), whereas a greater percentage of females (β=0.027, (0.011, 0.044), P=0.004) and longer study duration independently predicted a higher WMD for CRP (β=0.049, (0.018, 0.079), P=0.005). Available high-quality RCTs did not support a beneficial effect of cholecalciferol on systemic IL-6 and CRP. Future studies should consider the confounding effects of age, gender and study duration, while possibly targeting an achieved 25(OH)D ⩾80 nmol/l.
通过对随机对照试验（RCT）的系统评价，研究了维生素D状态[25(OH)D]与全身炎症之间的因果关系。入选的RCT持续时间≥12周，在无急性炎症性疾病的成年人中进行，且质量较高（雅达评分≥3）。在符合我们标准的14项研究中，9项研究（15个研究组）允许提取数据。维生素D对白细胞介素-6（IL-6）的加权平均差（WMD）（WMD（95%置信区间）=0.1，（-0.166，0.366）pg/ml，P=0.462）或C反应蛋白（CRP）（WMD=-0.324，（-1.007，0.359）mg/l，P=0.352）没有影响。对25(OH)D水平≥80 nmol/l的试验进行亚组分析表明，CRP有降低的趋势（WMD=-0.834，（-1.726，0.058）mg/l，P=0.067），然而异质性显著（I=66.7%，P=0.017）。采用低剂量（<1000 IU/d）的研究显示CRP升高（WMD=0.615，（0.132，1.098），P=0.013）。相比之下，≥1000 IU/d对CRP有有利影响（WMD=-0.939，（-1.805，-0.073），P=0.034），但异质性显著（I=61.3%，P=0.017）。Meta回归表明，年龄较大预示IL-6（β=-0.02，（-0.034，-0.006）pg/ml，P=0.013）和CRP（β=-0.06，（-0.103，-0.017），P=0.01）显著降低，而女性比例较高（β=0.027，（0.011，0.044），P=0.004）和研究持续时间较长独立预示CRP的WMD较高（β=0.049，（0.018，0.079），P=0.005）。现有的高质量RCT不支持胆钙化醇对全身IL-6和CRP有有益作用。未来的研究应考虑年龄、性别和研究持续时间的混杂效应，同时可能将目标设定为使25(OH)D≥80 nmol/l。
