Kentson Magnus, Leanderson Per, Jacobson Petra, Persson Hans Lennart
Division of Medicine, Ryhov Hospital, Jönköping, Sweden.
Department of Medical and Health Sciences (IMH), Linköping University, Linköping, Sweden.
Int J Chron Obstruct Pulmon Dis. 2018 Apr 27;13:1389-1398. doi: 10.2147/COPD.S156121. eCollection 2018.
The prevalence of individuals deficient in vitamin D (defined as a serum level of the stable metabolite 25(OH)D <50 nmol/L) is increasing in countries with low annual ultraviolet (UV) radiation and among individuals unable to perform outdoor activities, for example, COPD patients.
To assess the role of vitamin D deficiency, independently of seasonal variation, the peak annual value of 25(OH)D was measured in subjects with advanced COPD ± long-term oxygen therapy (LTOT) and lung healthy control subjects. A method to grade the individual annual UV light exposure was designed and tested.
Sixty-six Caucasians with advanced COPD (28 with LTOT) and 47 control subjects were included, and the levels of 25(OH)D were determined in late summer/early fall when the annual peak was assumed. Questionnaires about COPD symptoms, general health, lifestyle, dietary habits and QoL were used to collect data. Lung function tests and blood sampling were performed.
The peak annual 25(OH)D of COPD subjects was significantly lower than in the control subjects, but there was no significant difference between COPD patients with and without LTOT. Ongoing vitamin D supplementation was the single most important intervention to maintain 25(OH)D levels ≥50 nmol/L. Among vitamin D-deficient COPD subjects, 25(OH) D correlated positively with forced expiratory volume in 1 second as % predicted, Modified British Medical Research Council score, blood oxygenation, food portion size, Mediterranean Diet Score and Ultraviolet Score.
Vitamin D deficiency was common among healthy individuals and COPD subjects. Peak annual 25(OH)D levels of COPD subjects correlated with clinically important outcomes. The present study emphasizes the need to routinely monitor vitamin D status among patients with advanced COPD and to consider to medicate those with vitamin D deficiency with vitamin D supplementation.
在年紫外线（UV）辐射量低的国家以及无法进行户外活动的人群（如慢性阻塞性肺疾病（COPD）患者）中，维生素D缺乏个体（定义为稳定代谢物25(OH)D血清水平<50 nmol/L）的患病率正在上升。
为了评估维生素D缺乏的作用，独立于季节变化，在晚期COPD±长期氧疗（LTOT）患者和肺部健康对照者中测量了25(OH)D的年度峰值。设计并测试了一种对个体年度紫外线暴露进行分级的方法。
纳入66例晚期COPD患者（28例接受LTOT）和47例对照者，在夏末/秋初测定25(OH)D水平，此时假定为年度峰值。使用关于COPD症状、总体健康状况、生活方式、饮食习惯和生活质量的问卷收集数据。进行肺功能测试和血液采样。
COPD患者的年度25(OH)D峰值显著低于对照者，但接受LTOT和未接受LTOT的COPD患者之间无显著差异。持续补充维生素D是维持25(OH)D水平≥50 nmol/L的最重要单一干预措施。在维生素D缺乏的COPD患者中，25(OH)D与预测值百分比的第1秒用力呼气量、改良英国医学研究委员会评分、血液氧合、食物份量、地中海饮食评分和紫外线评分呈正相关。
维生素D缺乏在健康个体和COPD患者中很常见。COPD患者的年度25(OH)D峰值与临床重要结局相关。本研究强调有必要对晚期COPD患者常规监测维生素D状态，并考虑对维生素D缺乏者补充维生素D进行药物治疗。
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