Brighenti S, Bergman P, Martineau A R
Department of Medicine, Center for Infectious Medicine (CIM), Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden.
Department of Laboratory Medicine (LABMED), Clinical Microbiology, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden.
J Intern Med. 2018 May 27. doi: 10.1111/joim.12777.
Tuberculosis (TB) has troubled mankind for millennia, but current treatment strategies are long and complicated and the disease remains a major global health problem. The risk of Mycobacterium tuberculosis (Mtb) infection or progression of active TB disease is elevated in individuals with vitamin D deficiency. High-dose vitamin D was used to treat TB in the preantibiotic era, and in vitro experimental data show that vitamin D supports innate immune responses that restrict growth of Mtb. Several randomized controlled trials have tested whether adjunctive vitamin D supplementation enhances the clinical and microbiological response to standard antimicrobial chemotherapy for pulmonary TB. The effects have been modest at best, and attention is turning to the question of whether vitamin D supplementation might have a role in preventing acquisition or reactivation of latent Mtb infection. In this article, we describe the effects of vitamin D on host immune responses to Mtb in vitro and in vivo and review the results of clinical trials in the field. We also reflect on the findings of clinical trials of vitamin D supplementation for the prevention of acute respiratory tract infections, and discuss how these findings might influence the design of future trials to evaluate the role of vitamin D in the prevention and treatment of TB.
结核病困扰人类已有数千年，但目前的治疗策略漫长且复杂，该疾病仍是全球主要的健康问题。维生素D缺乏的个体感染结核分枝杆菌（Mtb）或患活动性结核病进展的风险会升高。在抗生素出现之前的时代，高剂量维生素D曾被用于治疗结核病，体外实验数据表明，维生素D可支持限制Mtb生长的固有免疫反应。多项随机对照试验检验了补充维生素D作为辅助治疗是否能增强肺结核患者对标准抗微生物化疗的临床和微生物学反应。其效果充其量也很有限，人们的注意力正转向补充维生素D是否可能在预防潜伏性Mtb感染的获得或再激活方面发挥作用这一问题。在本文中，我们描述了维生素D在体外和体内对宿主针对Mtb的免疫反应的影响，并综述了该领域的临床试验结果。我们还思考了补充维生素D预防急性呼吸道感染的临床试验结果，并讨论了这些结果可能如何影响未来评估维生素D在结核病预防和治疗中作用的试验设计。
