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维生素D与小儿消化系统疾病之间的相互作用

The Crosstalk between Vitamin D and Pediatric Digestive Disorders.

作者信息

Mărginean Cristina Oana, Meliț Lorena Elena, Borka Balas Reka, Văsieșiu Anca Meda, Fleșeriu Tudor

机构信息

Department of Pediatrics I, "George Emil Palade" University of Medicine, Pharmacy, Science, and Technology of Târgu Mureș, Gheorghe Marinescu Street No 38, 540136 Târgu Mureș, Romania.

Department of Infectious Disease, "George Emil Palade" University of Medicine, Pharmacy, Science, and Technology of Târgu Mureș, Gheorghe Marinescu Street No 38, 540136 Târgu Mureș, Romania.

出版信息

Diagnostics (Basel). 2022 Sep 27;12(10):2328. doi: 10.3390/diagnostics12102328.

Abstract

Vitamin D is a cyclopentane polyhydrophenanthrene compound involved mainly in bone health and calcium metabolism but also autophagy, modulation of the gut microbiota, cell proliferation, immune functions and intestinal barrier integrity. The sources of vitamin D include sunlight, diet and vitamin D supplements. Vitamin D3, the most effective vitamin D isoform is produced in the human epidermis as a result of sunlight exposure. Vitamin D undergoes two hydroxylation reactions in the liver and kidney to reach its active form, 1,25-dihydroxyvitamin D. Recent studies highlighted a complex spectrum of roles regarding the wellbeing of the gastrointestinal tract. Based on its antimicrobial effect, it was recently indicated that vitamin D supplementation in addition to standard eradication therapy might enhance eradication rates. Moreover, it was suggested that low levels of vitamin D might also be involved in the acquisition of infection. In terms of celiac disease, the negative effects of vitamin D deficiency might begin even during intrauterine life in the setting of maternal deficiency. Moreover, vitamin D is strongly related to the integrity of the gut barrier, which represents the core of the pathophysiology of celiac disease onset, in addition to being correlated with the histological findings of disease severity. The relationship between vitamin D and cystic fibrosis is supported by the involvement of this micronutrient in preserving lung function by clearing airway inflammation and preventing pathogen airway colonization. Moreover, this micronutrient might exert anticatabolic effects in CF patients. Inflammatory bowel disease patients also experience major benefits if they have a sufficient level of circulating vitamin D, proving its involvement in both induction and remission in these patients. The findings regarding the relationship between vitamin D, food allergies, diarrhea and constipation remain controversial, but vitamin D levels should be monitored in these patients in order to avoid hypo- and hypervitaminosis. Further studies are required to fill the remaining gaps in term of the complex impact of vitamin D on gastrointestinal homeostasis.

摘要

维生素D是一种环戊烷多氢菲化合物,主要参与骨骼健康和钙代谢,还涉及自噬、肠道微生物群调节、细胞增殖、免疫功能和肠道屏障完整性。维生素D的来源包括阳光、饮食和维生素D补充剂。维生素D3是最有效的维生素D异构体,人体表皮在阳光照射下会产生这种物质。维生素D在肝脏和肾脏中经历两次羟基化反应,以达到其活性形式1,25-二羟基维生素D。最近的研究突出了维生素D在胃肠道健康方面的一系列复杂作用。基于其抗菌作用,最近有研究表明,在标准根除疗法的基础上补充维生素D可能会提高根除率。此外,有人提出维生素D水平低可能也与感染的发生有关。就乳糜泻而言,维生素D缺乏的负面影响甚至可能在母亲缺乏维生素D的情况下,在子宫内就开始出现。此外,维生素D与肠道屏障的完整性密切相关,肠道屏障完整性是乳糜泻发病病理生理学核心,而且还与疾病严重程度的组织学表现相关。维生素D与囊性纤维化之间的关系得到了这种微量营养素通过清除气道炎症和防止病原体在气道定植来维持肺功能的支持。此外,这种微量营养素可能对囊性纤维化患者发挥抗分解代谢作用。炎症性肠病患者如果循环维生素D水平充足,也会受益匪浅,这证明维生素D参与了这些患者的疾病诱导和缓解过程。关于维生素D与食物过敏、腹泻和便秘之间关系的研究结果仍存在争议,但应监测这些患者的维生素D水平,以避免维生素缺乏症和维生素过多症。关于维生素D对胃肠道内环境稳定的复杂影响,还需要进一步研究来填补剩余的空白。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/28d8/9600444/a9800806feb8/diagnostics-12-02328-g001.jpg

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