维生素 D 在 COVID-19 和长 COVID-19 中的药理学评价:最近的研究证实了临床验证,并强调二甲双胍可提高 VDR 敏感性和疗效。
Pharmacological evaluation of vitamin D in COVID-19 and long COVID-19: recent studies confirm clinical validation and highlight metformin to improve VDR sensitivity and efficacy.
机构信息
Department of Pharmacology, Faculty of Medicine, Assiut University, Assiut, Egypt.
Faculty of Agriculture, Assiut University, Assiut, Egypt.
出版信息
Inflammopharmacology. 2024 Feb;32(1):249-271. doi: 10.1007/s10787-023-01383-x. Epub 2023 Nov 13.
Nearly four years after its first appearance, and having gone from pandemic to endemic, the SARS-CoV-2 remains out of control globally. The purpose of this study was to evaluate the clinical efficacy of vitamin D (VD) in COVID-19 and long COVID-19, explain the discrepancy in clinical outcomes and highlight the potential impact of metformin on VD efficacy in recent articles. Articles from January 2022 to August 2023 were selected for this review. The objective of this study was achieved by reviewing, analyzing, and discussing articles demonstrating (1) the mechanism of action of VD (2) observational or randomized clinical trials (RCTs) that support or not the beneficial clinical effects of VD in COVID-19 or long COVID. (3) genetic and non-genetic reasons for the variation in the effects of VD. Articles were collected from electronic databases such as PubMed, Scopus, MEDLINE, Google Scholar, Egyptian Knowledge Bank, Science Direct, and Cochrane Database of Systematic Reviews. Twenty three studies conducted in vitro or in animal models indicated that VD may act in COVID-19 through protecting the respiratory system by antimicrobial peptide cathelicidins, reducing lung inflammation, regulating innate and adaptive immune functions and up regulation of autophagy gene activity. Our review identified 58 clinical studies that met the criteria. The number of publications supporting a beneficial clinical activity of VD in treating COVID-19 was 49 (86%), including 12 meta-analyses. Although the total patients included in all articles was 14,071,273, patients included in publications supporting a beneficial role of VD in COVID-19 were 14,029,411 (99.7%). Collectively, extensive observational studies indicated a decisive relationship between low VD levels and the severity of COVID-19 and mortality outcomes. Importantly, evidence from intervention studies has demonstrated the effectiveness of VD supplements in treating COVID-19. Furthermore, the results of 4 observational studies supported the beneficial role of VD in alleviating symptoms of long COVID-19 disease. However, eight RCTs and one meta-analysis of RCTs may contain low-grade evidence against a beneficial role of VD in COVID-19. Twenty-five articles have addressed the association between VDR and DBP genetic polymorphisms and treatment failure of VD in COVID-19. Impaired VDR signaling may underlie the variability of VD effects as non-genetic mechanisms. Interestingly, in recent studies, metformin has a beneficial therapeutic role in COVID-19 and long COVID-19, possibly by improving AMPK signaling of the VDR and enhancing the efficacy of the VD. In conclusion, evidence has been significantly strengthened over the past 18 months, with several meta-analyses and RCTs reporting conclusive beneficial effects of VD supplementation against COVID-19 and highlighting metformin to improve VDR sensitivity and efficacy in treating COVID-19 and long COVID-19.
新冠病毒(SARS-CoV-2)自首次出现以来已近四年,其流行状况已从大流行转变为地方病,但仍在全球范围内失控。本研究旨在评估维生素 D(VD)在 COVID-19 和长新冠中的临床疗效,解释临床结果的差异,并强调最近文章中二甲双胍对 VD 疗效的潜在影响。本综述选取了 2022 年 1 月至 2023 年 8 月的文章。通过回顾、分析和讨论表明:(1)VD 的作用机制;(2)观察性或随机对照临床试验(RCT)支持或不支持 VD 在 COVID-19 或长新冠中的有益临床效果;(3)VD 作用差异的遗传和非遗传原因的文章,实现了研究目标。文章来源于电子数据库,如 PubMed、Scopus、MEDLINE、Google Scholar、埃及知识库、Science Direct 和 Cochrane 系统评价数据库。23 项在体外或动物模型中进行的研究表明,VD 可能通过抗菌肽 cathelicidins 保护呼吸系统、减轻肺部炎症、调节先天和适应性免疫功能以及上调自噬基因活性来发挥作用。本综述共识别了 58 项符合标准的临床研究。支持 VD 在治疗 COVID-19 中具有有益临床活性的出版物数量为 49(86%),包括 12 项荟萃分析。尽管所有文章中总共包括了 14071273 名患者,但支持 VD 在 COVID-19 中具有有益作用的出版物中包括了 14029411(99.7%)名患者。综上所述,广泛的观察性研究表明,VD 水平低与 COVID-19 的严重程度和死亡率结局之间存在决定性关系。重要的是,干预研究的证据表明 VD 补充剂在治疗 COVID-19 方面有效。此外,4 项观察性研究的结果支持 VD 在缓解长新冠疾病症状方面的有益作用。然而,8 项 RCT 和一项 RCT 的荟萃分析可能包含证据质量较低,无法证明 VD 在 COVID-19 中的有益作用。25 篇文章探讨了 VDR 和 DBP 遗传多态性与 COVID-19 中 VD 治疗失败之间的关系。VD 信号转导受损可能是 VD 作用差异的非遗传机制。有趣的是,在最近的研究中,二甲双胍在 COVID-19 和长新冠中有有益的治疗作用,可能通过改善 VDR 的 AMPK 信号转导并增强 VD 的疗效来实现。总之,过去 18 个月的证据显著增强,几项荟萃分析和 RCT 报告了 VD 补充剂对抗 COVID-19 的明确有益作用,并强调了二甲双胍可提高 VDR 敏感性和治疗 COVID-19 和长新冠的疗效。