维生素D补充、慢性阻塞性肺疾病与哮喘急性加重以及肺功能下降
Vitamin D Supplementation, Chronic Obstructive Lung Disease and Asthma Exacerbations, and Lung Function Decline.
作者信息
Gold Diane R, Carey Vincent J, Hersh Craig P, Wan Emily, Camargo Carlos A, Lee I-Min, Cook Nancy R, Nassikas Nicholas, Buring Julie E, Manson JoAnn E, Luttmann-Gibson Heike
机构信息
The Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, United States; The Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, United States; Harvard Medical School, Boston, MA, United States.
The Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, United States; Harvard Medical School, Boston, MA, United States.
出版信息
J Nutr. 2025 May;155(5):1417-1428. doi: 10.1016/j.tjnut.2025.02.003. Epub 2025 Feb 6.
BACKGROUND
It remains unclear whether supplementation with vitamin D reduces risk of acute exacerbations of chronic obstructive lung disease (COPD) or asthma, major contributors to the world-wide burden of disease.
OBJECTIVES
To compare effects of vitamin D with placebo supplementation for the prespecified primary endpoints 1) acute exacerbations of COPD and 2) decline in pulmonary function measures of airflow obstruction. Prespecified secondary endpoints included asthma exacerbations and control.
METHODS
Lung VITamin D and OmegA-3 TriaL (VITAL) is an ancillary study of VITAL, a United States nationwide, randomized, placebo-controlled trial with a 2-by-2 factorial design of vitamin D (2000 IU/d) and marine n-3 fatty acids (1 g/d) among men 50 y and women 55 y of age or older. Of 25,871 randomly divided participants, 3632 at risk for respiratory exacerbations, including 1977 with COPD by diagnosis or symptoms and 1654 with self-reported asthma diagnosis, were followed annually for 5 y by self-administered respiratory questionnaire. Spirometry was performed at baseline and 2 y after randomization by 1648 participants from 12 urban centers. Decline in forced expiratory volume in 1 s (FEV) and FEV/forced vital capacity was measured between baseline and follow-up.
RESULTS
Supplementation with vitamin D was not associated with lower risk of any primary or secondary end point. Over the 5-y follow-up, the number of COPD exacerbations was 0.27/y in the vitamin D group and 0.25/y in the placebo group (rate ratio 1.10; 95% confidence interval, 0.93, 1.29). Over the 2-y follow-up, supplementation was not associated with slower decline (mL/y) in FEV.
CONCLUSIONS
Supplementation with vitamin D, compared with placebo, did not result in a lower rate of COPD exacerbations or improved pulmonary function in community-dwelling adults not selected for vitamin D deficiency. This trial was registered at Lung VITAL clinicaltrials.gov as NCT01728571 with Protocol ID 2010-P-000622 (https://prevention.cancer.gov/clinical-trials/clinical-trials-search/nct01728571).
背景
补充维生素D是否能降低慢性阻塞性肺疾病（COPD）或哮喘急性加重的风险尚不清楚，而这两种疾病是全球疾病负担的主要因素。
目的
比较维生素D与安慰剂补充剂对预先设定的主要终点的影响，即1）COPD急性加重和2）气流阻塞肺功能指标的下降。预先设定的次要终点包括哮喘加重和控制情况。
方法
肺维生素D和ω-3试验（VITAL）是VITAL的一项辅助研究，VITAL是一项美国全国性的随机、安慰剂对照试验，采用2×2析因设计，对年龄在50岁及以上男性和55岁及以上女性补充维生素D（2000 IU/天）和海洋n-3脂肪酸（1 g/天）。在25871名随机分组的参与者中，3632名有呼吸加重风险，包括1977名经诊断或有症状的COPD患者和1654名自我报告有哮喘诊断的患者，通过自我管理的呼吸问卷每年随访一次，为期5年。来自12个城市中心的1648名参与者在基线和随机分组后2年进行了肺活量测定。在基线和随访之间测量第1秒用力呼气量（FEV）和FEV/用力肺活量的下降情况。
结果
补充维生素D与任何主要或次要终点的较低风险无关。在5年的随访中，维生素D组的COPD加重次数为每年0.27次，安慰剂组为每年0.25次（率比1.10；95%置信区间，0.93，1.29）。在2年的随访中，补充剂与FEV较慢下降（mL/年）无关。
结论
与安慰剂相比，在未因维生素D缺乏而入选的社区居住成年人中，补充维生素D并未降低COPD加重率或改善肺功能。该试验在Lung VITAL clinicaltrials.gov上注册，注册号为NCT01728571，方案编号为2010-P-000622（https://prevention.cancer.gov/clinical-trials/clinical-trials-search/nct01728571）。
Zotero 插件