Sun Mengqing, Qian Yang, Cai Chenting, Zhang Jiaqian, Qi Ruonan, Ma Hongying, Ding Qunli, Wang Shanshan, Lv Dan
Department of Respiratory and Critical Care Medicine, the First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang Province, People's Republic of China.
Int J Chron Obstruct Pulmon Dis. 2025 Jun 23;20:2023-2033. doi: 10.2147/COPD.S520795. eCollection 2025.
Vitamin D is well known for its role in bones, but it also has a variety of extra-skeletal effects. Vitamin D deficiency is becoming a global health problem. Chronic obstructive pulmonary disease (COPD) is the third leading cause of death in the world, resulting in an enormous medical and economic burden. Accumulating evidence indicates a high prevalence of vitamin D deficiency in patients with COPD, which has emerged as a significant modulator of disease progression. This comprehensive review systematically examines the multifactorial etiology of vitamin D deficiency in COPD, encompassing insufficient sunlight exposure, malnutrition, smoking, comorbidities, and chronic inflammatory states. Clinical observational studies have demonstrated significant associations between vitamin D deficiency and increased exacerbation frequency, accelerated lung function decline, and elevated mortality risk. Mechanistically, we elucidate the pleiotropic effects of vitamin D in COPD pathogenesis, including its anti-inflammatory activity, suppression of oxidative stress, modulation of innate and adaptive immunity, inhibition of hepcidin, and reduction in pulmonary infection risk. Building on current evidence, we critically evaluate the clinical efficacy of various vitamin D supplementation strategies. This review aims to provide clinicians with an evidence-based framework for incorporating vitamin D assessment and supplementation into comprehensive COPD management while also identifying key directions for future research.
维生素D因其在骨骼方面的作用而广为人知,但它也具有多种骨骼外效应。维生素D缺乏正成为一个全球性的健康问题。慢性阻塞性肺疾病(COPD)是全球第三大死因,造成了巨大的医疗和经济负担。越来越多的证据表明,COPD患者中维生素D缺乏的患病率很高,维生素D缺乏已成为疾病进展的一个重要调节因素。这篇综述系统地研究了COPD患者维生素D缺乏的多因素病因,包括阳光照射不足、营养不良、吸烟、合并症和慢性炎症状态。临床观察性研究表明,维生素D缺乏与急性加重频率增加、肺功能加速下降和死亡风险升高之间存在显著关联。从机制上讲,我们阐明了维生素D在COPD发病机制中的多效性作用,包括其抗炎活性、氧化应激抑制、固有免疫和适应性免疫调节、铁调素抑制以及肺部感染风险降低。基于当前证据,我们批判性地评估了各种维生素D补充策略的临床疗效。本综述旨在为临床医生提供一个基于证据的框架,以便将维生素D评估和补充纳入COPD综合管理中,同时也确定未来研究的关键方向。