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维生素D,您补对了吗?
发布时间:2023-10-25 | 来源:宜宾市第五人民医院 | 浏览:5624
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   维生素D,您补对了吗?


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维生素D是一种脂溶性的开环固醇类物质,是人体必不可少的脂溶性维生素,除发挥调节钙磷代谢、维持骨健康的功能外,还参与组织细胞的分化、增殖和免疫调节。
        
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维生素D缺乏和不足是全球公共卫生问题之一,其主要原因是阳光直接暴露不足、膳食中缺乏维生素D。孕妇、肤色深的人群(黑人、西班牙人、皮肤黑色素增加者)、肥胖者、儿童和老年人是维生素D缺乏的高风险人群。全球约30%~ 60%的儿童和成年人存在维生素D缺乏和不足;欧洲国家的维生素D缺乏率为 6.9%~81.8% 。国外一项研究发现 36%的孕妇缺乏维生素 D1。《2015—2017 年中国居民营养与健康状况监测报告》显示,2016—2017年中国6~17岁儿童青少年血清维生素D缺乏率为 18.6%;男童血清维生素D缺乏率为15.0%,女童为22.7%;城市儿童青少年血清维生素D 缺乏率为 18.7%,农村儿童青少年为18.5%;2015年中国≥18 岁人群血清维生素D缺乏率为21.4%;男性血清维生素 D缺乏率为16.1%,女性为26.8%;城市居民血清维生素D缺乏率为24.7%,农村居民为17.8%2维生素D缺乏会导致佝偻病、骨质软化症、手足抽搐症、骨质疏松症,并与癌症、心血管疾病、糖尿病、慢性肾脏病、自身免疫疾病等相关。

与维生素D缺乏相关的3种骨性疾病:
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01
小儿佝偻病
这是因缺乏维生素D引起钙、磷代谢失常而发生的以骨骼及软骨基质的生长板钙化缺陷疾病,以骨骼甚至发育障碍为主,更是一种严重危害儿童的慢性营养性疾病。

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02
骨质疏松症
这是一种由多种原因导致的骨密度和骨质量下降,骨微结构破坏,造成骨脆性增加,从而容易发生骨折的全身性骨病。

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03
软骨病
软骨病是由于血清25-(OH)D缺乏、缺钙或缺磷, 导致成年人的骨质矿化不足。多发生于妊娠、多产妇、体弱多病的老人。大部分情况下, 软骨病患者的血清25-(OH)D水平降低。

维生素D缺乏相关的6种非骨性疾病:
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01
肌力减弱
维生素D促进蛋白质合成和肌肉细胞生长,骨骼肌是活性维生素D代谢产物的靶器官,近端肌无力是维生素D缺乏的特征性表现。  
除此之外,维生素D可以通过影响肌细胞膜的钙离子通道调节蛋白酶A及C的信息转录等非基因途径影响肌肉钙代谢。维生素D缺乏时,肌力下降,骨折风险增加。
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02
代谢综合征
这是多种代谢异常簇集发生在同一个体的临床状态:主要包括肥胖、糖耐量减低/糖尿病、脂代谢紊乱、高血压等。
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03
高血压
补充维生素D可降低高血压患者和甲状旁腺功能亢进患者的血压,维生素D与血压相关联的机制与肾素-血管紧张素系统密切相关。
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04
糖尿病
目前研究发现维生素D与糖尿病关系密切,维生素D缺乏不仅可以使胰岛β细胞功能紊乱、加重胰岛素抵抗,还能增加糖尿病心血管并发症的发病率。
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05
感染
维生素D可诱导固有免疫细胞表达抗菌肽。抗菌肽具有抗细菌和抗病毒活性,维生素D不足可导致机体防御反应降低,可能是感染易发的原因之一。
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06
肿瘤
维生素D可促进细胞分化、抑制细胞增殖。缺乏维生素D,可能导致某些恶性肿瘤的发生。
在许多良性及恶性肿瘤中发现了维生素D受体,研究认为维生素D可抑制多种人类肿瘤细胞增殖,其中包括肺癌、前列腺癌、结肠癌和白血病细胞等。
维生素D营养状况评价应依据维生素D缺乏的病因、临床表现、血生化及骨骼X线检查,测定血清25(OH)D水平是最可靠的诊断标准。

维生素D营养状况判定指标及参考判定值[μg/L(nmol/L)]
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在普通人群中因地制宜进行维生素D营养状况评价,根据风险及合并危险因素的情况进行分层干预。对于维生素D水平正常或不足人群,应积极预防维生素D缺乏;对维生素D缺乏者,可通过增加户外活动、日光照射时间、改善膳食维生素D摄入、补充维生素D制剂和钙剂等方法维持机体维生素D的正常水平。

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宜宾市第五人民医院检验科每日常规开展血清25(OH)D检测,有任何检测咨询及报告疑问解答请致电:0831-3334478.

参考文献:
[1]McAreeT,JacobsB,Manickavasagar T, et al. Vitamin D deficiency in pregnancystill a public health issue[J]. Matern Child Nutr, 2013, 9(1): 2330. DOI: 10.1111/ mcn.12014.
[2] 赵丽云, 丁钢强, 赵文华 . 20152017年中国居民营养与健康状况监测报告[M]. 北京: 人民卫生出版社, 2022.

供稿:检验科  任宴梅  肖家琪
核稿:曹   芳
审稿:徐风万


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