维生素D,衰老和免疫系统

V. Bueno
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摘要

免疫系统在衰老过程中发生的变化会增加感染风险、对肿瘤发展的易感性和自身免疫。为了避免这些情况,人们提出了体育锻炼、补充剂和益生菌等干预措施。补充维生素D可能有助于老年人的免疫系统稳态,因为大部分老年人的循环维生素D水平较低。此外,观察性研究表明,维生素D状态与感染、癌症、糖尿病和心血管疾病等慢性病之间存在关联。最近观察到,患有新冠肺炎和维生素D缺乏症的老年患者肺损伤严重程度加重,住院时间延长,死亡风险增加,这表明维生素D在新冠肺炎患者的预后中起着重要作用。在一份病例系列报告中,高剂量补充维生素D改善了临床恢复,但在另一项研究中,未发现维生素D水平与新冠肺炎感染风险之间存在明显联系。维生素D补充剂和疫苗接种后免疫反应的改善、结核病、肺炎和败血症的结果也存在争议。据推测,维生素D可以调节免疫系统,从而在对病原体/疫苗的免疫反应中提供效力,并减少炎症表型。这篇综述将讨论维生素D和免疫系统的稳态;基于文献的维生素D和感染的临床数据;以及维生素D与疫苗接种后免疫反应之间的可能联系。
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Vitamin D, ageing, and the immune system
Changes occurring in the immune system along the ageing process increase the risk of infection, susceptibility to tumor development, and autoimmunity. Interventions such as physical exercise, supplements, and probiotics have been proposed in order to circumvent these conditions. Vitamin D supplementation could contribute to the immune system homeostasis in older adults since a large proportion of this population has low levels of circulating vitamin D. Additionally, observational studies have shown the association between vitamin D status and infections, chronic diseases such as cancer, diabetes, and cardiovascular disease. Recently it was observed that old patients with COVID-19 and vitamin D deficiency had enhanced severity of lung damage, longer stay at the hospital, and increased risk of death, suggesting that vitamin D plays an important role in the patient outcome from COVID-19. A high dose of vitamin D supplementation improved clinical recovery in a case-series report but in another study, no evident link between levels of vitamin D and risk of COVID-19 infection was found. Results also remain debatable for vitamin D supplements and improvement of immune response after vaccination, tuberculosis, pneumonia, and sepsis. It has been hypothesized that vitamin D could modulate the immune system and thus provide both efficacies in the immune response to pathogens/vaccinations and reduction of the inflammatory phenotype. This review will discuss vitamin D and homeostasis of the immune system; the literature-based clinical data on vitamin D and infections; and the possible link between vitamin D and immune response after vaccination.
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