A POSSIBLE LINK BETWEEN VITAMIN-D DEFICIENCY AND IMPAIRED HOST DEFENSE TO MYCOBACTERIUM-TUBERCULOSIS
A POSSIBLE LINK BETWEEN VITAMIN-D DEFICIENCY AND IMPAIRED HOST DEFENSE TO MYCOBACTERIUM-TUBERCULOSIS
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DOI：
10.1016/0041-3879(85)90068-6
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发表时间：
1985-01-01
期刊：
影响因子：
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通讯作者：
DAVIES, PDO
中科院分区：
文献类型：
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作者：
DAVIES, PDO
作者从他自己的工作和其他人的工作中收集了证据，表明维生素D水平低下可能是一个病因因素，可以解释英国结核病流行病学的某些方面。1978年至1979年进行的一项全国调查显示，印度次大陆人种的呼吸道结核病年发病率是白人的30倍，非呼吸道疾病的年发病率是白人的80倍。在白人人口中，年龄最大的年龄组结核病发病率最高；受感染的人主要是流浪者和寄宿者，而且几乎都是中年男性。许多工人报告说，在英国的亚洲人的维生素D水平比本土白人低，而且这两个种族的老年人缺乏维生素D的风险都在增加。作者还指出，他自己的研究表明，在英国，结核病患者的血清25-羟基胆钙化醇（25-OHD）浓度明显低于匹配的对照个体，而在印度尼西亚，25-OHD浓度较高的患者的病情较轻。最近的研究确实表明，维生素D缺乏可能会导致细胞免疫反应受损，而抗结核病最有效的两种药物异烟肼和利福平似乎都会损害维生素D的代谢。因此，有证据支持维生素D缺乏可能对化疗产生不利影响的可能性。[然而，目前可用的证据表明，特定人群缺乏维生素D可能使他们更容易感染结核病，这可能被错误地解释了。在作者声称支持这一假设的两项研究中，他都忽略了血清25-OHD是由日光照射决定的这一事实。在为50名呼吸道结核病患者（主要是白人）选择匹配的对照个体时，他考虑了年龄和性别，并在可能的情况下使用了其他家庭成员，但没有提到户外消遣、职业、最近的假期等特征，所有这些特征都已被证明会影响维生素D的状态。在他的印度尼西亚研究中，患者和对照组之间的维生素D水平没有差异，他的结论是维生素D水平低可能会导致更严重的感染，这忽略了社会经济因素的影响，而社会经济因素在决定感染机会和暴露于阳光下的可能性方面可能更为重要。说,公牛。1986、83、摘要2281]。在英国，毫无疑问，许多亚洲人的维生素D水平很低，但据我所知，没有人检查过游民等的血清25-OHD，其中许多人的25-OHD浓度可能相对较高，因为他们的户外生活方式。无论如何，25-OHD随年龄增长的下降在女性中比在男性中更为明显；研究表明，在65岁以上的男性中，25-OHD的浓度在所有年龄段都较高。因此，维生素D状况似乎不太可能导致英国白人男性易患结核病，尽管亚洲社区的维生素D状况往往较差，但作者并未排除社会经济因素可能导致感染风险增加和维生素D状况较差的可能性，并且需要更好的控制Thurnham
The author has drawn together evidence from his own work and that of others to suggest that poor vitamin D status may be an aetiological factor to explain certain aspects of the epidemiology of tuberculosis (TB) in the UK.A national survey carried out in 1978-79 showed that the annual incidence for respiratory TB among persons whose ethnic origins were in the Indian subcontinent was 30 times greater than that in the white population and for non-respiratory disease, 80 times. In the white population it is the oldest age groups which have the highest incidence of TB; those infected comprise particularly vagrants and lodging-house dwellers and are almost entirely men in the latter half of life. Many workers have reported that vitamin D status of Asians in the UK is poorer than that of the indigenous white population and also that there is an increased risk of vitamin D deficiency in the elderly of both racial groups. The author also points out that his own studies demonstrated in the UK significantly lower serum 25-hydroxycholecalciferol (25-OHD) concentrations in tuberculosis patients than in matched control individuals, and in Indonesia less severe disease in those with higher 25-OHD concentrations.Recent work does suggest that vitamin D deficiency may result in an impaired cellular immune response and that the 2 most effective drugs against TB, isoniazid and rifampicin, would both appear to compromise vitamin D metabolism. Therefore, there is evidence to support the possibility that vitamin D deficiency may adversely affect chemotherapy. [However, the evidence currently available to suggest that poor vitamin D status in particular groups may make them more vulnerable to infection from TB may have been wrongly interpreted. In both of the author's studies where he claims support for this hypothesis he overlooks the fact the serum 25-OHD was determined by daylight exposure. In selecting matched control individuals for a study on 50, mainly white, patients with respiratory TB, he took into account age and sex and used other family members where possible, but characteristics such as outdoor pastimes, occupation, recent holidays etc., all of which have been shown to influence vitamin D status, were not mentioned. In his Indonesian study there was no difference in vitamin D status between patients and control subjects and his conclusion that poor vitamin D status may have predisposed to more severe infection overlooked the influence of socioeconomic factors which are probably much more important in determining both chance of infection and exposed to sunlight [seeTrop. Dis. Bull.,1986,83,abst. 2281]. In the UK there is no doubt that many Asians have poor vitamin D status but no one to my knowledge has examined the serum 25-OHD of vagrants etc., many of whom may well have relatively high concentrations of 25-OHD because of their outdoor lifestyle. In any case, the fall in 25-OHD with age is much more evident in women than in men; studies have shown that over the age of 65 years the concentration of 25-OHD is higher in men at all ages.It would seem unlikely, therefore, that vitamin D statusper seis responsible for predisposing white UK males to TB and, although vitamin D status is often poor in the Asian community, the author has not excluded the possibility that socioeconomic factors may be responsible both for the increased risk of infection and the poor vitamin D status, and better controls are needed.]newline˜D.I. Thurnham