维生素D与哮喘发病率以及哮喘急性发作的关系：一项以人群为基础的大规模成人研究
2015/02/25
摘要
背景:缺乏维生素D对哮喘，哮喘发病率及其控制的影响尚不明确。本文旨在探索成人血清25-羟基维生素D水平与哮喘发病率以及哮喘急性发作之间的相关性。
方法：本研究从Clalit健康服务部门（Health Maintenance Organization 卫生维护组织）抽取了从2008年7月1日至2012年7月1日，有过维生素D测试结果的记录且年龄在22-50岁之间的以色列成人哮喘患者作为一个队列。我们对该人群中经医生诊断为哮喘以及哮喘急性发作的患者进行了鉴别。以下任何一种情况均被定义为哮喘急性发作：处方口服皮质类固醇激素，处方大于5次短效β-受体激动剂以及4次以上因哮喘就诊。研究采用logistic回归模型评估维生素D与哮喘的发生及其哮喘急性发作之间的相关性。
结果：该队列中纳入了约308，000名至少检测过一次维生素D水平的哮喘患者。其中，经医师诊断为哮喘的患者约为6.9％（21，237），而在一般人群中该比例为5.7％。两组的血清25-OHD水平近似。然而，缺乏维生素D的哮喘患者发生急性发作的可能性比处于正常水平范围的患者高出25％。在控制已知混杂因素的情况下，这种相关性依然存在。
结论：虽然维生素D水平与医生诊断的哮喘缺乏明显的相关性,但与哮喘急性发作呈强相关性。本文提供的证据支持对这种处于未控制以及反复急性发作的哮喘患者亚组进行维生素D的筛查。
Vitamin D, asthma prevalence and asthma exacerbations: a large adult population-based study
Confino CR, Brufman I, Goldberg A, Feldman BS.
ABSTRACT
BACKGROUND: The impact of low vitamin D status on asthma, asthma morbidity and control is unclear. We aimed to investigate in adults the associations between serum 25-hydroxyvitamin D level and prevalent asthma as well as asthma exacerbations.
METHODS: A cohort of Israeli adults aged 22–50 years with documented vitamin D status were extracted from Clalit Health Services (HMO) between July 1, 2008 and July 1, 2012. Among this population, those with physician-diagnosed asthma and asthma exacerbations were identified. Asthma exacerbations were defined as any of the following: prescription for oral corticosteroids, >5 prescriptions for short acting beta agonists and more than four visits to a physician for asthma. Logistic regression models assessed the associations between vitamin D and both asthma and asthma exacerbations.
RESULTS: Approximately 308 000 members with at least one vitamin D measurement were included in the cohort. Among them, 6.9% (21 237) had physician-diagnosed asthma vs 5.7% in the general population. Serum 25-OHD levels across both groups were similar. However, among those with vitamin D deficiency, the odds of having an exacerbation were 25% greater compared to those with levels in the normal range. This association remained significant after controlling for known confounders.
CONCLUSION: While there was no significant association between vitamin D status and physician-diagnosed asthma, there was a strong association with asthma exacerbations. The presented evidence supports vitamin D screening in the subgroup of asthmatics that are uncontrolled and experience recurrent exacerbations.
Allergy. 2014 Aug 19. doi: 10.1111/all.12508.
背景:缺乏维生素D对哮喘，哮喘发病率及其控制的影响尚不明确。本文旨在探索成人血清25-羟基维生素D水平与哮喘发病率以及哮喘急性发作之间的相关性。
方法：本研究从Clalit健康服务部门（Health Maintenance Organization 卫生维护组织）抽取了从2008年7月1日至2012年7月1日，有过维生素D测试结果的记录且年龄在22-50岁之间的以色列成人哮喘患者作为一个队列。我们对该人群中经医生诊断为哮喘以及哮喘急性发作的患者进行了鉴别。以下任何一种情况均被定义为哮喘急性发作：处方口服皮质类固醇激素，处方大于5次短效β-受体激动剂以及4次以上因哮喘就诊。研究采用logistic回归模型评估维生素D与哮喘的发生及其哮喘急性发作之间的相关性。
结果：该队列中纳入了约308，000名至少检测过一次维生素D水平的哮喘患者。其中，经医师诊断为哮喘的患者约为6.9％（21，237），而在一般人群中该比例为5.7％。两组的血清25-OHD水平近似。然而，缺乏维生素D的哮喘患者发生急性发作的可能性比处于正常水平范围的患者高出25％。在控制已知混杂因素的情况下，这种相关性依然存在。
结论：虽然维生素D水平与医生诊断的哮喘缺乏明显的相关性,但与哮喘急性发作呈强相关性。本文提供的证据支持对这种处于未控制以及反复急性发作的哮喘患者亚组进行维生素D的筛查。
(罗维嘉1 张红萍1 王刚1 四川大学华西医院中西医结合科呼吸病组 610041 摘译)
（Allergy. 2014 Aug 19. doi: 10.1111/all.12508.)
（Allergy. 2014 Aug 19. doi: 10.1111/all.12508.)
Vitamin D, asthma prevalence and asthma exacerbations: a large adult population-based study
Confino CR, Brufman I, Goldberg A, Feldman BS.
ABSTRACT
BACKGROUND: The impact of low vitamin D status on asthma, asthma morbidity and control is unclear. We aimed to investigate in adults the associations between serum 25-hydroxyvitamin D level and prevalent asthma as well as asthma exacerbations.
METHODS: A cohort of Israeli adults aged 22–50 years with documented vitamin D status were extracted from Clalit Health Services (HMO) between July 1, 2008 and July 1, 2012. Among this population, those with physician-diagnosed asthma and asthma exacerbations were identified. Asthma exacerbations were defined as any of the following: prescription for oral corticosteroids, >5 prescriptions for short acting beta agonists and more than four visits to a physician for asthma. Logistic regression models assessed the associations between vitamin D and both asthma and asthma exacerbations.
RESULTS: Approximately 308 000 members with at least one vitamin D measurement were included in the cohort. Among them, 6.9% (21 237) had physician-diagnosed asthma vs 5.7% in the general population. Serum 25-OHD levels across both groups were similar. However, among those with vitamin D deficiency, the odds of having an exacerbation were 25% greater compared to those with levels in the normal range. This association remained significant after controlling for known confounders.
CONCLUSION: While there was no significant association between vitamin D status and physician-diagnosed asthma, there was a strong association with asthma exacerbations. The presented evidence supports vitamin D screening in the subgroup of asthmatics that are uncontrolled and experience recurrent exacerbations.
Allergy. 2014 Aug 19. doi: 10.1111/all.12508.
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哮喘的诊断 – 新理论
