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УДК: 613.2–053.6:577.16 DOI:10.33920/med-08-2410-03

Недостаточность витамина D и необходимость его восполнения при COVID-19

Кривошеев Владимир Васильевич д-р техн. наук, профессор, ведущий аналитик АУ Ханты-Мансийского автономного округа — Югры «Технопарк высоких технологий», 628011, г. Ханты-Мансийск, ул. Промышленная, д. 19, e-mail: vvk_usu@mail.ru, https://orcid.org/0000-0002-8125-0890
Козловский Илья Вячеславович врач высшей квалификации, БУ «Окружная клиническая больница», 628012, Тюменская область, Ханты-Мансийский автономный округ — Югра, г. Ханты-Мансийск, ул. Калинина, 40, e-mail: ilya1537@yandex.ru, https://orcid.org/0000-0001-8683-7319
Никитина Лидия Юрьевна д-р мед. наук, врач-методист, Национальный медицинский исследовательский центр по профилю «пульмонология», г. Москва, 119048, ул. Доватора, д. 15, e-mail: Lidiya_nikitina@mail.ru, https://orcid.org/0000-0002-7722-5457
Федоров Андрей Валерьевич начальник управления развития проектной деятельности АУ Ханты-Мансийского автономного округа — Югры «Технопарк высоких технологий», 628011, г. Ханты-Мансийск, ул. Промышленная, д. 19, e-mail: a.fedorov@tp86.ru, https://orcid.org/0009-0001-1770-3349

С начала пандемии COVID-19 прошло более пяти лет, но, хотя фундаментальная роль влияния витамина D на иммунную систему совершенно очевидна для абсолютного большинства специалистов, встречаются публикации, в которых выражается резко отрицательное отношение к применению препаратов витамина D для лечения пациентов, инфицированных SARS-CoV-2. Цель работы: «обобщение международного опыта по вопросу недостаточности витамина D у больных COVID-19 и необходимости его восполнения». Из архива Национальной библиотеки медицины США, содержащего 15 768 полных версий статей о влиянии витамин D на заболеваемость населения коронавирусом, нами отобрано 49 статей, в которых изложены результаты клинического применения препаратов витамина D для лечения пациентов с подтвержденным диагнозом COVID-19. Из их числа результаты 38 исследований, в которых приняли участия свыше 3 800 пациентов, инфицированных SARS-CoV-2, показали положительные результаты использования препаратов витамина D в качестве терапевтического средства для лечения пациентов с подтвержденным диагнозом COVID-19 (улучшение маркеров воспаления, снижение необходимости в искусственной вентиляции легких, уменьшение продолжительности пребывания в клинике, снижение госпитальной смертности). Еще в трех статьях авторы делают вывод о неэффективности использования препаратов витамина D для лечения пациентов с COVID-19, однако в них имеется информация о полезности такого применения, хотя различия результатов в группах вмешательства и контрольных группах не является статистически значимыми. Семь статей свидетельствуют о нулевых результатах применения препаратов витамина D, и в одной статье говорится о том, что прием витамина D ухудшил состояние критически больных пациентов. Соотношение положительных, положительных, но статистически не значимых, нулевых и отрицательных результатов клинических испытаний применения препаратов витамина D для лечения пациентов с подтвержденным диагнозом COVID-19 (38:3:7:1) существенно смещено в сторону полезности применения добавок витамина D для снижения тяжести течения заболевания и уменьшения госпитальной смертности от коронавирусной инфекции. Наиболее распространенным видом препарата витамина D, используемым в терапии COVID-19, является холекальциферол, менее часто используется кальцидиол, еще реже (описаны единичные случаи) используются кальцитриол и эргокальциферол. На сегодняшний день кальцидиол продемонстрировал наибольшую эффективность в комплексной терапии COVID-19.

Литература:

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1. Tian Y., Rong L. Letter: does vitamin D have a potential role against COVID-19? Authors reply. Alimentary Pharmacology & Therapeutics. 2020;52 (2):410–411 doi: https://doi.org/10.1111/apt.15817

2. Piraux A. Interest of vitamin D in COVID-19. Review. Actualites Pharmaceutiques. 2021 Apr;60 (605):52–55. doi: 10.1016/j.actpha.2021.02.012

3. Ismailova A., White J. H. Vitamin D, infections and immunity. Review. Reviews in Endocrine & Metabolic Disorders. 2022 Apr;23 (2):265–277. doi: 10.1007/s11154-021-09679-5 [3]

4. Zhong Z, Zhao L, Zhao Y, Xia S. High-dose vitamin D supplementation in patients with COVID-19: A meta-analysis of randomized controlled trials. Food Sciences and Nutrition. 2023 Dec 7;12 (3):1808– 1817. doi: 10.1002/fsn3.3875

5. Sinopoli A., Sciurti A., Isonne C., et al. The Efficacy of Multivitamin, Vitamin A, Vitamin B, Vitamin C, and Vitamin D Supplements in the Prevention and Management of COVID-19 and Long-COVID: An Updated Systematic Review and Meta-Analysis of Randomized Clinical Trials. Nutrients. 2024 Apr 29;16 (9):1345. doi: 10.3390/nu16091345

6. Mercola J., Grant W. B., Wagner C. L. Evidence Regarding Vitamin D and Risk of COVID-19 and Its Severity. Review. Nutrients. 2020 Oct 31;12 (11):3361. DOI: 10.3390/nu12113361 [6]

7. Borsche L., Glauner B., von Mendel J. COVID-19 Mortality Risk Correlates Inversely with Vitamin D3 Status, and a Mortality Rate Close to Zero Could Theoretically Be Achieved at 50 ng/mL 25 (OH) D3: Results of a Systematic Review and Meta-Analysis. Meta-Analysis. Nutrients. 2021 Oct 14;13 (10):3596. doi: 10.3390/nu13103596

8. Alcala-Diaz J. F., Limia-Perez L., Gomez-Huelgas R., et al. Calcifediol Treatment and Hospital Mortality Due to COVID-19: A Cohort Study. Nutrients. 2021 May 21;13 (6):1760 DOI:10.3390/nu13061760

9. Annweiler C., Beaudenon M., Gautier J., et al. High-dose versus standard-dose vitamin D supplementation in older adults with COVID-19 (COVIT-TRIAL): A multicenter, open-label, randomized controlled superiority trial. PLoS Med. 2022 May 31;19 (5):e1003999. doi: 10.1371/journal.pmed.1003999

10. Annweiler C., Hanotte B., Grandin de l’Eprevier C., et al. Vitamin D and survival in COVID-19 patients: A quasi-experimental study. Journal of Steroid Biochemistry and Molecular Biology. 2020 Nov; (204):105771. doi: 10.1016/j.jsbmb.2020.105771

11. Annweiler G., Corvaisier M., Gautier J., et al. Vitamin D Supplementation Associated to Better Survival in Hospitalized Frail Elderly COVID-19 Patients: The GERIA-COVID Quasi-Experimental Study. Nutrients. 2020 Nov 2;12 (11):3377. doi: 10.3390/nu12113377

12. Caballero-García A., Pérez-Valdecantos D., Guallar P., et al. Effect of Vitamin D Supplementation on Muscle Status in Old Patients Recovering from COVID-19 Infection. Medicina (Kaunas). 2021 Oct 9;57 (10):1079. doi: 10.3390/medicina57101079

13. Caccialanza R., Laviano A., Lobascio F., et al. Early nutritional supplementation in non-critically ill patients hospitalized for the 2019 novel coronavirus disease (COVID-19): Rationale and feasibility of a shared pragmatic protocol. Nutrition. 2020 Jun; (74):110835. doi: 10.1016/j.nut.2020.110835

14. Cangiano B., Fatti L. M., Danesi L., et al. Mortality in an Italian nursing home during COVID-19 pandemic: correlation with gender, age, ADL, vitamin D supplementation, and limitations of the diagnostic tests. Aging (Albany NY). 2020 Dec 22;12 (24):24522–24534. doi: 10.18632/aging.202307

15. Entrenas Castillo M., Entrenas Costa L. M., et al. «Effect of calcifediol treatment and best available therapy versus best available therapy on intensive care unit admission and mortality among patients hospitalized for COVID-19: A pilot randomized clinical study». Randomized Controlled Trial. Journal of Steroid Biochemistry and Molecular Biology. 2020 Oct; (203):105751. doi: 10.1016/j.jsbmb.2020.105751

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Значение витамина D для поддержания здоровья костей и метаболизма кальция хорошо известно. Однако в последнее время появляется все больше доказательств того, что дефицит витамина D является катализатором смертности от ишемической болезни сердца, инсульта, хронической обструктивной болезни легких, диабета, цирроза печени, рака и туберкулеза. Дефицит витамина D негативно сказывается на мертворождаемости, младенческой, детской и подростковой смертности, оказывает большое влияние на протекание и исходы беременности, отрицательно влияет на мужскую и женскую фертильность, усугубляет уровень стресса, снижает умственные способности человека. Тяжелый дефицит витамина D является предиктором летального исхода для пациентов, инфицированных SARS-CoV-2. Особенно опасным становится низкий уровень витамина D при тяжелом заболевании человека.

В настоящее время даже противники использования препаратов витамина D не отрицают факт низкого уровня кальцидиола [25(OH)D] в сыворотке крови пациентов, страдающих большинством патологий. Если соглашаться с такими выводами, а не соглашаться с ними очень сложно, то логичным выглядят рекомендации о необходимости поддержания достаточного (оптимального) уровня витамина D как для профилактики заболевания, так и в качестве терапевтического средства для снижения тяжести его течения.

С начала пандемии COVID-19 прошло более пяти лет, но, хотя фундаментальная роль влияния витамина D на иммунную систему совершенно очевидна для абсолютного большинства специалистов, на протяжение всего периода времени, вплоть до сегодняшнего дня, встречаются публикации, в которых выражается резко отрицательное отношение к применению препаратов витамина D для лечения пациентов, инфицированных SARS-CoV-2.

Основываясь на данных современной [на тот момент] литературы, Tian Y. et al. (Peking University First Hospital, 2020) отмечают, что пациенты с низким уровнем витамина D могут подвергаться повышенному риску тяжелого COVID-19, но не находят доказательств того, что витамин D может принести какую-либо пользу в качестве лекарственного средства при COVID-19 [1].

Для Цитирования:
Кривошеев Владимир Васильевич, Козловский Илья Вячеславович, Никитина Лидия Юрьевна, Федоров Андрей Валерьевич, Недостаточность витамина D и необходимость его восполнения при COVID-19. Санитарный врач. 2024;10.
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