Pain, as a complex physiological and pathological phenomenon, has always been a hot topic in medical research in terms of its mechanism of occurrence and influencing factors. Vitamin D, as a fat soluble vitamin, has been shown to be closely associated with pain in recent years, in addition to its classic role in regulating calcium and phosphorus metabolism. The polymorphism of the vitamin D receptor (VDR) gene can lead to changes in the structure and function of VDR, thereby affecting vitamin D levels. Meanwhile, VDR gene polymorphism can indirectly or directly participate in the occurrence and development of pain. This article aims to review the research on the relationship between vitamin D and its receptor gene polymorphism and pain, and provide reference for potential therapeutic targets and personalized intervention strategies for pain.
Primary osteoporosis is a common metabolic disease in China, causing immense disease and economic burden to patients, their families and the society. Prevention is an important strategy to reduce the disease burden of primary osteoporosis. Calcium, as a basic element for maintaining bone health, plays an important role in the prevention of primary osteoporosis. This guideline was initiated by the Chinese Pharmaceutical Society Evidence-based Pharmacy Specialised Committee. The standard methodology for the development of evidence-based clinical practice guidelines of the World Health Organization (WHO) was employed. A multidisciplinary guideline working group was formed. Delphi method was used to select and eventually identified 15 key clinical questions. Systematic evaluation was carried out on each of the key clinical question and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) was used to formed 15 recommendations, providing guidance for standardizing the clinical practice of calcium supplementation in prevention of primary osteoporosis in adults in China.
Objective To evaluate the association between vitamin D levels and polycystic ovarian syndrome (PCOS) by Mendelian randomization (MR) analysis, and assess the role of obesity in this association. Methods Public genome-wide association studies were used to obtain single nucleotide polymorphism (SNP) data of exposure and outcome. Inverse variance weighting (IVW) was used as the main analysis method to analyze the causal relationship between vitamin D level (including total vitamin D level, serum 25-hydroxyvitamin D level) and vitamin D-binding protein level and polycystic ovary syndrome. In addition, multivariate MR method was used to explore the influence of obesity. Results IVW method showed that 25-hydroxyvitamin D was a protective factor for PCOS (OR=0.185, 95%CI 0.058 to 0.585, P=0.004). There was no interference of heterogeneity or horizontal pleiotropy among the data, and the data tended to be stable in general. The remaining total vitamin D levels and vitamin D-binding protein levels did not show an association with PCOS at the genetic level. MVMR analysis adjusted for obesity and BMI in adolescents showed that 25-hydroxyvitamin D was still negatively associated with the risk of PCOS. Conclusion By bidirectional Mendelian randomization analysis, serum 25-hydroxyvitamin D is identified as a protective factor for PCOS, and the increase of serum 25-hydroxyvitamin D level can reduce the risk of PCOS. Obesity does not affect the causal relationship between serum 25-hydroxyvitamin D and PCOS at the genetic level.
Objective To observe the level of vitamin D in patients with steroid resistant (SR) asthma, and investigate the effect of 1,25-(OH)2D3 on JNK/AP-1 and glucocorticoid receptor of T lymphocytes in SR asthmatics. Methods Sixty-two outpatients and inpatients with asthma with acute exacerbation between 2014 and 2015 were recruited in the study, including 26 cases of steroid sensitive (SS) asthmatics and 36 cases of SR asthmatics. Meanwhile 25 healthy volunteers were recruited as control. Clinical data were collected and peripheral venous blood was sampled for measuring the level of 25-(OH)D and separating the T lymphocytes. T lymphocytes were assigned to six groups, ie. a healthy control group (Group A), a SS asthmatics control group (Group B), a SR asthmatics control group (Group C), a SR asthmatics with JNK inhibitor (SP600125)+1,25-(OH)2D3 group (Group D), a SR asthmatics with JNK inhibitor (SP600125) group (Group E), and a SR asthmatics with 1,25-(OH)2D3 group (Group F). T lymphocytes were cultured for 48 hours. By the end of culture, the expression of phospho-JNK (p-JNK) and phospho-glucocorticoid receptor (p-GR) of T lymphocytes were detected by Western blot method, and the expression of c-Jun mRNA was detected by RT-PCR method. Results The level of 25-(OH) D was lower in Group B and Group C than Group A (P<0.05), and lower in Group C than Group B (P<0.05). The level of p-JNK was higher in Group B and Group C than Group A (P<0.05), higher in Group C than Group B (P<0.05), lower in Group E and Group F than Group C (P<0.05), lower in Group D than Group F (P<0.05). The level of p-GR was lower in Group C than Group A and Group B (P<0.05), higher in Group E and Group F than Group C (P<0.05), higher in Group D than Group F (P<0.05). The level of c-Jun mRNA was higher in Group B and Group C than Group A (P<0.05), higher in Group C than Group B (P<0.05), lower in Group E and Group F than Group C (P<0.05), and lower in Group D than Group F (P<0.05). The 25-(OH) D level was negatively correlated with the expression of p-JNK and c-Jun mRNA in Group C (r=–0.69, r=–0.65, P<0.05). However, there was a positive correlation between the 25-(OH) D level and p-GR (r=0.72, P<0.05). Conclusions There is a high prevalence of vitamin D deficiency or lack in SR asthmatics. 1,25-(OH)2D3 can promote the expression of p-GR by inhibiting the JNK/AP-1 signaling pathway of T lymphocytes in SR asthmatics, which may be one of the mechanisms of vitamin D to improve glucocorticoid resistance in SR asthmatics.
ObjectiveTo systematically review vitamin D nutritional status among children and adolescents in China.MethodsCNKI, CBM, WanFang Data, VIP and PubMed databases were electronically searched to collect cross-sectional studies on vitamin D nutritional status among children and adolescents in China from inception to September, 2020. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies. Meta-analysis was then performed by using Stata 11.0 software.ResultsA total of 23 cross-sectional studies involving 38 047 total sample size were included.The results of meta-analysis showed that the combined vitamin D deficiency rate was 27.9% (95%CI 21.9% to 33.8%), and the inadequate rate was 31.6% (95%CI 25.7% to 37.6%).Subgroup analysis showed that vitamin D deficiency rate of females was higher than that of males (25.3% vs. 22.5%). The vitamin D deficiency rate of children aged 10 to 18 was higher than those aged 6 to 9 (44.9% vs. 32.9%). The vitamin D deficiency rate of children in the north was higher than that in south (36.1% vs. 14.8%). The vitamin D deficiency rate from 2015 to 2018 was higher than that from 2011 to 2014 (34.9% vs. 17.6%). In addition, the vitamin D deficiency rate ofurban children was higher than that of rural children (29.9% vs. 24.9%).ConclusionsThe incidence of vitamin D deficiency among children and adolescents is high in China. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above conclusions.
Objective To systematically review the impact of vitamin D supplement on blood pressure, so as to provide a basis for clinical treatment. Methods Such databases as The Cochrane Library (Issue 8, 2011), MEDLINE (1996 to August 2011), EMbase (1974 to August 2011), CBM (1989 to 2011), CNKI (1997 to August 2011) and VIP (1989 to 2011) were searched to collect the randomized controlled trials (RCTs) about the impact of vitamin D supplement on blood pressure. Two reviewers independently screened the literature according to the inclusion criteria, extracted the data and assessed the quality. Then the meta-analysis was performed using RevMan 5.0 software. Results A total of 8 studies involving 907 participants were included. The methodological quality based on the improved Jadad scales displayed that, 7 studies scored 4 to 7 and only 1 study scored less than 4. The results of meta-analysis showed that compared with the placebo groups, vitamin D supplement had no significant difference in both systolic and diastolic blood pressure. Conclusion Based on current research evidences, compared with placebo, vitamin D supplement has no marked impact on either systolic or diastolic blood pressure. Due to the lack of studies, this conclusion still needs to be proved by conducting more well designed, large sample, and multicenter RCTs.
ObjectiveTo investigate the correlation between serum level of 25(OH)D3 and peripheral neuropathy in patients with impaired glucose tolerance. MethodsA total of 108 patients with impaired glucose tolerance treated or examined between January 2012 and July 2014 were recruited in this study. According to whether peripheral neuropathy was combined, the patients were divided into neuropathy group (n=50) and non-neuropathy group (n=58). The level of 25(OH)D3 was measured and compared between the two groups, and the correlation of 25(OH)D3 with the clinical indexes of impaired glucose tolerance was analyzed. ResultsThe level of 25(OH)D3 in the neuropathy group and non-neuropathy group was respectively (16.1±4.2) and (19.6±4.7) ng/mL with a significant difference (P<0.05). The 25(OH)D3 deficiency rate of the above two groups was respectively 80.0% and 41.38%, also with a significant difference (P<0.05). The 25(OH)D3 level had a negative correlation with body mass index (BMI) and glycosylated hemoglobin (P<0.05). Conclusions There is a significant relationship between impaired glucose tolerance and 25(OH)D3 level. The 25(OH)D3 level has a negative correlation with BMI and glycosylated hemoglobin.
Objective To systematically review the effect of vitamin D (VitD) supplementation on cognitive function in people with cognitive impairment and non-cognitive disorders. MethodsThe PubMed, Web of Science, Cochrane Library, EMbase, CBM, CNKI, WanFang Data and VIP databases were searched to collect randomized controlled trials (RCTs) about the effect of VitD supplementation on cognitive function of patients with cognitive impairment or non-cognitive disorders from inception to March, 2022. Two reviewers independently screened the literature, extracted data, and assessed the risk of bias of the included studies. Meta-analysis was then performed using RevMan 5.4 software. Results A total of 19 articles including 8 684 cases were included. The results of meta-analysis showed that mini-mental state examination (MMSE) score (MD=1.70, 95%CI 1.20 to 2.21, P<0.01), Montreal cognitive assessment (MoCA) score (MD=1.51, 95%CI 1.00 to 2.02, P<0.01), Wechsler Adult Intelligence Scale-Revised (WAIS-RC) score (MD=9.12, 95%CI 7.77 to 10.47, P<0.01) and working memory (SMD=1.87, 95%CI 1.07 to 2.67, P<0.01) in the VitD group of patients with cognitive impairment were all better than those in the control group. However, the overall cognitive function and working memory of the non-cognitive impairment population were not significantly different compared with the control group. In terms of language fluency and language memory, there was no significant difference between the VitD group and the control group. In terms of the executive functions, at the intervention time of> 6 months, the VitD and control groups were statistically significant (SMD=0.15, 95%CI 0.01 to 0.28, P=0.03). Conclusion Current evidence suggests that VitD supplementation can effectively improve the overall cognitive function and working memory of patients with cognitive impairment, and has a positive effect on executive function at an intervention time of >6 months. Due to the limited quality and quantity of the included studies, more high-quality studies are needed to verify the above conclusion.
ObjectiveTo investigate the clinical value of peripheral blood vitamin D level in predicting the outcome of weaning from mechanical ventilation in critically ill patients.MethodsA total of 130 critically ill patients who undergoing mechanical ventilation for more than 48 hours in our hospital were recruited from June 2014 to June 2017. Serum 25(OH)D3 was detected on admission and before spontaneous breathing test (SBT) meanwhile general clinical data and laboratory examination indexes were recorded. The cases were divided into a successful weaning group and a failure weaning group according to the outcome of weaning from mechanical ventilation. Logistic regression equation was used to analyze the relationship between vitamin D level and failure weaning, and a receiver operating characteristic (ROC) curve was used to analyze the predictive value for failure weaning.ResultsThere were 46 patients with failure weaning among 130 patients (35.38%). Compared with the successful weaning group, the failure weaning group had significantly higher Acute Physiology and Chronic Health EvaluationⅡ score, longer duration in intensive care unit, higher respiratory rate, higher rapid shallow breathing index, higher C-reactive protein, higher N-terminal prohormone of brain natriuretic peptide, higher serum creatinine, and significantly lower albumin (all P<0.05). 25(OH)D3 level classifications on admission and before SBT in the failure weaning group were worse than those in the successful weaning group (P<0.05). 25(OH)D3 levels of the failure weaning group were lower than those of the successful weaning group [on admission: (18.16±4.33) ng/ml vs. (21.60±5.25) ng/ml, P<0.05; before SBT: (13.50±3.52) ng/mlvs. (18.61±4.30) ng/ml, P<0.05]. Multivariate logistic regression analysis showed that 25(OH)D3 levels on admission and before SBT were independent risk factors for failure weaning (OR values were 2.257 and 2.613, respectively, both P<0.05). ROC curve analysis showed that areas under ROC curve were 0.772 and 0.836, respectively, with sensitivities of 80.3% and 85.2%, specificities of 69.0% and 71.0%, respectively.Conclusions25(OH)D3 deficiency or insufficiency is common in critically ill patients. The lower the level of vitamin D, the higher the risk of failure weaning. So it may be an independent predictor of failure weaning.
ObjectiveTo systematically review the efficacy of vitamin D supplementation on patients with polycystic ovary syndrome (PCOS).MethodsPubMed, EMbase, The Cochrane Library, Web of Science, EBSCO, CBM, WanFang Data, CNKI and VIP databases were electronically searched to collect randomized controlled trials (RCTs) on the efficacy of vitamin D supplementation for PCOS from inception to July 2019. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies, then, meta-analysis was performed by using RevMan 5.3 software.ResultsA total of 11 RCTs involving 692 patients were included. The results of meta-analysis showed that compared with placebo, vitamin D could reduce the level of hypersensitive C-reactive protein (hs-CRP) (MD=−0.54, 95%CI −1.00 to −0.08, P=0.02) and total testosterone (MD=−0.17, 95%CI −0.29 to −0.05, P=0.004), and increase endometrial thickness (MD=1.78, 95%CI 0.49 to 3.06, P=0.007). However, there were no significant differences between two groups in the incidence of sex hormone binding globulin (SHBG) level and hypertrichosis’s score (mF-G) (P>0.05).ConclusionsCurrent evidence indicates that vitamin D supplementation can significantly reduce the level of total testosterone and hs-CRP, and increase endometrial thickness of PCOS. Due to the limited quality and quantity of the included studies, more high quality studies are required to verify the above conclusions.