淺談維生素D
- berne Hsieh
- 2022年7月22日
- 讀畢需時 15 分鐘
日期：109.10 於台中
維生素D既是維生素又是激素。這是一種維生素，因為沒有它，你的身體就不能吸收鈣; 這是一種激素，因為你的身體是在皮膚暴露於陽光的情況下製造的。 有兩種主要形式的維生素D，兩者都有他們的名字中的鈣化醇一詞。在拉丁文中，calciferol的意思是“鈣載體”。維生素D2（麥角鈣化醇）和D3（膽鈣化醇）在體內具有相似的作用，都可以在強化食品和補充劑中找到。 有力的證據告訴我們，維生素D和鈣補充劑的組合對預防和治療骨質疏鬆症非常有幫助。維生素D的其他潛在用途幾乎沒有支持證據。 要求/來源 維生素D的劑量通常以國際單位（IU）而非毫克表示。醫學研究所的推薦膳食津貼指南是：
嬰兒出生至1歲時：400國際單位
1-70歲：600國際單位
70歲以上：800國際單位
孕婦或哺乳期婦女：600 IU
此外苯妥英（Dilantin）， 撲米酮（Mysoline）和 苯巴比妥 用於癲癇發作; 皮質類固醇 ; 西咪替丁 （Tagamet）治療潰瘍; 血液稀釋藥物 肝素 ; 而抗結核藥物 異煙肼（INH） 和 利福平可能會干擾維生素D的吸收或活性。 治療劑量 出於治療目的，維生素D是以要求/來源（有時甚至更高的量）中描述的營養劑量服用。如果您希望超過維生素D攝入的營養水平，建議進行醫生監督。 治療用途 毫無疑問，如果你擔心 骨質疏鬆症，你應該服用 鈣和維生素D.這種組合似乎有助於預防骨質流失。即使你正在服用其他治療骨質疏鬆症，情況也是如此。畢竟，如果沒有足夠的維生素D攝入量，就不能在沒有鈣的情況下建立骨骼，並且不能正確吸收和利用鈣質。 維生素D還可能有助於防止導致骨質疏鬆性骨折的跌倒。在對26項隨機試驗的回顧中，研究人員發現維生素D和鈣一起降低了高風險老年人跌倒的風險。 一些證據表明，獲得足夠的維生素d可能有助於預防 癌症乳腺癌，結腸癌，胰腺癌，前列腺癌和皮膚的，但在這個問題上的研究已經取得了好壞參半的結果。一項研究表明，聯合使用鈣和維生素D，但不是單獨補充，可以幫助降低結腸癌的風險。然而，一個非常大的研究，涉及36000絕經後婦女發現，用1000毫克的鈣加400國際單位維生素d補充日常飲食沒有降低患乳腺癌的風險在為期7年。根據這項安慰劑對照研究的結果，維生素D與乳腺癌風險似乎沒有聯繫。 微弱的證據表明，足夠的維生素D攝入量可能會降低高血壓和 糖尿病的風險 。對超過36,000名絕經後婦女進行的一項非常大型的隨機安慰劑對照試驗發現，每天補充1000 mg鈣和400 IU維生素D並不能減少或預防7年隨訪期間的高血壓。這些結果可能受限於非學習鈣的使用。 對242例患者的4項隨機試驗的回顧發現，維生素D補充劑可降低糖尿病前期和2型糖尿病患者的空腹血糖水平。在有316名患者的6項試驗中，維生素D還與胰島素敏感性改善有關。然而，在兩項試驗中184例患者進行了4項試驗和2例糖尿病進展的長期血糖控制方面沒有顯著差異。 一項初步研究表明補充維生素D和鈣可能對多囊卵巢綜合徵患者有幫助。 已發表的研究的一項薈萃分析（正式統計檢查）發現了一些證據表明，在推薦水平使用維生素D可能會降低總體死亡率。這篇文章建議，但並沒有試圖建立，是多麼的維生素d可能做到這一點。同樣，2011年對50項隨機試驗（包括94,148人）的廣泛審查發現，維生素D 3（但不包括其他形式的維生素）降低了維生素D缺乏風險的老年女性的死亡風險。 有時提到維生素D可作為治療 牛皮癬。然而，這一建議是基於丹麥研究使用卡泊三醇，這是一種外用維生素D 3（應用於皮膚）的變體。卡泊三醇不會影響人體對鈣的吸收，因此它與您可以在商店購買的維生素D非常不同。
有人認為維生素Ｄ水平下降，維生素D補充劑可能對季節性情感障礙有幫助 （“冬季藍調”）。一項在44人的冬季進行的小型雙盲，安慰劑對照試驗發現，維生素D補充劑可改善各種心情狀況。然而，2217女年滿70的雙盲，安慰劑對照研究未能找到利益。假設光療（成功用於SAD）通過提高維生素D水平起作用，但有證據表明情況並非如此。 一項涉及164名男性（18-28歲）的隨機安慰劑對照試驗發現，服用維生素D 3 （每日400單位持續6個月）可以預防 呼吸道感染。 但是，沒有證據表明維生素減少病假或感冒症狀的嚴重程度。在322名服用維生素D 3 18個月的健康成年人的試驗中發現了類似的結果。感冒量或嚴重程度沒有差異。 維生素Ｄ補充劑也都 沒有出現，以幫助提高兒童的健康成長。 什麼是維生素D的科學證據？ 骨質疏鬆 嚴重 骨質疏鬆症患者的維生素D水平通常較低。單獨補充維生素D可能不過是最低限度的幫助最多，但鈣和維生素D的組合可能更有效。 補充維生素D加鈣可能有助於骨折發生後的癒合 。 有趣的是，維生素D可能為老年人的骨質疏鬆症提供另一個好處：大多數（儘管不是全部）研究發現補充維生素D可改善老年人（特別是女性老年人）的平衡並降低摔倒的風險。然而，在過去一年中有409名女性住在家中，有過一次或多次摔傷史的隨機試驗中並非如此。與安慰劑聯合運動相比，沒有運動的維生素D與跌倒風險降低無關。在這種情況下，力量和平衡練習是改善身體機能的唯一干預措施。 憂鬱症 在對13項隨機試驗和4,394例患者的兩項綜述中，與安慰劑相比，維生素D 3 補充劑（口服或肌內註射）對減輕憂鬱症狀無效。然而，在對2名患有嚴重，臨床顯著憂鬱症的患者進行的分析中發現了一些益處 。 安全問題 當按推薦劑量服用時，維生素D似乎是安全的。但是，當使用過量時，維生素D會在體內累積並引起中毒症狀。每日攝入量約40,000 IU（約為每日推薦攝入量的100倍）時，維生素D會導致血鈣水平升高。
由於製造錯誤，比這個高五倍的劑量被少數人所消耗; 由此產生的毒性是嚴重的，並可能導致一個人死亡。
然而，在這些極其過量的劑量之下，尚不清楚維生素D在什麼水平變成有毒。維生素D每日攝入量的安全上限如下：
0-6個月的嬰兒：1,000 IU（國際單位）
嬰兒6-12個月：1,500 IU
1-3歲：2,500 IU
4-8歲：3,000 IU
9歲及以上：4,000 IU
孕婦或哺乳期婦女：4,000 IU
但是請注意，有些權威人士認為這些上限已經設定得太低了。他們的論點與“ 需求/來源” 部分討論的營養需求緊密相關 。 沒有不同意見，患有結節病或甲狀旁腺功能亢進症的患者在沒有首先諮詢醫生的情況下絕不應服用維生素D。 服用維生素D和鈣補充劑可能會干擾鈣通道阻滯劑家族中某些藥物的作用 。這是你想這個組合前請諮詢醫師是很重要的。 鈣，維生素D和 噻嗪類利尿劑的組合可能會導致體內鈣水平過高。如果您正在服用噻嗪類利尿劑，您應該諮詢醫生有關正確劑量的維生素D和鈣的信息。 你應該知道的相互作用 如果您服用某些藥物，您可能需要額外的維生素D，例如：
如果您正在服用 鈣通道阻滯劑，除非在醫生的監督下，否則不要服用高劑量維生素D（含鈣）。如果您服用噻嗪類利尿劑，除非在醫生的監督下服用 ，否則不要服用鈣和維生素D補充劑。
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