維生素D缺乏症及臨床治療準則

10.6666/ClinMed.201808_82(2).0088

陳怡君

維生素D不足(vitamin D insufficiency) ； 維生素D缺乏(vitamin D deficiency) ； 臨床治療準則(clinical guidelines)

臨床醫學月刊

82卷2期（2018 / 08 / 31）

482 - 489

繁體中文

近年來維生素D相關研究從骨骼健康鈣磷平衡的角度，拓展到多重生理作用的賀爾蒙角色，研究發現人體許多組織細胞核都含有維生素D受體(vitamin D receptor)，且活性代謝產物1,25- dihydroxyvitamin D並非單靠肝臟與腎臟轉化才能產生，其他組織器官包括免疫細胞、角質細胞、攝護腺、乳房、腸道、與肺等皆有1α-hydroxylase活性可自行轉化出具有生理活性的維生素D，且不受鈣磷濃度的調控影響。國際學會建議維生素D濃度(25-hydroxyvitamin D)至少達到20ng/ml才能預防骨骼疾病，許多專業機構建議濃度要達到30-100ng/ml才能確保骨骼健康，維生素D的多重生理作用才有機會表現。維生素D缺乏是全球普遍的現象，盛行率高達50-70%，原因與現代社會戶外日曬時間縮短，富含維生素D的天然食物有限等因素相關，最適合的補充劑量受條件影響有不同的建議，主要依照年紀分群，每日建議劑量在400到2000國際單位(IU)。臨床醫療人員應秉持實證醫學的態度來審視，避免過與不及，尤其針對高風險族群進行檢測並給予適當治療，避免營養素缺乏導致原可預防的疾病，本文就近期維生素D相關的臨床研究與治療指引進行文獻探討。

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