{"id":31415,"date":"2024-04-26T00:00:56","date_gmt":"2024-04-26T00:00:56","guid":{"rendered":"https:\/\/zydq.1006ss.com\/?p=31415"},"modified":"2024-04-26T00:00:56","modified_gmt":"2024-04-26T00:00:56","slug":"%e6%b9%98%e9%9b%85%e4%ba%8c%e9%99%a2%ef%bc%9a%e7%bb%b4%e7%94%9f%e7%b4%a0d%e5%92%8c%e4%ba%ba%e7%b1%bb%e5%85%8d%e7%96%ab%e7%9a%84%e6%9c%80%e6%96%b0%e7%a0%94%e7%a9%b6%e8%bf%9b%e5%b1%95%ef%bc%882012","status":"publish","type":"post","link":"http:\/\/zydq.1006ss.com\/?p=31415","title":{"rendered":"\u6e58\u96c5\u4e8c\u9662\uff1a\u7ef4\u751f\u7d20D\u548c\u4eba\u7c7b\u514d\u75ab\u7684\u6700\u65b0\u7814\u7a76\u8fdb\u5c55\uff082012\u5e74\uff09"},"content":{"rendered":"<p>\u7ef4\u751f\u7d20D\u548c\u4eba\u7c7b\u514d\u75ab\u7684\u6700\u65b0\u7814\u7a76\u8fdb\u5c55\u9a6c\u4e01, \u80e1\u745b, \u82cf\u6b23\u6458\u8981\uff1a\u6700\u8fd15\u5e74, \u4eba\u4eec\u5173\u4e8e\u7ef4\u751f\u7d20D\u5bf9\u5065\u5eb7\u76ca\u5904\u7684\u8ba4\u8bc6\u53d1\u751f\u4e86\u663e\u8457\u7684\u53d8\u5316, 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\u800c\u5bf9\u5c40\u90e8\u7ef4\u751f\u7d20D\u6c34\u5e73\u7684\u53d8\u5316\u66f4\u4e3a\u654f\u611f\u3002\u672c\u6587\u5c31\u8fd9\u4e9b\u7814\u7a76\u8fdb\u5c55\u4f5c\u4e00\u7efc\u8ff0, \u5e76\u5177\u4f53\u9610\u8ff0\u4e86\u6700\u65b0\u8ba4\u53ef\u7684\u7ef4\u751f\u7d20D\u5bf9\u514d\u75ab\u7cfb\u7edf\u7684\u4f5c\u7528, \u540c\u65f6\u4e5f\u7a81\u663e\u4e86\u5c06\u8fd9\u4e9b\u4f5c\u7528\u5e94\u7528\u4e8e\u4e34\u5e8a\u6240\u9762\u4e34\u7684\u6311\u6218\u3002\u5f15\u8a00\u57282010\u5e74\u5e74\u5e95, \u7f8e\u56fd\u533b\u5b66\u7814\u7a76\u9662 (IOM) , \u4e00\u4e2a\u975e\u76c8\u5229\u7684\u72ec\u7acb\u7684\u975e\u653f\u5e9c\u673a\u6784, \u53d1\u8868\u4e86\u4e00\u7bc7\u957f\u671f\u7814\u7a76\u7684\u7ed3\u679c, \u5b9a\u4e49\u4e86\u6700\u6709\u76ca\u4e8e\u4eba\u4f53\u5065\u5eb7\u7684\u7ef4\u751f\u7d20D\u548c\u9499\u6c34\u5e73\u7684\u53c2\u8003\u503c\u8303\u56f4\u3002\u8fd9\u9879\u7814\u7a76\u7684\u5c0f\u7ec4\u6210\u5458\u90fd\u662f\u7ecf\u8fc7\u7cbe\u5fc3\u6311\u9009\u7684\u79d1\u5b66\u5bb6\u548c\u4e34\u5e8a\u533b\u751f, \u5728\u7814\u7a76\u7684\u8fc7\u7a0b\u4e2d\u4ed6\u4eec\u4e5f\u9762\u4e34\u7740\u5f88\u591a\u6311\u6218, \u5176\u4e2d\u4e00\u4e2a\u6700\u4e0d\u80fd\u88ab\u5ffd\u89c6\u7684\u6311\u6218\u662f\u88ab\u4e89\u8bae\u591a\u5e74\u7684\u7ef4\u751f\u7d20D\u548c\u9499\u7684\u751f\u7406\u4f5c\u7528\u548c\u8425\u517b\u4f5c\u7528\u3002\u5173\u4e8e\u8bc4\u4ef7\u7ef4\u751f\u7d20D\u8425\u517b\u4f5c\u7528\u7684\u53e6\u4e00\u4e2a\u6311\u6218\u662f\u5982\u4f55\u5b9a\u4e49\u7ef4\u751f\u7d20D\u7684\u5404\u79cd\u4ee3\u8c22\u4ea7\u7269\u3002\u7ef4\u751f\u7d20D\u4e00\u822c\u88ab\u8ba4\u4e3a\u662f\u5728\u65e5\u5149\u7167\u5c04\u4f5c\u7528\u4e0b\u7531\u76ae\u80a4\u5185\u76847-\u8131\u6c22\u80c6\u56fa\u9187\u8f6c\u53d8\u800c\u6765\u7684\u5185\u6e90\u6027\u7ef4\u751f\u7d20D (\u4e5f\u88ab\u79f0\u4e3a\u7ef4\u751f\u7d20D3\u6216\u80c6\u56fa\u5316\u9187) , \u7ef4\u751f\u7d20D\u4e5f\u53ef\u4ee5\u4ece\u5bcc\u542b\u7ef4\u751f\u7d20D3\u7684\u81b3\u98df\u6216\u5bcc\u542b\u7ef4\u751f\u7d20D2 (\u53c8\u79f0\u9ea6\u89d2\u9499\u5316\u56fa\u9187) \u7684\u852c\u83dc\u4e2d\u83b7\u5f97\u3002\u7531\u76ae\u80a4\u751f\u6210\u7684\u548c\u98df\u7269\u6765\u6e90\u7684\u7ef4\u751f\u7d20D\u7ecf\u8fc7\u4ee3\u8c22\u9996\u5148\u751f\u621025OHD, \u8840\u6e0525OHD\u662f\u8840\u6db2\u5faa\u73af\u4e2d\u7ef4\u751f\u7d20D\u7684\u4e3b\u8981\u5b58\u5728\u5f62\u5f0f, \u5e38\u4f5c\u4e3a\u8bc4\u4ef7\u4f53\u5185\u7ef4\u751f\u7d20D\u8425\u517b\u72b6\u51b5\u7684\u6307\u6807\u3002\u751f\u7406\u6d53\u5ea6\u768425OHD\u4e0d\u662f\u6d3b\u8dc3\u7684\u4fe1\u53f7\u5206\u5b50, \u5b83\u5728\u80be\u5185\u76841\u03b1-\u7f9f\u5316\u9176 (CYP27B1) \u7684\u4f5c\u7528\u4e0b\u8f6c\u5316\u6210\u7ef4\u751f\u7d20D\u7684\u6d3b\u6027\u5f62\u5f0f1, 25 (OH) 2D, \u901a\u8fc7\u8fd9\u79cd\u65b9\u5f0f\u4ea7\u751f\u76841, 25 (OH) 2D\u4e0e\u7c7b\u56fa\u9187\u6fc0\u7d20\u76f8\u4f3c, \u4e0e\u7ec6\u80de\u6838\u5185\u7684\u7ef4\u751f\u7d20D\u53d7\u4f53 (VDR) \u7ed3\u5408\u540e, \u5bf9\u9776\u57fa\u56e0\u7684\u8f6c\u5f55\u548c\u7ffb\u8bd1\u8fdb\u884c\u8c03\u63a7, \u8fdb\u800c\u5b9e\u73b0\u5176\u751f\u7269\u5b66\u529f\u80fd\u3002<\/p>\n<p>\u5728IOM\u62a5\u544a\u91cc\u9762\u4e3b\u8981\u6d89\u53ca\u7ef4\u751f\u7d20D\u7684\u7248\u5757\u4e2d, \u8be5\u59d4\u5458\u4f1a\u63d0\u51fa\u4e86\u56db\u4e2a\u91cd\u8981\u7684\u95ee\u9898: (1) \u7ef4\u751f\u7d20D\u53ca\u5176\u91cd\u8981\u7684\u4ee3\u8c22\u4ea7\u7269\u2014\u2014\u6fc0\u7d20\u539f25OHD\u548c\u6d3b\u60271, 25 (OH) 2D, \u4e0e\u4eba\u4f53\u5065\u5eb7\u7684\u54ea\u4e9b\u65b9\u9762\u76f8\u5173; (2) \u5bf9\u8fd9\u4e9b\u65b9\u9762\u7684\u5065\u5eb7\u800c\u8a00, \u7406\u60f3\u7684\u8840\u5faa\u73af\u4e2d\u7ef4\u751f\u7d20D\u7684\u6d53\u5ea6 (\u6216\u8005\u66f4\u786e\u5207\u7684\u8bf4\u662f\u8840\u6e0525OHD\u6d53\u5ea6) \u662f\u591a\u5c11; (3) \u6bcf\u5929\u9700\u8981\u6444\u5165\u591a\u5c11\u7ef4\u751f\u7d20D\u624d\u80fd\u8fbe\u5230\u548c\u7ef4\u6301\u7406\u60f3\u6c34\u5e73\u7684\u8840\u6e0525OHD; (4) \u8865\u5145\u7ef4\u751f\u7d20D\u4ea7\u751f\u4e0d\u826f\u53cd\u5e94\u7684\u53ef\u80fd\u6027\u3002\u8be5\u62a5\u544a\u8ba4\u4e3a\u4e34\u5e8a\u4e0a\u7ef4\u751f\u7d20D\u7684\u4e3b\u8981\u7528\u9014\u4ecd\u662f\u5176\u7ecf\u5178\u4f5c\u7528\u2014\u2014\u8c03\u8282\u9aa8\u9abc\u5065\u5eb7\u3002\u636e\u6b64, IOM\u8ba4\u4e3a, 50n M (20ng\/ml) \u8840\u6e05\u6d53\u5ea6\u768425OHD\u80fd\u591f\u6539\u5584\u9aa8\u5bc6\u5ea6 (BMD) \u3002\u5bf9\u5927\u591a\u6570\u7f8e\u56fd\u548c\u52a0\u62ff\u5927\u4eba\u6765\u8bf4, BMD\u662f\u9aa8\u9abc\u5065\u5eb7\u7684\u6807\u5fd7\u3002\u7136\u800c, IOM\u4e5f\u627f\u8ba4\u80a4\u8272\u6df1\u7684\u4eba (\u5176\u7d2b\u5916\u7ebf\u8bf1\u5bfc\u76ae\u80a4\u4ea7\u751f\u7ef4\u751f\u7d20D\u7684\u6548\u7387\u66f4\u4f4e) \u548c\u751f\u6d3b\u5728\u5317\u534a\u7403\u7684\u7eac\u5ea6\u66f4\u9ad8\u5730\u533a\u7684\u4eba (\u5c24\u5176\u662f\u5317\u6b27\u4eba\u7fa4, \u5373\u7eac\u5ea6\u6bd4\u52a0\u62ff\u5927\u8bb8\u591a\u57ce\u5e02\u66f4\u9ad8\u7684\u51e0\u4e2a\u56fd\u5bb6) \u53ef\u80fd\u4f1a\u66f4\u96be\u8fbe\u5230\u8fd9\u4e2a\u76ee\u6807\u6c34\u5e73\u3002\u4e3a\u4e86\u4f7f25OHD\u8fbe\u523050n M\u7684\u76ee\u6807\u6c34\u5e73, IOM\u5c06\u7ef4\u751f\u7d20D\u7684\u63a8\u8350\u6444\u5165\u91cf\u9002\u5ea6\u589e\u52a0\u5230600IU\/\u5929, \u5c3d\u7ba1\u5df2\u6709\u62a5\u9053\u6307\u51fa\u7ef4\u751f\u7d20D\u7684\u5242\u91cf\u8fbe10000IU\/\u5929\u4e0d\u4f1a\u4ea7\u751f\u526f\u4f5c\u7528, \u4f46\u662f\u5b89\u5168\u8303\u56f4\u6700\u597d\u4e0d\u8d85\u8fc74000IU\/\u5929\u3002IOM\u540c\u65f6\u6307\u51fa, \u5c3d\u7ba1\u76ee\u524d\u8fd8\u6ca1\u6709\u4e34\u5e8a\u8bd5\u9a8c\u6570\u636e\u652f\u6301\u7ef4\u751f\u7d20D\u7684\u9aa8\u5916\u4f5c\u7528\u53ef\u4ee5\u52a0\u5f3a\u5065\u5eb7, \u4f46\u662f\u6709\u5145\u8db3\u7684\u7406\u7531\u53bb\u8fdb\u884c\u4e0b\u4e00\u6b65\u66f4\u6df1\u5165\u7684\u7814\u7a76\u3002<\/p>\n<p>IOM\u7684\u62a5\u544a\u5f97\u5230\u4e86\u5305\u62ec\u7f8e\u56fd\u9aa8\u9abc\u4e0e\u77ff\u7269\u8d28\u7814\u7a76\u5b66\u4f1a\u5728\u5185\u7684\u5f88\u591a\u7ec4\u7ec7\u673a\u6784\u7684\u8ba4\u53ef, IOM\u8c28\u614e\u7684\u63a8\u8350\u6444\u5165\u91cf\u4e5f\u5728\u5176\u4ed6\u7684\u7814\u7a76\u4e2d\u5f97\u5230\u4e86\u652f\u6301\u3002\u4f46\u662f\u8be5\u62a5\u544a\u5e76\u6ca1\u5f97\u5230\u666e\u904d\u652f\u6301, \u6765\u81ea\u4e16\u754c\u5404\u5730\u7684\u7ef4\u751f\u7d20D\u7814\u7a76\u8005\u63d0\u51fa\u4e86\u4e0d\u540c\u7684\u89c2\u70b9\u3002\u5b58\u5728\u8fd9\u79cd\u5bf9\u7acb\u89c2\u70b9\u7684\u4e00\u4e2a\u5173\u952e\u539f\u56e0\u662f\u76ee\u524d\u5173\u4e8e25OHD\u548c1, 25 (OH) 2D\u975e\u7ecf\u5178\u4f5c\u7528\u4ee5\u53ca\u7ef4\u751f\u7d20D\u5f02\u5e38\u5bf9\u5065\u5eb7\u5f71\u54cd\u7684\u7814\u7a76\u663e\u8457\u589e\u52a0\u3002\u8fd9\u7bc7\u7efc\u8ff0\u63a5\u4e0b\u6765\u4f1a\u63d0\u53ca\u4e00\u4e9b\u7ef4\u751f\u7d20D\u7684\u65b0\u89c2\u70b9\u53ca\u5176\u751f\u7406\u4f5c\u7528\u76f8\u5173\u7684\u7814\u7a76, \u63a2\u8ba8\u8fd9\u4e9b\u7814\u7a76\u4e0eIOM\u62a5\u544a\u7684\u76f8\u5173\u6027, \u4ee5\u53ca\u5982\u4f55\u66f4\u597d\u5730\u5b9a\u4e49\u7ef4\u751f\u7d20D\u5728\u4eba\u7c7b\u5065\u5eb7\u4e2d\u6240\u626e\u6f14\u7684\u89d2\u8272\u3002\u8fd9\u4e9b\u7814\u7a76\u5305\u62ec\u7ef4\u751f\u7d20D\u5728\u9632\u6cbb\u5e38\u89c1\u80bf\u7624\u3001\u9ad8\u8840\u538b\u3001\u5fc3\u8840\u7ba1\u75be\u75c5\u548c\u5927\u8111\u53d1\u80b2\u4e2d\u6240\u8d77\u7684\u4f5c\u7528\u3002\u800c\u5173\u4e8e\u7ef4\u751f\u7d20D\u5728\u8fd9\u4e9b\u65b9\u9762\u7684\u7814\u7a76\u90fd\u5df2\u5404\u6210\u5b66\u79d1, \u8fd9\u7bc7\u7efc\u8ff0\u4f1a\u7279\u522b\u5173\u6ce8\u7ef4\u751f\u7d20D\u7684\u53e6\u4e00\u4e2a\u7a81\u51fa\u7684\u975e\u7ecf\u5178\u4f5c\u7528, \u5373\u514d\u75ab\u8c03\u8282\u5242\u7684\u4f5c\u7528\u3002<\/p>\n<p>&nbsp;<\/p>\n<p>\u7ef4\u751f\u7d20\u5145\u8db3\u3001\u4e0d\u8db3\u548c\u7f3a\u4e4f\u591a\u5e74\u6765, \u4f53\u5185\u7ef4\u751f\u7d20D\u662f\u5426\u7f3a\u4e4f\u88ab\u7b80\u5355\u5b9a\u4e49\u4e3a\u6709\u65e0\u4f5d\u507b\u75c5\u7684\u8868\u73b0 (\u6210\u4eba\u8868\u73b0\u4e3a\u8f6f\u9aa8\u75c5) , \u800c\u5230\u4e8621\u4e16\u7eaa, \u8fd9\u6837\u7684\u4e34\u5e8a\u95ee\u9898\u76f8\u5bf9\u51cf\u5c11, \u5728\u8fd9\u79cd\u60c5\u51b5\u4e0b, \u8840\u6e0525OHD&lt;20n M (8ng\/ml) \u5927\u81f4\u8ba4\u4e3a\u662f\u7ef4\u751f\u7d20D\u6c34\u5e73\u7f3a\u4e4f\u3002\u7136\u800c, \u8fc7\u53bb\u5341\u5e74\u8fdb\u884c\u7684\u5404\u79cd\u7814\u7a76\u8868\u660e, \u5728\u6ca1\u6709\u4f5d\u507b\u75c5\u6216\u8f6f\u9aa8\u75c5\u7684\u60c5\u51b5\u4e0b\u4e5f\u4f1a\u5b58\u5728\u7ef4\u751f\u7d20D\u7684\u4e0d\u8db3\u3002\u8fd9\u79cd\u8bc4\u4ef7\u7ef4\u751f\u7d20D\u6c34\u5e73\u7684\u65b0\u89c2\u70b9\u6e90\u4e8e\u4e00\u4e9b\u5173\u4e8e\u8840\u6e0525OHD\u7684\u6c34\u5e73\u4e0e\u8840\u6e05\u7532\u72b6\u65c1\u817a\u7d20 (PTH) \u6c34\u5e73\u5448\u6301\u7eed\u8d1f\u76f8\u5173\u7684\u7814\u7a76, \u8fd9\u4e9b\u7814\u7a76\u6307\u51fa\u5f53\u8840\u6e0525OHD\u7684\u6c34\u5e73\u8fbe\u523075n M (30ng\/ml) \u65f6, \u8840PTH\u7684\u6c34\u5e73\u4e0d\u518d\u964d\u4f4e\u3002\u5728\u89c2\u5bdf\u80a0\u9499\u5438\u6536\u65f6\u4e5f\u5f97\u5230\u7c7b\u4f3c\u7684\u7ed3\u679c, \u4ece\u800c\u5f97\u51fa\u7ed3\u8bba:\u8840\u6e0525OHD&gt;75n M\u662f\u7ef4\u751f\u7d20D\u7684\u7406\u60f3\u6c34\u5e73\u3002\u8fd9\u4e9b\u7814\u7a76\u4e5f\u4f7f\u201c\u7ef4\u751f\u7d20D\u4e0d\u8db3 (vitamin D insufficiency) \u201d\u8fd9\u4e00\u672f\u8bed\u7684\u66f4\u5e7f\u6cdb\u5e94\u7528\u5f97\u5230\u8ba4\u53ef\u3002\u201c\u7ef4\u751f\u7d20D\u4e0d\u8db3\u201d\u8fd9\u4e00\u672f\u8bed\u4e8e\u4e8c\u5341\u4e16\u7eaa\u516b\u5341\u5e74\u4ee3\u9996\u6b21\u63d0\u51fa, \u662f\u6307\u6ca1\u6709\u4f5d\u507b\u75c5\u7684\u4eba\u7fa4\u7ef4\u751f\u7d20D\u6c34\u5e73\u5904\u4e8e\u6b20\u4f73\u7684\u72b6\u6001 (\u8840\u6e0525OHD&lt;75n M) \u3002\u5728\u63a5\u53d7\u8fd9\u4e2a\u65b0\u89c2\u70b9\u7684\u540c\u65f6, IOM\u7684\u62a5\u544a\u7740\u91cd\u5f3a\u8c03\u4e86\u5176\u4ed6\u4e00\u4e9b\u53cd\u5bf9\u5c06\u8840\u6e0525OHD\u6d53\u5ea675 n M\u5b9a\u4e49\u4e3a\u7ef4\u751f\u7d20D\u53d1\u6325\u4fc3\u9499\u4f5c\u7528\u7684\u7406\u60f3\u6c34\u5e73\u7684\u7814\u7a76\u3002\u5728\u4e00\u4e9b\u7814\u7a76\u4e2d, \u66f4\u4f4e\u6c34\u5e73\u7684\u8840\u6e0525OHD\u88ab\u5b9a\u4e49\u4e3a\u7406\u60f3\u6c34\u5e73, \u800c\u6709\u65f6\u5019\u6839\u672c\u4e0d\u53ef\u80fd\u660e\u786e\u5730\u7ed9\u51fa\u4e00\u4e2a\u7406\u60f3\u7684\u5207\u70b9\u3002\u4e8b\u5b9e\u4e0a, \u6709\u7814\u7a76\u8ba4\u4e3a\u8840\u6e0525OHD\u4e0e\u5065\u5eb7\u7684\u5173\u7cfb\u5448U\u5f62\u66f2\u7ebf, \u9ad8\u6c34\u5e73\u7684\u8840\u6e0525OHD\u4e5f\u53ef\u4ee5\u5bfc\u81f4\u5065\u5eb7\u6076\u5316, \u8b6c\u5982\u67d0\u4e9b\u7f55\u89c1\u7684\u80bf\u7624\u3002\u56e0\u6b64\u5bf9\u4e8e\u4e0d\u540c\u7684\u751f\u7269\u5b66\u4f5c\u7528\u548c\u4e34\u5e8a\u8868\u73b0, \u7406\u60f3\u7ef4\u751f\u7d20D\u6c34\u5e73\u4e5f\u662f\u4e0d\u540c\u7684\u3002<\/p>\n<p>\u5faa\u73af\u4e2d25OHD\u7684\u6c34\u5e73\u80fd\u76f4\u63a5\u53cd\u6620\u4f53\u5185\u7ef4\u751f\u7d20D\u7684\u72b6\u6001, \u4efb\u4f55\u4e2a\u4f53\u90fd\u662f\u901a\u8fc7\u76ae\u80a4\u5728\u7d2b\u5916\u7ebf\u7684\u4f5c\u7528\u4e0b\u5408\u6210\u6216\u81b3\u98df\u4e2d\u6444\u5165\u800c\u83b7\u5f97\u7ef4\u751f\u7d20D\u3002\u56e0\u6b64, \u7ef4\u751f\u7d20D\u7684\u6c34\u5e73\u4f1a\u56e0\u5730\u7406\u3001\u793e\u4f1a\u548c\u7ecf\u6d4e\u56e0\u7d20\u7684\u4e0d\u540c\u800c\u5728\u4eba\u7fa4\u4e2d\u4ea7\u751f\u5f88\u5927\u7684\u5dee\u5f02\u3002\u4f9d\u636e\u65b0\u7684\u7ef4\u751f\u7d20D\u53c2\u8003\u503c\u8303\u56f4, \u53ef\u4ee5\u770b\u51fa\u5168\u7403\u8303\u56f4\u5185\u6709\u5f88\u5927\u6bd4\u4f8b\u7684\u4eba\u7fa4\u5728\u4ee5\u524d\u88ab\u8ba4\u4e3a\u662f\u7ef4\u751f\u7d20D\u5145\u8db3, \u800c\u73b0\u5728\u4e5f\u88ab\u8ba4\u4e3a\u662f\u7ef4\u751f\u7d20D\u4e0d\u8db3\u3002\u8fdb\u800c\u4ea7\u751f\u4e00\u4e2a\u95ee\u9898, \u7ef4\u751f\u7d20D\u4e0d\u8db3\u662f\u5426\u4e0e\u67d0\u4e9b\u9aa8\u5916\u75be\u75c5\u5b58\u5728\u8054\u7cfb\u3002\u4eba\u4eec\u4ece\u4e24\u4e2a\u5b8c\u5168\u4e0d\u540c\u7684\u65b9\u9762\u6765\u56de\u7b54\u8fd9\u4e2a\u95ee\u9898, \u5206\u522b\u662f\u5173\u4e8e\u7ef4\u751f\u7d20D\u514d\u75ab\u8c03\u8282\u4f5c\u7528\u7684\u4f53\u5916\u7814\u7a76\u548c\u6d41\u884c\u75c5\u5b66\u7684\u7814\u7a76\u3002<\/p>\n<p>&nbsp;<\/p>\n<p>\u7ef4\u751f\u7d20D\u4e0e\u56fa\u6709\u514d\u75ab:25OHD\u80de\u5185\u5206\u6ccc\u6d3b\u6027\u7684\u65b0\u8303\u4f8b\u7ef4\u751f\u7d20D\u548c\u56fa\u6709\u514d\u75ab\u7684\u8054\u7cfb\u6700\u521d\u8d77\u6e90\u4e8e\u9c7c\u809d\u6cb9\u5728\u80ba\u7ed3\u6838 (TB) \u6cbb\u7597\u4e2d\u7684\u4f7f\u7528\u3002\u8fd1\u5e74\u6765\u91cd\u70b9\u7814\u7a76\u4e86\u7ef4\u751f\u7d20D\u5bf9\u80ba\u7ed3\u6838 (TB) \u81f4\u75c5\u83cc\u2014\u2014\u7ed3\u6838\u5206\u652f\u6746\u83cc (M.tb) \u4f5c\u7528\u7684\u7ec6\u80de\u548c\u5206\u5b50\u673a\u5236\u3002\u65e9\u572825\u5e74\u524d\u5c31\u6709\u7814\u7a76\u63d0\u51fa\u6d3b\u60271, 25 (OH) 2D\u80fd\u591f\u51cf\u5c11\u7ed3\u6838\u5206\u679d\u6746\u83cc\u5728\u5de8\u566c\u7ec6\u80de\u4e2d\u7684\u589e\u6b96, \u5de8\u566c\u7ec6\u80deCYP27B1\u523a\u6fc0\u56e0\u5b50\u7ec6\u80de\u5e72\u6270\u7d20\u03b3 (IFN\u03b3) \u80fd\u591f\u589e\u5f3a\u8fd9\u79cd\u4f5c\u7528\u3002\u7136\u800c, \u4eba\u4eec\u5bf9\u7ef4\u751f\u7d20D\u5728\u7ed3\u6838\u75c5\u4e2d\u662f\u600e\u6837\u53d1\u6325\u6297\u83cc\u4f5c\u7528\u7684\u8ba4\u8bc6\u66f4\u591a\u6e90\u81ea\u8fd1\u671f\u7684\u7814\u7a76\u3002\u8fd9\u4e9b\u7814\u7a76\u65e8\u5728\u786e\u5b9a\u4f5c\u4e3a\u6740\u83cc\u5173\u952e\u7ec6\u80de\u7684\u5355\u6838-\u5de8\u566c\u7ec6\u80de\u5bf9M.tb\u7684\u4f5c\u7528\u65b9\u5f0f\u3002<\/p>\n<p>&nbsp;<\/p>\n<p>\u5355\u6838-\u5de8\u566c\u7ec6\u80de\u80fd\u591f\u541e\u566c\u75c5\u539f\u4f53, \u5982M.tb, \u540c\u65f6\u4e5f\u80fd\u901a\u8fc7Toll\u6837\u53d7\u4f53 (TLRs) \u8fd9\u6837\u7684\u6a21\u5f0f\u8bc6\u522b\u53d7\u4f53 (PRR) \u6765\u8bc6\u522b\u75c5\u539f\u76f8\u5173\u7684\u5206\u5b50\u6a21\u5f0f (PAMPs) \u3002\u57282006\u5e74, \u6709\u7814\u7a76\u6307\u51fa\u5355\u6838\u7ec6\u80de\u88abM.tb\u6d3b\u5316\u540e, \u901a\u8fc7TLR2\/1\u8bc6\u522bPAMP, \u4ece\u800c\u4e0a\u8c03CYP27Bl\u548cVDR\u7684\u8868\u8fbe\u3002\u8fd9\u4e9b\u7814\u7a76\u8868\u660e\u5728\u9047\u5230M.tb\u65f6, \u5355\u6838\u7ec6\u80de\u80fd\u4fc3\u8fdb\u5c40\u90e8\u7ef4\u751f\u7d20D\u7684\u6d3b\u5316, \u4f7f1, 25 (OH) 2D\u4e0e\u5185\u6e90\u6027VDR\u7ed3\u5408\u3002\u7ef4\u751f\u7d20D\u80fd\u591f\u901a\u8fc7\u8fd9\u79cd\u65b9\u5f0f\u8c03\u63a7\u57fa\u56e0\u8868\u8fbe, \u4ea7\u751f\u7ecf\u5178\u7684\u80de\u5185\u5206\u6ccc\u514d\u75ab\u53cd\u5e94 (\u89c1\u56fe1) \u3002\u80de\u5185\u5206\u6ccc\u76841, 25 (OH) 2D\u4e0eVDR\u7ed3\u5408\u540e\u76f4\u63a5\u8c03\u63a7\u6297\u5fae\u751f\u7269\u86cb\u767d (\u5373\u6297\u83cc\u80bd) \u7684\u8f6c\u5f55\u3002\u529f\u80fd\u5206\u6790\u8868\u660e, 25OHD\u4ecb\u5bfc\u7684\u6297\u83cc\u80bd\u80fd\u591f\u589e\u52a0\u5355\u6838\u7ec6\u80de\u7684\u6740\u83cc\u4f5c\u7528\u3002\u56e0\u6b64, \u5c3d\u7ba1M.tb\u901a\u8fc7TLR2\/1\u9014\u5f84\u4f7f\u5355\u6838\u7ec6\u80deCYP27B1\u548cVDR\u6d3b\u5316, \u4f46\u662f\u968f\u540e\u7684\u6740\u83cc\u6548\u80fd\u8fd8\u662f\u4f9d\u8d56\u4e8e\u6709\u8db3\u591f\u768425OHD\u8f6c\u5316\u4e3a1, 25 (OH) 2D, \u8840\u6e0525OHD\u7684\u6c34\u5e73\u4e0e\u5355\u6838\u7ec6\u80de\u6297\u83cc\u80bd\u7684\u8868\u8fbe\u5b58\u5728\u7740\u76f8\u5173\u6027\u3002\u4ece\u800c\u5f97\u51fa\u7ed3\u8bba, \u4f53\u5185\u4f4e\u6c34\u5e73\u7684\u8840\u6e0525OHD\u5c06\u4f1a\u5bfc\u81f4\u5355\u6838\u7ec6\u80de\u7684\u6297\u83cc\u6d3b\u6027\u964d\u4f4e, \u4f7f\u611f\u67d3\u98ce\u9669\u589e\u5927;\u76f8\u53cd, \u5bf9\u7ef4\u751f\u7d20D\u4e0d\u8db3\u7684\u4e2a\u4f53\u8865\u5145\u7ef4\u751f\u7d20D\u80fd\u591f\u4fc3\u8fdbTLR\u4ecb\u5bfc\u7684\u5355\u6838\u7ec6\u80de\u6297\u83cc\u80bd\u7684\u8868\u8fbe, \u4f7f\u6297\u611f\u67d3\u80fd\u529b\u589e\u5f3a\u3002<\/p>\n<p>\u5bbf\u4e3b\u5bf9\u75c5\u539f\u4f53 (\u5982M.tb) \u7684\u6297\u611f\u67d3\u80fd\u529b\u5e76\u4e0d\u5355\u5355\u4f9d\u9760\u56fa\u6709\u514d\u75ab\u53cd\u5e94\u3002\u6211\u4eec\u5c0f\u7ec4\u7684\u7814\u7a76\u663e\u793aT\u7ec6\u80de\u7684\u7ec6\u80de\u56e0\u5b50\u5728\u52a0\u5f3a\u548c\u51cf\u5f31\u7ef4\u751f\u7d20D\u4ecb\u5bfc\u7684\u6297\u83cc\u80bd\u7684\u751f\u6210\u4e2d\u53d1\u6325\u7740\u81f3\u5173\u91cd\u8981\u7684\u4f5c\u7528\u3002\u4e8b\u5b9e\u4e0a, \u5355\u6838\u7ec6\u80de\u7ec6\u80de\u56e0\u5b50\u7684\u5206\u6ccc\u53ef\u80fd\u53d7\u80de\u5185\u5206\u6ccc\u7684\u7ef4\u751f\u7d20D\u7684\u8c03\u63a7\u3002\u4f3c\u4e4e\u6297\u611f\u67d3\u53cd\u5e94\u7684\u589e\u5f3a\u5c06\u9ad8\u5ea6\u4f9d\u8d56\u4e8e\u7ef4\u751f\u7d20D\u7684\u53ef\u7528\u6027, \u901a\u8fc7\u6b63\u5e38\u4eba\u4f53\u514d\u75ab\u53cd\u5e94\u7684\u5176\u4ed6\u6210\u5206\u4f5c\u51fa\u7684\u989d\u5916\u8c03\u6574\u3002\u7ef4\u751f\u7d20D\u8fd8\u53ef\u4ee5\u901a\u8fc7\u5f71\u54cd\u5de8\u566c\u7ec6\u80de\u6216\u6811\u7a81\u7ec6\u80de (DCs) \u7684\u6297\u539f\u5448\u9012\u6765\u5f71\u54cd\u56fa\u6709\u514d\u75ab\u53cd\u5e94, \u4f17\u6240\u5468\u77e5, \u8fd9\u4e9b\u7ec6\u80de\u90fd\u8868\u8fbeVDR\u30021, 25 (OH) 2D\u80fd\u6291\u5236\u6811\u7a81\u72b6\u7ec6\u80de\u7684\u6210\u719f, \u6291\u5236\u6297\u539f\u5448\u9012\u548c\u4fc3\u8fdb\u8010\u53d7\u6027T\u7ec6\u80de\u53cd\u5e94 (\u89c1\u56fe1) \u3002\u548c\u5355\u6838\u7ec6\u80de\u4e00\u6837, DCs\u4e5f\u8868\u8fbeCYP27B1, \u6240\u4ee51, 25 (OH) 2D\u548c25OHD\u4e5f\u80fd\u591f\u901a\u8fc7DCs\u8c03\u8282\u6297\u539f\u5448\u9012\u3002\u8fd9\u4e9b\u7ed3\u8bba\u662f\u5728VDR\u548cCYP27B1\u57fa\u56e0\u6572\u9664\u5c0f\u9f20\u7684\u7814\u7a76\u4e2d\u5f97\u5230\u7684, \u8be5\u7814\u7a76\u8868\u660e, \u6dcb\u5df4\u817a\u5f02\u5e38\u4e0e\u6210\u719f\u6811\u7a81\u7ec6\u80de\u548c\u5f02\u5e38\u8f6c\u8fd0\u6811\u7a81\u7ec6\u80de\u7684\u6570\u91cf\u589e\u52a0\u5bc6\u5207\u76f8\u5173\u3002<\/p>\n<p>&nbsp;<\/p>\n<p>\u7ef4\u751f\u7d20D\u548c\u9002\u5e94\u6027\u514d\u75ab\u7ef4\u751f\u7d20D\u548c\u514d\u75ab\u7cfb\u7edf\u7684\u65e9\u671f\u7814\u7a76\u8bc1\u660e, T\u3001B\u7ec6\u80de\u90fd\u6709VDR\u53d7\u4f53\u7684\u8868\u8fbe\u3002\u8fdb\u4e00\u6b65\u7814\u7a76\u53d1\u73b0\u53ea\u6709\u6d3b\u5316\u7684\u548c\u589e\u6b96\u7684\u6dcb\u5df4\u7ec6\u80de\u624d\u4f1a\u8868\u8fbeVDR\u53d7\u4f53, \u4ece\u800c\u8ba4\u4e3a1, 25 (OH) 2D\u5bf9\u6dcb\u5df4\u7ec6\u80de\u5177\u6709\u6291\u5236\u589e\u6b96\u7684\u4f5c\u7528\u3002\u8f85\u52a9\u578bT\u7ec6\u80de (Th) \u662f1, 25 (OH) 2D\u7684\u4e3b\u8981\u9776\u7ec6\u80de, 1, 25 (OH) 2D\u80fd\u6291\u5236Th\u7ec6\u80de\u7684\u589e\u6b96, \u8c03\u8282\u7ec6\u80de\u56e0\u5b50\u7684\u4ea7\u751f\u3002\u521d\u59cbTh\u7ec6\u80de\u88ab\u6297\u539f\u6d3b\u5316\u540e\u8f6c\u5316\u4e3aTh1\u548cTh2\u7ec6\u80de\u4e24\u4e2a\u4e9a\u7fa4, Th1\u7ec6\u80de\u4e3b\u8981\u5206\u6cccIL-2, IFN\u03b3\u548c\u80bf\u7624\u574f\u6b7b\u56e0\u5b50\u03b1 (TNF-\u03b1) , \u4ecb\u5bfc\u7ec6\u80de\u514d\u75ab, Th2\u7ec6\u80de\u4e3b\u8981\u5206\u6cccIL-3, IL-4, IL-5\u548cIL-10, \u4ecb\u5bfc\u4f53\u6db2\u514d\u75ab\u3002\u5728\u4f53\u5916\u7814\u7a76\u4e2d\u53d1\u73b0, 1, 25 (OH) 2D\u80fd\u6291\u5236Th1\u7ec6\u80de\u56e0\u5b50\u7684\u4ea7\u751f, \u4fc3\u8fdbTh2\u7ec6\u80de\u56e0\u5b50\u7684\u4ea7\u751f\u3002\u5206\u6cccIL-17\u7684Th17\u7ec6\u80de\u662fTh\u7ec6\u80de\u53e6\u4e00\u4e9a\u7fa4, \u7ef4\u751f\u7d20D\u5bf9\u5176\u4e5f\u6709\u4f5c\u7528\u3002\u7814\u7a76\u53d1\u73b0\u75281, 25D\u6cbb\u7597\u6613\u611f\u81ea\u8eab\u6027\u514d\u75ab\u75be\u75c5\u7684\u975e\u80a5\u80d6\u578b\u7cd6\u5c3f\u75c5\u5c0f\u9f20 (NOD) , \u80fd\u591f\u964d\u4f4e\u8840\u6e05IL-17\u7684\u6c34\u5e73, 1, 25 (OH) 2D\u5bf9\u5c0f\u9f20\u89c6\u7f51\u819c\u81ea\u8eab\u514d\u75ab\u7684\u6291\u5236\u4f5c\u7528\u4e0eTh17\u6d3b\u6027\u7684\u6291\u5236\u76f8\u5173\u3002\u6700\u8fd1\u7684\u7814\u7a76\u663e\u793a, 1, 25 (OH) 2D\u6291\u5236IL17\u7684\u4ea7\u751f\u662f\u901a\u8fc7\u6291\u5236IL17\u57fa\u56e0\u7684\u76f4\u63a5\u8f6c\u5f55\u30021, 25 (OH) 2D\u4f5c\u7528\u7684\u53e6\u4e00T\u7ec6\u80de\u4e9a\u7fa4\u662f\u8c03\u8282\u6027T\u7ec6\u80de (Treg) \u3002Treg\u662f\u514d\u75ab\u6291\u5236\u7ec6\u80de, \u80fd\u591f\u6291\u5236\u8fc7\u5206\u7684\u514d\u75ab\u53cd\u5e94\u548c\u81ea\u8eab\u514d\u75ab\u53cd\u5e94\u3002\u75281, 25 (OH) 2D\u6cbb\u7597\u80be\u75c5\u75c5\u4eba\u80fd\u591f\u589e\u52a0\u5faa\u73af\u4e2dTreg\u7ec6\u80de\u7684\u6570\u91cf, \u8868\u660eTreg\u7ec6\u80de\u5728\u4ecb\u5bfc\u7ef4\u751f\u7d20D\u7684\u514d\u75ab\u8c03\u8282\u65b9\u9762\u8d77\u91cd\u8981\u4f5c\u7528\u3002<\/p>\n<p>\u76ee\u524d, \u5173\u4e8e\u7ef4\u751f\u7d20D\u548cT\u7ec6\u80de\u529f\u80fd\u7684\u7814\u7a76\u4e3b\u8981\u96c6\u4e2d\u5728\u6d3b\u60271, 25 (OH) 2D\u5bf9T\u7ec6\u80de\u7684\u4f5c\u7528\u3002\u5c3d\u7ba1\u6709\u7814\u7a76\u663e\u793a\u8840\u6e0525OHD\u6c34\u5e73\u4e0e\u67d0\u4e9b\u5177\u4f53T\u7ec6\u80de\u7fa4\u6709\u5173\u7cfb, \u4f46\u662f\u5c1a\u4e0d\u6e05\u695a\u7684\u662f\u7ef4\u751f\u7d20D\u6c34\u5e73\u53d8\u5316\u5bf9T\u7ec6\u80de\u5f71\u54cd\u7684\u4f5c\u7528\u673a\u5236\u3002\u6709\u7814\u7a76\u663e\u793a\u8840\u5faa\u73af\u4e2d25OHD\u7684\u6c34\u5e73\u4e0e\u591a\u53d1\u6027\u786c\u5316\u75c7 (MS) \u60a3\u8005\u4f53\u5185\u7684Treg\u7ec6\u80de\u6d3b\u6027\u76f8\u5173\u300225OHD\u5bf9T\u7ec6\u80de\u529f\u80fd\u7684\u5f71\u54cd\u4e3b\u8981\u901a\u8fc7\u4ee5\u4e0b\u56db\u4e2a\u53ef\u80fd\u9014\u5f84 (\u89c1\u56fe1) : (1) \u901a\u8fc7\u5728\u80be\u810f\u5f62\u6210\u7684\u6d3b\u60271, 25 (OH) 2D\u8fdb\u5165\u8840\u5faa\u73af\u76f4\u63a5\u4f5c\u7528\u4e8eT\u7ec6\u80de; (2) \u4f5c\u7528\u4e8e\u8868\u8fbeCYP27B1\u7684DC, \u4f7f\u5176\u80de\u5185\u5206\u6ccc1, 25 (OH) 2D, \u4ece\u800c\u95f4\u63a5\u5bf9T\u7ec6\u80de\u7684\u6297\u539f\u5448\u9012\u4ea7\u751f\u5f71\u54cd; (3) \u4f7f\u8868\u8fbeCYP27B1\u7684\u5355\u6838\u7ec6\u80de\u6216\u8005DC\u65c1\u5206\u6ccc\u6d3b\u60271, 25 (OH) 2D, \u4ece\u800c\u76f4\u63a5\u4f5c\u7528\u4e8eT\u7ec6\u80de; (4) T\u7ec6\u80de\u81ea\u8eab\u80de\u5185\u5206\u6ccc\u6d3b\u60271, 25 (OH) 2D\u3002\u4f46\u6211\u4eec\u5c1a\u4e0d\u6e05\u695a\u7684\u662f, \u5bf9\u4e8e\u4e00\u4e2a\u5177\u4f53\u7684T\u7ec6\u80de\u4e9a\u7fa4, \u5230\u5e95\u662f\u4e00\u4e2a\u673a\u5236\u7684\u4f5c\u7528\u8fd8\u662f\u591a\u4e2a\u673a\u5236\u7684\u5171\u540c\u4f5c\u7528\u3002\u6bd4\u5982\u8bf4, 1, 25 (OH) 2D\u5bf9Treg\u80fd\u591f\u901a\u8fc7DCs\u8d77\u95f4\u63a5\u4f5c\u7528, \u4e5f\u80fd\u591f\u76f4\u63a5\u4f5c\u7528\u4e8eT\u7ec6\u80de\u3002\u4f46\u662f\u5982\u4e0a\u6240\u8ff0, DCs\u4e5f\u8868\u8fbeCYP27B1, \u4e5f\u80fd\u572825OHD\u5bf9Treg\u7684\u4f5c\u7528\u4e2d\u8d77\u4ecb\u5bfc\u4f5c\u7528\u3002\u6709\u8da3\u7684\u662f, \u6709\u7814\u7a76\u663e\u793aT\u7ec6\u80de\u4e0a\u4e5f\u6709CYP27B1\u7684\u8868\u8fbe, \u8fd9\u5c31\u610f\u5473\u774025OHD\u4e5f\u53ef\u80fd\u901a\u8fc7\u5f71\u54cdT\u7ec6\u80de\u7684\u80de\u5185\u5206\u6ccc\u800c\u76f4\u63a5\u4f5c\u7528\u4e8eT\u7ec6\u80de, \u4f46\u662f\u786e\u5207\u4f5c\u7528\u5c1a\u4e0d\u6e05\u695a\u3002<\/p>\n<p>&nbsp;<\/p>\n<p>\u5bf9\u4e8eB\u7ec6\u80de, \u65e9\u6709\u7814\u7a76\u8bc1\u5b9eB\u7ec6\u80de\u4e0a\u4e5f\u6709VDR\u7684\u8868\u8fbe, \u4f46\u662f1, 25 (OH) 2D\u6291\u5236B\u7ec6\u80de\u589e\u6b96\u548c\u514d\u75ab\u7403\u86cb\u767d\u4ea7\u751f\u7684\u4f5c\u7528\u4ecd\u88ab\u8ba4\u4e3a\u662f\u901a\u8fc7Th\u7ec6\u80de\u4ecb\u5bfc\u7684\u95f4\u63a5\u4f5c\u7528\u3002\u7136\u800c\u6700\u8fd1\u7814\u7a76\u8bc1\u5b9e, 1, 25 (OH) 2D\u5bf9B\u7ec6\u80de\u4e5f\u6709\u76f4\u63a5\u4f5c\u7528, \u5c24\u5176\u662f\u5bf9\u6d46\u7ec6\u80de\u7684\u6291\u5236\u548c\u8bb0\u5fc6\u7ec6\u80de\u7684\u7c7b\u522b\u8f6c\u5316\u3002\u8fd9\u4e9b\u4f5c\u7528\u66f4\u52a0\u652f\u6301\u4e86\u7ef4\u751f\u7d20D\u5728B\u7ec6\u80de\u76f8\u5173\u7684\u81ea\u8eab\u514d\u75ab\u6027\u75be\u75c5\u5982\u7cfb\u7edf\u6027\u7ea2\u6591\u72fc\u75ae (SLE) \u4e2d\u7684\u6cbb\u7597\u4f5c\u7528\u3002\u6709\u7814\u7a76\u663e\u793a1, 25 (OH) 2D\u80fd\u591f\u901a\u8fc7\u8c03\u8282IL-10\u548cCCR10\u6765\u4f5c\u7528\u4e8eB\u7ec6\u80de, \u63d0\u793a\u7ef4\u751f\u7d20D\u5bf9B\u7ec6\u80de\u7684\u4f5c\u7528\u5df2\u8fdc\u8fdc\u8d85\u51fa\u6291\u5236B\u7ec6\u80de\u589e\u6b96\u548c\u514d\u75ab\u7403\u86cb\u767d\u4ea7\u751f\u3002<\/p>\n<p>&nbsp;<\/p>\n<p>\u7ef4\u751f\u7d20D\u6c34\u5e73\u3001\u514d\u75ab\u8c03\u8282\u548c\u4eba\u7c7b\u75be\u75c5\u6700\u521d\u7684\u4f53\u5916\u7814\u7a76\u53d1\u73b0\u7ef4\u751f\u7d20D\u80fd\u591f\u6740\u706dM.tb, \u4e8e\u662f\u540e\u6765\u7684\u7814\u7a76\u4e3b\u8981\u96c6\u4e2d\u5728\u7ef4\u751f\u7d20D\u5bf9\u80ba\u7ed3\u6838\u7684\u6cbb\u7597\u3002\u6d41\u884c\u75c5\u5b66\u7814\u7a76\u663e\u793a\u8840\u6e0525OHD\u6c34\u5e73\u4f4e\u4e8e75 n M\u4e0e\u80ba\u7ed3\u6838\u7684\u9ad8\u611f\u67d3\u7387\u5bc6\u5207\u76f8\u5173, \u4e4b\u524d\u7684\u7efc\u8ff0\u4e5f\u652f\u6301\u7ef4\u751f\u7d20D\u5bf9\u80ba\u7ed3\u6838\u5177\u6709\u4fdd\u62a4\u4f5c\u7528\u3002\u5c3d\u7ba1\u8fd9\u4e9b\u7814\u7a76\u5e76\u6ca1\u6709\u6307\u660e\u8fd9\u5176\u4e2d\u7684\u56e0\u679c\u5173\u7cfb, \u4f46\u8fd9\u4f7f\u5f97\u4eba\u4eec\u53bb\u8fdb\u4e00\u6b65\u7814\u7a76\u8865\u5145\u7ef4\u751f\u7d20D\u7684\u4e34\u5e8a\u6548\u679c\u3002\u5176\u4e2d\u4e00\u4e2a\u7814\u7a76\u663e\u793a, \u53e3\u670d\u5355\u5242\u91cf\u7ef4\u751f\u7d20D2 (100, 000IU2.5mg) \u540e\u62bd\u53d6\u7684\u8840\u6db2\u6837\u672c\u5728\u4f53\u5916\u80fd\u591f\u6291\u5236M.tb\u7684\u751f\u957f\u3002\u53e6\u4e00\u4e2a\u7814\u7a76\u5728\u80ba\u7ed3\u6838\u60a3\u8005\u7684\u4f20\u7edf\u6cbb\u7597\u65b9\u6848\u4e0a\u52a0\u7528\u7ef4\u751f\u7d20D\u6cbb\u7597 (10, 000IU\/0.25mg\u7ef4\u751f\u7d20D3\/\u5929) , \u53d1\u73b0\u7ef4\u751f\u7d20D\u80fd\u591f\u51cf\u5c11\u75f0\u6d82\u7247\u6297\u9178\u6746\u83cc (AFB) \u8f6c\u9634\u7684\u65f6\u95f4\u3002\u8fd1\u671f\u7684\u4e24\u4e2a\u968f\u673a\u3001\u5bf9\u7167\u3001\u53cc\u76f2\u7814\u7a76\u8bc4\u4ef7\u4e86\u5bf9\u7ef4\u751f\u7d20D\u6cbb\u7597\u80ba\u7ed3\u6838\u7684\u7597\u6548\u3002\u5176\u4e2d\u4e00\u4e2a\u7814\u7a76\u6765\u81ea\u51e0\u5185\u4e9a\u6bd4\u7ecd\u5171\u548c\u56fd\u7684\u80ba\u7ed3\u6838\u8bca\u6240, \u53d1\u73b0\u75283\u00d7100, 000IU (3\u00d72.5mg) \u7684\u7ef4\u751f\u7d20D3\u6ce8\u5c04\u5e76\u4e0d\u80fd\u63d0\u9ad8\u80ba\u7ed3\u6838\u7684\u7597\u6548, \u800c\u96be\u4ee5\u89e3\u91ca\u7684\u662f\u6cbb\u7597\u7ec4\u7684\u8840\u6e0525OHD\u6c34\u5e73\u8f83\u5bf9\u7167\u7ec4\u5e76\u6ca1\u6709\u5347\u9ad8\u3002\u82f1\u56fd\u4e00\u4e2a\u7c7b\u4f3c\u7684\u7814\u7a76\u53d1\u73b0, \u75284\u00d7100, 000IU (4\u00d72.5mg) \u7684\u7ef4\u751f\u7d20D3\u6ce8\u5c04\u80fd\u591f\u63d0\u9ad8\u80ba\u7ed3\u6838\u60a3\u8005\u8840\u6e0525OHD\u7684\u6c34\u5e73, \u4f46\u662f\u6cbb\u7597\u7ec4\u7684\u75f0\u6d82\u7247\u8f6c\u9634\u7684\u65f6\u95f4\u8f83\u5bf9\u7167\u5e76\u65e0\u663e\u8457\u5dee\u522b, \u4e8e\u662f\u7814\u7a76\u4eba\u5458\u5206\u6790\u4e86\u80ba\u7ed3\u6838\u60a3\u8005\u7684\u9057\u4f20\u57fa\u56e0\u53d8\u5f02, \u53d1\u73b0VDR\u57fa\u56e0\u7684\u5355\u6838\u82f7\u9178\u591a\u6001\u6027 (SNP) \u4e3aTaq1-tt\u57fa\u56e0\u578b\u7684\u80ba\u7ed3\u6838\u60a3\u8005\u752825OHD\u6cbb\u7597\u80fd\u663e\u8457\u51cf\u5c11\u75f0\u6d82\u7247\u8f6c\u9634\u7684\u65f6\u95f4\u3002\u56e0\u6b64, \u9057\u4f20\u56e0\u7d20\u5c06\u4f1a\u5f71\u54cd\u7ef4\u751f\u7d20D\u7684\u6cbb\u7597\u6548\u679c, \u6211\u4eec\u63a5\u4e0b\u6765\u5c06\u8be6\u7ec6\u8ba8\u8bba\u7ef4\u751f\u7d20D\u5728\u8fd9\u65b9\u9762\u7684\u751f\u7406\u673a\u80fd\u3002\u5728\u8fd9\u4e9b\u7814\u7a76\u4e2d\u90fd\u6d89\u53ca\u4e86\u7ef4\u751f\u7d20D\u6cbb\u7597\u7684\u975e\u5e38\u5177\u4f53\u7684\u76ee\u6807 (\u5982\u75f0\u6d82\u7247\u8f6c\u9634\u7684\u65f6\u95f4) , \u4f46\u4ed6\u4eec\u5e76\u6ca1\u6709\u63cf\u8ff0\u8865\u5145\u7ef4\u751f\u7d20D\u5bf9\u80ba\u7ed3\u6838\u60a3\u8005\u7684\u7ba1\u7406\u548c\u7597\u6548\u7684\u5f71\u54cd\u3002\u800c\u4e14\u8fd9\u4e9b\u7814\u7a76\u90fd\u662f\u5728\u4f20\u7edf\u7684\u6297\u7ed3\u6838\u6cbb\u7597\u57fa\u7840\u4e0a\u8865\u5145\u7ef4\u751f\u7d20D, \u56e0\u6b64\u8fd8\u5b58\u5728\u4e00\u4e9b\u95ee\u9898, \u672a\u6765\u7684\u7814\u7a76\u9700\u8981\u89e3\u51b3\u8fd9\u4e9b\u95ee\u9898, \u4f7f\u8865\u5145\u7ef4\u751f\u7d20D\u4f5c\u4e3a\u9632\u6cbb\u80ba\u7ed3\u6838\u7684\u6709\u6548\u624b\u6bb5\u3002<\/p>\n<p>\u7ef4\u751f\u7d20D\u7684\u6297\u611f\u67d3\u4f5c\u7528\u4e0d\u4ec5\u4ec5\u9650\u4e8e\u5bf9\u80ba\u7ed3\u6838\u7684\u6cbb\u7597, \u5728\u53e6\u4e00\u79cd\u5206\u652f\u6746\u83cc\u75c5\u2014\u2014\u9ebb\u98ce\u75c5\u4e2d\u4e5f\u53d1\u73b0\u4e86CYP27B1\u548cVDR\u7684\u8868\u8fbe\u5dee\u5f02, \u5c24\u5176\u53d1\u73b0\u4e86\u4fb5\u8680\u6027\u8f83\u5c0f\u7684\u7c7b\u7ed3\u6838\u578b\u9ebb\u98ce (T-lep) \u6bd4\u7ed3\u8282\u578b\u9ebb\u98ce (L-lep) \u8868\u8fbe\u66f4\u9ad8\u6c34\u5e73\u7684CYP27B1\u548cVDR\u3002T-lep\u578b\u60a3\u8005\u7684\u5206\u652f\u6746\u83cc\u611f\u67d3\u7a0b\u5ea6\u8f83L-lep\u578b\u8f7b, \u53ef\u80fd\u662f\u7531\u4e8e\u5176\u80de\u5185\u5206\u6ccc\u4e86\u66f4\u591a\u76841, 25 (OH) 2D, \u4ece\u800c\u589e\u5f3a\u4e86T-lep\u578b\u60a3\u8005\u7684\u6297\u83cc\u80fd\u529b\u3002\u5728\u8fd9\u4e9b\u7814\u7a76\u4e2d\u6709\u8da3\u7684\u662f, \u65e9\u671f\u7684\u7814\u7a76\u53d1\u73b0\u9633\u5149\u7167\u5c04\u80fd\u591f\u6cbb\u7597\u9ebb\u98ce\u75c5, \u8fd9\u4e0e\u80ba\u7ed3\u6838\u548c\u7ef4\u751f\u7d20D\u7684\u65e9\u671f\u7814\u7a76\u76f8\u4f3c\u3002\u5728\u5176\u4ed6\u611f\u67d3\u6027\u75be\u75c5\u4e2d, \u5982\u8d25\u8840\u75c7, \u8840\u6e0525OHD\u6d53\u5ea6\u4e0e\u5faa\u73af\u4e2d\u6297\u83cc\u80bd\u7684\u6c34\u5e73\u76f8\u5173, \u7ee7\u800c\u4e0e\u91cd\u5927\u75be\u75c5\u7684\u98ce\u9669\u589e\u52a0\u76f8\u5173\u3002\u7136\u800c, \u8d25\u8840\u75c7\u60a3\u8005\u8840\u6e0525OHD\u6c34\u5e73\u4e0e\u6297\u83cc\u80bd\u7684\u7684\u8054\u7cfb\u5177\u4f53\u4e0e\u54ea\u79cd\u7c7b\u578b\u7684\u7ec6\u80de\u4f5c\u7528\u76f8\u5173\u6211\u4eec\u5c1a\u4e0d\u6e05\u695a\u3002\u6709\u7814\u7a76\u8ba4\u4e3a\u5faa\u73af\u4e2d\u7684\u6297\u83cc\u80bd\u4e3b\u8981\u6765\u6e90\u4e8e\u4e2d\u6027\u7c92\u7ec6\u80de\u3002\u4f46\u662f, \u5c3d\u7ba1\u4e2d\u6027\u7c92\u7ec6\u80de\u8868\u8fbeVDR, \u5374\u7f3a\u4e4fCYP27B1\u6d3b\u6027\u3002\u8fd9\u8868\u660e, \u5b83\u4eec\u66f4\u53ef\u80fd\u5bf91, 25 (OH) 2D\u4ea7\u751f\u53cd\u5e94, \u800c\u4e0d\u662f25OHD (\u89c1\u56fe1) \u3002\u8fd9\u4e0e\u5355\u6838\u7ec6\u80de\u4e0d\u540c, \u5355\u6838\u7ec6\u80de\u4ea7\u751f\u7684\u6297\u83cc\u80bd\u4e0e\u8840\u6e0525OHD\u7684\u6c34\u5e73\u5bc6\u5207\u76f8\u5173, \u4e0e\u80de\u5185\u5206\u6ccc\u53cd\u5e94\u4e00\u81f4\u3002\u7ef4\u751f\u7d20D\u6c34\u5e73\u8f83\u4f4e\u4e5f\u4e0e\u665a\u671f\u80be\u75c5\u60a3\u8005\u7684\u611f\u67d3\u548c\u6b7b\u4ea1\u7387\u76f8\u5173, \u4e5f\u4e0e\u4e0a\u547c\u5438\u9053\u611f\u67d3\u76f8\u5173\u3002\u5173\u4e8e\u540e\u8005, \u503c\u5f97\u6ce8\u610f\u7684\u662f, \u6297\u83cc\u80bd\u80fd\u663e\u793a\u51fa\u6297\u75c5\u6bd2\u6027\u548c\u6297\u83cc\u7279\u6027, \u4ece\u800c\u63a8\u65ad\u7ef4\u751f\u7d20D\u80fd\u591f\u589e\u5f3a\u4eba\u4f53\u5bf9\u4e00\u4e9b\u75be\u75c5\u5982\u6d41\u611f\u7684\u62b5\u6297\u529b\u3002\u540c\u6837\u503c\u5f97\u5173\u6ce8\u7684\u662f, 25OHD\u548c1, 25 (OH) 2D\u4ecb\u5bfc\u7684\u6297\u83cc\u80bd\u4e5f\u4f5c\u7528\u4e8e\u4e00\u4e9b\u7ecf\u5178\u514d\u75ab\u7cfb\u7edf\u4ee5\u5916\u7684\u7ec6\u80de, \u5982\u89d2\u86cb\u767d\u7ec6\u80de\u3001\u652f\u6c14\u7ba1\u4e0a\u76ae\u7ec6\u80de\u3001\u9aa8\u9ad3\u7ec6\u80de\u7cfb\u3001\u80ce\u76d8\u7684\u8131\u819c\u6ecb\u517b\u5c42\u7ec6\u80de\u3002\u56e0\u6b64, \u7ef4\u751f\u7d20D\u7684\u56fa\u6709\u6297\u83cc\u4f5c\u7528\u975e\u5e38\u5e7f\u6cdb, \u5bf9\u591a\u79cd\u75be\u75c5\u8d77\u4f5c\u7528\u3002<\/p>\n<p>\u7ef4\u751f\u7d20D\u5728\u6297\u539f\u5448\u9012\u548c\u6dcb\u5df4\u7ec6\u80de\u529f\u80fd\u4e0a\u7684\u4e0d\u540c\u4f5c\u7528\u8868\u660e, \u7ef4\u751f\u7d20D\u7684\u514d\u75ab\u8c03\u8282\u4f5c\u7528\u4e0d\u5c40\u9650\u4e8e\u56fa\u6709\u7684\u6297\u83cc\u53cd\u5e94\u3002\u5c24\u5176\u662f, \u7ef4\u751f\u7d20D\u4f5c\u4e3a\u516c\u8ba4\u7684\u5bf9\u81ea\u8eab\u514d\u75ab\u6027\u75be\u75c5\u6709\u76ca\u7684\u73af\u5883\u56e0\u7d20, \u4e5f\u88ab\u8ba4\u4e3a\u662f\u6709\u76ca\u7684\u9057\u4f20\u56e0\u7d20\u3002\u7814\u7a76\u53d1\u73b0, \u521d\u8bca\u76841\u578b\u7cd6\u5c3f\u75c5\u60a3\u8005\u7684\u8840\u6e0525OHD\u6c34\u5e73\u8f83\u4f4e, \u800c\u8865\u5145\u7ef4\u751f\u7d20D\u80fd\u591f\u62b5\u62971\u578b\u7cd6\u5c3f\u75c5, \u76f8\u4f3c\u7684\u7814\u7a76\u5728\u591a\u53d1\u6027\u786c\u5316\u75c7 (MS) \u4e2d\u4e5f\u6709\u62a5\u9053, \u5e76\u5728MS\u7684\u52a8\u7269\u5b9e\u9a8c\u4e2d\u5f97\u5230\u8bc1\u5b9e\u3002\u6709\u8da3\u7684\u662f, \u52a8\u7269\u5b9e\u9a8c\u663e\u793a, \u5728\u96cc\u9f20\u4f53\u5185, \u7ef4\u751f\u7d20D\u80fd\u66f4\u6709\u6548\u5730\u62b5\u6297\u5b9e\u9a8c\u6027\u7684MS, \u8fd9\u662f\u56e0\u4e3a\u96cc\u6fc0\u7d20\u5bf9VDR\u548cCYP27B1\u6709\u8c03\u8282\u4f5c\u7528\u3002\u5176\u4ed6\u7684\u81ea\u8eab\u514d\u75ab\u75c5\u4e5f\u4e0e\u4f4e\u7ef4\u751f\u7d20D\u6c34\u5e73\u76f8\u5173, \u5305\u62ec\u514b\u7f57\u6069\u75c5\u3001\u7cfb\u7edf\u6027\u7ea2\u6591\u72fc\u75ae\u3001\u7c7b\u98ce\u6e7f\u6027\u5173\u8282\u708e\u53caGraves\u75c5\u7b49\u3002<\/p>\n<p>\u7ef4\u751f\u7d20D\u6c34\u5e73\u548c\u4eba\u7c7b\u75be\u75c5:\u8840\u6e0525OHD\u6d53\u5ea6\u4e4b\u5916\u7684\u5f71\u54cd\u56e0\u7d20\u3002<\/p>\n<p>\u968f\u7740\u68c0\u6d4b\u8840\u6e05\u7ef4\u751f\u7d20D\u6c34\u5e73\u7684\u65b9\u6cd5\u7684\u589e\u52a0, \u4eba\u4eec\u5bf9\u7ef4\u751f\u7d20D\u548c\u4eba\u7c7b\u5065\u5eb7\u4e4b\u95f4\u7684\u5173\u7cfb\u518d\u6b21\u4ea7\u751f\u5174\u8da3\u3002\u6210\u672c\u4f4e\u5ec9\u7684ELISA\u548cRIA\u66fe\u7ecf\u88ab\u5e7f\u6cdb\u5730\u7528\u6765\u6d4b\u5b9a\u8840\u6e0525OHD, \u73b0\u5728\u88ab\u6db2\u76f8\u8272\u8c31\u8d28\u8c31\u8054\u7528\u6cd5 (LC-MS) 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\u8fd9\u4e00\u7406\u8bba\u5c06\u53ef\u80fd\u6210\u4e3a\u672a\u6765\u4e34\u5e8a\u7814\u7a76\u7684\u91cd\u5fc3, \u4e5f\u53ef\u80fd\u80fd\u591f\u89e3\u91ca\u4e3a\u4ec0\u4e48\u8865\u5145\u7ef4\u751f\u7d20D\u5bf9\u67d0\u4e9b\u75c5\u4eba\u7684\u6cbb\u7597\u6548\u679c\u8f83\u5176\u4ed6\u75c5\u4eba\u66f4\u597d\u3002\u8fd9\u662f\u4e00\u4e2a\u7279\u522b\u7684\u95ee\u9898, \u5373\u5f53\u6bd4\u8f83\u4e0d\u540c\u79cd\u65cf\u4eba\u7fa4\u5bf9\u8865\u5145\u7ef4\u751f\u7d20D\u7684\u53cd\u5e94\u65f6, \u4f1a\u53d1\u73b0DBP\u57fa\u56e0\u7684\u7b49\u4f4d\u57fa\u56e0\u663e\u793a\u51fa\u5f88\u660e\u663e\u7684\u79cd\u65cf\u5206\u5e03\u6a21\u5f0f\u3002<\/p>\n<p>\u5c06\u6765, \u5173\u4e8e\u63d0\u9ad8\u8840\u6e0525OHD\u6c34\u5e73\u6240\u5e26\u6765\u7684\u66f4\u591a\u5065\u5eb7\u76ca\u5904\u7684\u7814\u7a76, \u4e5f\u9700\u8981\u7814\u7a76\u5982\u4f55\u66f4\u597d\u7684\u4f7f\u8840\u6e0525OHD\u8fbe\u5230\u76ee\u6807\u6c34\u5e73, \u5373\u8865\u5145\u7ef4\u751f\u7d20D\u7684\u6700\u4f73\u6a21\u5f0f\u3002\u4e0d\u8003\u8651\u65e5\u5e38\u8865\u5145, \u6211\u4eec\u4ecd\u4e0d\u6e05\u695a\u5173\u4e8e\u7ef4\u751f\u7d20D\u5728\u5404\u65b9\u9762\u7684\u5177\u4f53\u4f5c\u7528, \u4e0d\u540c\u5f62\u6001\u7684\u7ef4\u751f\u7d20D (\u5982\u7ef4\u751f\u7d20D2\u548c\u7ef4\u751f\u7d20D3) \u662f\u5426\u4f1a\u6709\u4e00\u4e9b\u7279\u522b\u7684\u529f\u6548\u3002\u4e00\u4e9b\u7814\u7a76 (\u5c3d\u7ba1\u4e0d\u662f\u6240\u6709\u7684) \u5df2\u7ecf\u62a5\u9053\u8865\u5145\u7ef4\u751f\u7d20D3\u6709\u66f4\u597d\u7684\u529f\u6548\u3002\u7136\u800c, \u8fd9\u53ea\u662f\u7b80\u5355\u7684\u4f9d\u636e\u5b83\u63d0\u9ad8\u8840\u6e0525OHD\u6c34\u5e73\u7684\u80fd\u529b\u800c\u5f97\u51fa\u7684\u7ed3\u8bba, \u800c\u4e1425OHD2\u548c25OHD3\u5728\u8f6c\u5316\u4e3a1, 25 (OH) 2D2\u548c1, 25 (OH) 2D3\u7684\u65b9\u9762\u53ef\u80fd\u5177\u6709\u76f8\u4f3c\u7684\u80fd\u529b, \u5e76\u4e14\u968f\u540e\u7684\u4f5c\u7528\u90fd\u662f\u901a\u8fc7VDR\u4ecb\u5bfc\u7684\u3002\u76ee\u524d, \u6211\u4eec\u5bf9\u7ef4\u751f\u7d20D2\u548c\u7ef4\u751f\u7d20D3\u7684\u4e0d\u540c\u514d\u75ab\u8c03\u8282\u4f5c\u7528\u4e86\u89e3\u751a\u5c11\u3002\u6709\u7814\u7a76\u663e\u793a, \u5408\u6210\u76841, 25 (OH) 2D\u7c7b\u4f3c\u7269\u5e15\u7acb\u9aa8\u5316\u9187 (Paracalcitol\u621619-nor 1, 25- (OH) 2D2) \u5177\u6709\u4e0e1, 25 (OH) 2D3\u76f8\u4f3c\u7684\u514d\u75ab\u8c03\u8282\u529f\u80fd, \u800c\u5bf9\u4e8e1, 25 (OH) 2D2\u5c1a\u65e0\u7c7b\u4f3c\u7ed3\u8bba\u3002\u4eca\u540e\u7684\u7814\u7a76, \u7279\u522b\u662f\u5728\u63a2\u7d2225OHD2\u548c25OHD3\u5bf9DBP\u7684\u4e0d\u540c\u7ed3\u5408\u529b\u4ee5\u53ca\u4e0e\u80be\u810f\u7684\u5185\u5206\u6ccc\u548c\u9776\u7ec6\u80de\u7684\u751f\u7269\u5229\u7528\u5ea6\u4e4b\u95f4\u7684\u8054\u7cfb\u65b9\u9762\u7684\u7814\u7a76\u5c06\u662f\u975e\u5e38\u6709\u8da3\u7684\u3002\u7efc\u4e0a\u6240\u8ff0, \u5728\u8fc7\u53bb\u76845\u5e74\u5185\u5173\u4e8e\u7ef4\u751f\u7d20D\u7684\u975e\u7ecf\u5178\u4f5c\u7528\u7684\u7814\u7a76\u5df2\u6709\u7740\u7a81\u98de\u731b\u8fdb\u7684\u8fdb\u5c55, \u7136\u800c\u8fd9\u8fd8\u8fdc\u8fdc\u4e0d\u591f, \u4eca\u540e\u76845\u5e74\u5c06\u4f1a\u6709\u66f4\u52a0\u5353\u8d8a\u7684\u7814\u7a76\u6210\u679c\u3002<\/p>\n<p>,<\/p>\n","protected":false},"excerpt":{"rendered":"<p>\u7ef4\u751f\u7d20D\u548c\u4eba\u7c7b\u514d\u75ab\u7684\u6700\u65b0\u7814\u7a76\u8fdb\u5c55\u9a6c\u4e01, \u80e1\u745b, \u82cf\u6b23\u6458\u8981\uff1a\u6700\u8fd15\u5e74, \u4eba\u4eec\u5173\u4e8e\u7ef4 &hellip; <a href=\"http:\/\/zydq.1006ss.com\/?p=31415\">\u7ee7\u7eed\u9605\u8bfb <span class=\"meta-nav\">&rarr;<\/span><\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[70],"tags":[],"class_list":["post-31415","post","type-post","status-publish","format-standard","hentry","category-70"],"_links":{"self":[{"href":"http:\/\/zydq.1006ss.com\/index.php?rest_route=\/wp\/v2\/posts\/31415","targetHints":{"allow":["GET"]}}],"collection":[{"href":"http:\/\/zydq.1006ss.com\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"http:\/\/zydq.1006ss.com\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"http:\/\/zydq.1006ss.com\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"http:\/\/zydq.1006ss.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=31415"}],"version-history":[{"count":0,"href":"http:\/\/zydq.1006ss.com\/index.php?rest_route=\/wp\/v2\/posts\/31415\/revisions"}],"wp:attachment":[{"href":"http:\/\/zydq.1006ss.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=31415"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"http:\/\/zydq.1006ss.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=31415"},{"taxonomy":"post_tag","embeddable":true,"href":"http:\/\/zydq.1006ss.com\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=31415"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}