Tom 18, Nr 4 (2022)
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Eksport do Mediów Społecznościowych

Eksport do Mediów Społecznościowych

Witamina D a stwardnienie rozsiane — aktualne poglądy i wnioski praktyczne

Weronika Galus1, Anna Walawska-Hrycek1, Ewa Krzystanek2
Pol. Przegl. Neurol 2022;18(4):231-245.

Streszczenie

Stwardnienie rozsiane (SM, sclerosis multiplex) jest najczęstszą przewlekłą, zapalną chorobą demielinizacyjną ośrodkowego układu nerwowego u młodych dorosłych, prowadzącą do pogorszenia jakości życia i niesprawności. Wśród czynników inicjujących uszkodzenie osłonki mielinowej i aksonów wyróżnia się czynniki genetyczne, epigenetyczne i środowiskowe, wśród których istotny jest niedobór witaminy D. W asocjacyjnych badaniach całego genomu potwierdzono związek między niskim stężeniem witaminy D w surowicy a rozwojem SM, niezależnie od innych czynników ryzyka. Bezsprzeczna jest również immunomodulująca rola tej witaminy w stymulowaniu tolerancji immunologicznej oraz hamowaniu proliferacji limfocytów B i produkcji immunoglobulin przez komórki plazmatyczne. Potwierdzono także udział witaminy D w zapobieganiu i hamowaniu eksperymentalnego autoimmunologicznego zapalenia mózgu na modelach mysich, a także jej efekt immunomodulujący u chorych na SM. Eksperymentalne badania toksycznej demielinizacji przeprowadzone na modelach zwierzęcych sugerują potencjał remielinizacyjny witaminy D. Liczne dowody potwierdzają zależność między stężeniem tej witaminy w surowicy chorych na SM a kliniczną i radiologiczną aktywnością choroby. Jednakże w dotychczasowych, randomizowanych badaniach klinicznych nie za obserwowano zahamowania postępu niesprawności, posługując się Rozszerzoną Skalą Niesprawności, analizą liczby nowych rzutów, rocznego wskaźnika rzutów czy regresji aktywności zapalnej mózgowia w badaniu rezonansu magnetycznego. Dlatego, jak dotąd, brakuje przekonujących danych na temat sposobu ewentualnej suplementacji witaminy D u chorych na SM. Obecne rekomendacje odnoszą się głównie do populacji osób zdrowych. Opinie ekspertów wskazują jednak na korzyści związane z suplementacją witaminy D u pacjentów z SM w bezpiecznych dawkach, tj. do 4000 j.m./dobę, regularnie kontrolując jej stężenie w surowicy, aż do uzyskania stężenia optymalnego (30–50 ng/ml). Poza zachowaniem prawidłowej struktury kości oczekuje się także uzyskania potencjalnego immunomodulującego wpływu witaminy D na przebieg SM.

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