A landmark finding in the treatment of covid-19 was just published on Aug. 29, 2020. 在對抗冠狀病毒的所有醫學努力中，很關鍵的一個新發現，2020年8月29號剛出爐的報告，下面是重點摘譯。
One of the leading nutrition scientists, Chris Masterjohn, PhD, just shared a timely digest about it. What i am sharing here, in addition to the link to Chris’ article, is a further digested short list of bilingual highlights for those of you who don’t have time to read even Chris’ 7-page “digest” or/and use Google Translate.
(Links to both Chris’ article and the research report are at the end of this article. 克里斯的文章連結和研究報告的連結都在本文最後面。)
The first randomized controlled trial (RCT) of vitamin D in COVID-19 has just been published. The results are astounding: vitamin D nearly abolished the odds of requiring treatment in ICU. Although the number of deaths was too small to say for sure, vitamin D may actually abolish the risk of death from COVID-19. (Note by Coach Denys: RCT is among the most credible protocols in medical research.)
自從今年初疫情發生以來，針對維生素D如何影響COVID-19病情的第一個 隨機對照試驗（RCT）剛剛發表了。 結果令人震驚：維生素D幾乎消除了感染者必須被送進ICU(加護病房)中進行治療的機率。 儘管死亡人數太少，不能肯定地說，但維生素D實際上可以消除死於COVID-19的風險。(小編註：隨機對照實驗 是醫學研究方法裡可信度最高的一種。)
The trial was conducted at the Reina Sofía University Hospital in Córdoba, Spain. The trial included 76 patients with COVID-19 pneumonia… The patients were randomly allocated to receive or not receive vitamin D in a 2:1 ratio. This resulted in 50 patients in the vitamin D group and 26 patients in the control group.
該試驗在西班牙科爾多瓦的雷納·索非亞大學醫院進行。 該試驗包括76例COVID-19肺炎患者… 患者被隨機分配為以2：1的比例接受或不接受維生素D補充，維生素D組50例，對照組26例。
The Vitamin D Treatment Protocol 維生素D治療方案簡介
The vitamin D was provided as oral calcifediol, also known as calcidiol, 25(OH)D, and 25-hydroxyvitamin D. This is a metabolite of vitamin D that our livers make. It is is the principle form of vitamin D that circulates in the blood, and we use it as a measure of vitamin D status.
Traces of 25(OH)D occur in food, and it is five times as potent as vitamin D… 25(OH)D is given an international unit (IU) value that equates it to vitamin D. Whereas one microgram (mcg) of vitamin D is 40 IU, 1 mcg of 25(OH)D is 200 IU.
食物中存在微量25(OH)D，其效力是維生素D的五倍。…25(OH)D具有相當於維生素D的國際單位(IU)值。而一微克(mcg )的維生素D為40 IU，1 mcg的25(OH)D為200 IU。
The treatment in this RCT was soft capsules of 532 mcg 25(OH)D on day 1 of admission to the hospital, followed by 266 mcg on days 3 and 7, and then 266 mcg once a week until discharge, ICU admission, or death.
該RCT的治療方法是：入院第1天服用532 mcg 25(OH)D軟膠囊，然後在第3天和第7天服用266 mcg，然後每週一次266 mcg，直到出院，入住ICU或死亡。
This is equivalent to 106,400 IU vitamin D on day 1, 53,200 IU on days 3 and 7, and 53,200 IU weekly thereafter. If this were given as daily doses, it would be the equivalent of 30,400 per day for the first week, followed by a maintenance dose of 7,600 IU per day.
這相當於第1天的106,400 IU維生素D，第3天和第7天的53,200 IU，此後每週的53,200 IU。 如果以每日劑量給藥，則第一周相當於每天30,400，然後是每天7,600 IU的維持劑量。
My suspicion is that the bolus dosing in the first week brought the patients’ vitamin D status into the 30-40 ng/mL range by the end of the week, and that most of the healing took place in the circa 40 ng/mL range.
(為何用如此高的劑量？) 我的懷疑是，第一周的大劑量使患者的維生素D狀態在本週結束時達到了30-40 ng / mL的範圍，因為大多數療癒都在40 ng / mL的範圍內發生 。
The Results: Near Abolition of ICU Risk 結果：被送進加護病房的風險近乎零
The results are absolutely stunning. 50% of the control group (13 people) required admission to the ICU. Only 2% of those in the vitamin D group (one person) required admission to the ICU.
這樣的結果實在太令人震驚了。 對照組中有50％(13人)需要入住ICU。 維生素D組(一個人)中只有2％需要入住 ICU。
Expressed as relative risk, vitamin D reduced the risk of ICU admission 25-fold. Put another way, it eliminated 96% of the risk of ICU admission. Expressed as an odds ratio, which is a less intuitive concept but is often used in statistics because it gives an estimate of the effect of the treatment that would be constant across scenarios with different levels of risk, vitamin D reduced the odds of ICU admission by 98%. Either way, vitamin D practically abolished the need for ICU admission.
以相對風險來看，維生素D讓入住加護病房的風險降低了25倍。 換句話說，它降低了96％的入住加護病房風險。 用統計學中比較不直觀的所謂優勢比(odd ratio)概念來看，維生素D降低了98％的入住加護病房機率 。 無論哪種方式來看，維生素D幾乎是完全消除了入住加護病房的需要。
No matter how you slice it, the effect of vitamin D is extremely compelling.
Because the study is small, the potential confounding variables were not perfectly evenly distributed between the two groups. There was more high blood pressure in the control group, and there was a borderline greater number of patients with diabetes in the control group. Though not statistically significant, the vitamin D group had more people over the age of 60 and five times as many people with organ transplants or who were otherwise on immunosuppressive drugs. To account for all of these differences, they adjusted for them statistically. In the adjusted model, vitamin D still reduced the odds of ICU admission by 97%, with the 95% confidence interval ranging from a 75% to a 99.7% reduction in the odds.
由於研究規模(參與人數)較小，因此潛在的混淆變量並未在兩組之間完美地平均分配。 對照組中的血壓更高，而對照組中的糖尿病患者數量也較高。 儘管在統計學上不顯著，但維生素D組的60歲以上人群更多，接受器官移植或使用免疫抑製劑的人數也大約是對照組的五倍。 為了平衡所有這些差異，他們進行了統計調整。 在調整後的模型中，維生素D還是讓入住加護病房的機率降低了97％…
Did Vitamin D Also Abolish the Risk of Death? 維生素D是否也消除了死亡風險？
All of the vitamin D patients were discharged without complications. Half the control group was discharged without ICU admission. Among the other half, 11 were eventually discharged from ICU, and 2 died.
Although there were, thankfully, too few deaths to run statistics on, since patients generally would be admitted to the ICU before dying, and since vitamin D nearly abolished the risk of ICU admission, we can infer that in a larger study with more deaths, vitamin D would probably abolish or nearly abolish the risk of death.
This Study Is the Single Most Important Vitamin D and COVID-19 Study 不管是針對維生素D或整個COVID-19病情的研究，這個研究報告都是到目前為止最重要的發現
Since the first vitamin D study was released as a preprint* on April 23, we have been waiting for data that could settle whether the association between vitamin D and COVID-19 incidence, severity, and mortality is a causal one.
This study settles the question: yes, it is causal.
… given the degree to which it is nearly entirely harmless, and almost without exception beneficial, to maintain 25(OH)D above 30 ng/mL, it would be irresponsible not to interpret this study as definitive evidence of causality. At an absolute minimum, maintaining vitamin D status in this range should be part of the public health message to reduce COVID-19 risk, and 25(OH)D should be universally screened in all hospitals to be treated in anyone with COVID-19, and should be universally screened in all testing centers when antibodies and PCR testing is done, so that everyone knows not only their COVID-19 exposure but also their vitamin D status. If it’s low, they should be given advice on how to bring it back up to normal.
鑑於將25(OH)D維持在30 ng / mL以上幾乎完全無害，並且幾乎無一例外是有益的，因此，”不將本研究銓釋為證實了因果關係的明確證據“ 是不負責任的。 至少，維持體內維生素D在該範圍內應該成為降低COVID-19風險的公共衛生信息之一，並且應該在所有醫院中普遍篩查25(OH)D，以治療任何患有COVID-19的人， 在進行抗體和PCR測試後，應在所有測試中心進行普遍篩查，以便每個人不僅知道其COVID-19暴露量，還知道體內維生素D的狀態。 如果很低，應該給他們建議如何使其恢復正常。
How I’ve Changed My Position 針對維生素D和冠狀病毒的關係，我在立場上的調整
While I remain agnostic whether there is some level of vitamin D above which infection risk is increased, the new RCT concerns severity and mortality. Although 25(OH)D levels weren’t measured, they must have hit at least 40 ng/mL by the time the patients were released, and they possibly exceeded 50 ng/mL. That they gave these patients such massive doses of vitamin D without measuring their vitamin D levels, and that this nearly abolished the need for ICU admission, suggests that there should be no concern about a U-shaped curve with severity or mortality for short-term dosing of up to 8,000 IU per day over several weeks or for temporarily pushing 25(OH)D above 50 ng/mL during the course of treatment.
雖然我仍然不確定是否存在一個特定的體內維生素D含量，高於此含量就會增加感染風險，但這個新的隨機對照試驗針對的是感染後的嚴重性和死亡率。(在這個試驗裡剛開始的時候)儘管未測量(病人體內的)25(OH)D水平，但在患者釋放時它們必須達到至少40 ng / mL，並且可能超過50 ng / mL。(進行試驗的研究人員)在不測量維生素D水平的情況下給這些患者提供了大劑量的維生素D，並且這幾乎消除了入住加護病房的需要。這表明如果在數週內每天最多給藥8,000 IU，或在治療過程中暫時將25(OH)D推至50 ng / mL以上，短期內不必擔心嚴重性或死亡率會呈U形的曲線。(小編註：也就是說病情先好轉然後很快又惡化)
Given that observational studies around infection risk can consistently show that it is increased at low vitamin D status but cannot show any consistent picture at high vitamin D status, I am, for now, relieving myself of concern about this U-shaped curve. If high vitamin D status can almost eliminate severity and mortality, the off-chance that in some people at some high level it could increase infection risk should be tolerated.