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La vitamine D : une nouvelle cible pour les réanimateurs ?

Vitamin D: a new tool in critically ill patients?

  • Mise au Point / Update
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Réanimation

Résumé

La mise en évidence de la présence d’un récepteur ubiquitaire de la vitamine D dans l’organisme a permis, au cours des dernières années, d’accroître considérablement les connaissances sur les différents rôles joués par la vitamine D. En plus des effets osseux bien connus de cette hormone, des effets pléiotropiques extraosseux ont été rapportés et suggèrent un rôle majeur de la vitamine D dans le contrôle métabolique et la fonction immunitaire de l’homme. À ce jour, l’impact de l’insuffisance vitaminique D a été essentiellement étudié dans la population générale. Des études récentes ont toutefois rapporté une forte prévalence de l’insuffisance en vitamine D chez les patients de réanimation. Des données récentes mais parcellaires suggèrent également une association entre la carence en vitamine D et l’hypocalcémie, la déminéralisation osseuse ou la mortalité dans le contexte des soins intensifs. Compte tenu de son rôle dans l’immunité innée ou adaptative, il n’est pas exclu que la vitamine D joue un rôle dans la cascade inflammatoire du patient de réanimation et que sa carence soit alors associée à un risque accru de morbimortalité. Ces hypothèses demandent confirmation par des études cliniques sur de plus grands effectifs de malades de réanimation. De même, un éventuel effet bénéfique de la supplémentation vitaminique D, associée ou non à un apport calcique, reste à démontrer dans ce contexte aigu.

Abstract

The detection of an ubiquitous vitamin D receptor in humans in the recent years has dramatically increased our knowledge regarding vitamin D effects. Besides its bone effects, pleiotropic effects of vitamin D have been reported in humans suggesting a key role for this hormone in metabolic control and immunity. To date, the impact of vitamin D insufficiency has been studied in the general population. However, recent studies have reported a high prevalence of vitamin D insufficiency in critically ill patients. Some data also suggest an association between vitamin D deficiency and hypocalcemia, bone demineralization, and mortality rate in the intensive care setting. Due to its role in immunity, we cannot rule out the possibility that vitamin D contributes enhance severe illness-related pro-inflammatory status resulting in increased morbidity and mortality. However, these hypotheses need to be assessed by large clinical studies in the intensive care setting. Furthermore, a possible beneficial effect of vitamin D supplementation, with or without associated calcium, remains to be demonstrated in well-designed randomized controlled trials.

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Authors and Affiliations

  1. Service de réanimation médicale, CHU de Caen, avenue Côte-de-Nacre, F-14000, Caen, France

    D. du Cheyron & O. Lucidarme

  2. UPRES EA 2128, Université Caen Basse-Normandie, F-14000, Caen, France

    D. du Cheyron

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  1. D. du Cheyron
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  2. O. Lucidarme
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Correspondence to D. du Cheyron.

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du Cheyron, D., Lucidarme, O. La vitamine D : une nouvelle cible pour les réanimateurs ?. Réanimation 20, 327–334 (2011). https://doi.org/10.1007/s13546-011-0269-4

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  • DOI: https://doi.org/10.1007/s13546-011-0269-4

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