PDF(Pubmed)
Abstract：
Over three years since the World Health Organization (WHO) declared COVID-19 a pandemic, it is still a global burden. Vaccines against COVID-19, caused by SARS-CoV-2, are available and effective for preventing disease. However, their protective effects are not 100%. Currently, the U.S. Food and Drug Administration (FDA) has only approved a limited number of inpatient treatments for COVID-19, such as remdesivir, baricitinib, and tocilizumab. These medications have indications and contraindications applicable to a select patient population. Finding additional effective therapies that are widely available with limited risk could be vital in optimizing treatment strategies for this viral illness. Some vitamins and supplements have been identified as potential options for managing COVID-19. Vitamin D (VD) deficiency has been associated with respiratory tract infections. Moreover, alpha-lipoic acid (ALA) is a powerful antioxidant and helps reduce inflammatory responses in many pathologic conditions. This review aims to analyze the current evidence regarding the effectiveness of VD and alpha-lipoic acid in COVID-19 infection in both outpatient and hospitalized patients. Relevant randomized controlled trials (RCTs) were identified via the PubMed database from January 1, 2021, to December 31, 2023. Inclusion criteria were as follows: the study design was a randomized controlled trial (RCT), the usage of a constant dose during the intervention period without any additional boluses, and a research ethics committee approved it. Exclusion criteria included a lack of an outcome or apparent intervention, additional boluses, or a single-dose regimen in all the interventional groups. There were 11 studies with a total sample size of 35,717 patients that met the criteria for this review. A total of 10 RCTs examined the efficacy of VD, and one RCT that reviewed the efficacy of ALA was identified. All of the articles investigated the use of VD or ALA during the treatment of COVID-19. The endpoints of each study varied, including length of stay in hospital, viral load, SARS-CoV-2 infection rate, mechanical ventilation, inflammatory markers, clinical symptoms, Sequential Organ Failure Assessment (SOFA) score, and mortality. In 8/10 VD supplementation trials, significant differences were identified between the interventional and placebo groups in the aforementioned parameters. In 2/10 VD supplementation trials, no significant differences were identified. The ALA supplementation RCT found no differences between the interventional and placebo groups in the SOFA score and 30-day all-cause mortality rate. The current literature suggests that VD can potentially reduce the SARS-CoV-2 infection rate, oxygen requirements, inflammatory markers, clinical symptoms, and mortality. Regarding ALA, although there was a suggestion of benefit, it was not statistically significant. Common limitations among the different studies included relatively small sample sizes, different geographical patient locations among studies, and differences in dosages. Trials investigating the effects of higher doses of VD supplementation on SARS-CoV-2 infection should be conducted. More research is needed to define best practices and optimal dosing protocols for the use of VD in COVID-19.
摘要：
自世界卫生组织（WHO）宣布COVID-19大流行以来三年多，这仍然是一个全球性的负担。由SARS-CoV-2引起的针对COVID-19的疫苗是可用的，可有效预防疾病。然而,它们的保护作用不是100%。目前,美国食品和药物管理局(FDA)仅批准了数量有限的COVID-19住院治疗，如雷姆德西韦，baricitinib,和托珠单抗。这些药物具有适用于选定患者群体的适应症和禁忌症。寻找其他有效的治疗方法，广泛使用，风险有限，对于优化这种病毒性疾病的治疗策略至关重要。一些维生素和补充剂已被确定为管理COVID-19的潜在选择。维生素D（VD）缺乏与呼吸道感染有关。此外，α-硫辛酸（ALA）是一种强大的抗氧化剂，有助于减少许多病理条件下的炎症反应。这篇综述旨在分析目前关于VD和α-硫辛酸在门诊和住院患者COVID-19感染中有效性的证据。从2021年1月1日至2023年12月31日，通过PubMed数据库确定了相关的随机对照试验（RCT）。纳入标准如下：研究设计为随机对照试验（RCT），在干预期间使用恒定剂量，没有任何额外的推注，一个研究伦理委员会批准了。排除标准包括缺乏结果或明显的干预，额外的丸剂，或所有介入组的单剂量方案。共有11项研究，总样本量为35,717例患者符合本综述的标准。共有10个RCT检查了VD的疗效，并确定了一个回顾ALA疗效的RCT。所有文章都研究了VD或ALA在COVID-19治疗过程中的使用。每一项研究的终点各不相同，包括住院时间,病毒载量,SARS-CoV-2感染率,机械通气,炎症标志物，临床症状,序贯器官衰竭评估（SOFA）评分，和死亡率。在8/10VD补充试验中，在上述参数方面,介入组和安慰剂组之间存在显著差异.在2/10的VD补充试验中，没有发现显著差异。ALA补充剂RCT发现，干预组和安慰剂组在SOFA评分和30天全因死亡率方面没有差异。目前的文献表明，VD可以潜在地降低SARS-CoV-2感染率，氧气需求,炎症标志物，临床症状,和死亡率。关于ALA,虽然有好处的建议，没有统计学意义。不同研究中的共同限制包括相对较小的样本量，研究中不同的患者地理位置，和剂量的差异。应进行研究高剂量VD补充剂对SARS-CoV-2感染的影响的试验。需要更多的研究来确定在COVID-19中使用VD的最佳实践和最佳给药方案。
