評論
打印
I want to go back to this vitamin D threshold issue
下面回到維生素D臨界值問題
because as I said this morning the illustration of the enabling effect of vitamin D
早上我講過維生素D的積極效果
Physiological regulation is no longer limited by vitamin D availability but the regulation is still there
生理調節不再受可用維生素D的限制不過調節仍然在
and I'm going to go back to revisit this scheme
我要回頭講這個體系
This is the old scheme and this is a new one that we need to be thinking about
這是老的體系，這是需要考慮的新體系
where the action in the periphery is where the action really is
外圍的活動才是真正活動所在
Now we know that our colleagues in the physiology recognized that
我們知道生理學的學者們認為
when your kidneys are damaged or they've been removed
患者如果腎臟受損或被去除
and you're dependent upon dialysis, you can't make 1,25D
依賴透析將無法生成1,25D
and so they did the logical thing and they gave their patients 1,25D
于是他們理所當然地給患者1,25D
By doing that allowed them completely to ignore the autocrine pathway
這讓他們完全忽略了自分泌方式
because this was what's needed to be optimized not simply supplying this that was missing
這才是需要優化的，而不只是供應失去的
They thought that you could get there this way but in fact that's not what the tissues are looking for
他們曾認為可以這樣來，這不是組織想要的
and the concentrations you're gonna achieve don't work
想獲得的濃度也達不到
which is why there's such a terrible vitamin D deficiency in patients who have renal disease
這就是腎病患者維生素D缺陷嚴重的原因
because the focus is not being on this
因為關注不在這里
That's changing today. I'm happy to say that
這現在有所改變，我很高興
but for years, I mean even the renal literature uses this in keywords, says it's vitamin D.
但很多年來，腎病文獻中甚至使用關鍵字"維生素D"
This is not vitamin D
這不是維生素D
This is a derivative of vitamin D. It's not vitamin D
這是維生素D衍生物，不是維生素D
Now, I'm going to show you a couple of examples
下面來看幾個例子
One of you today asked me about adjuvant therapy
有人今天問我輔助療法
Here's a perfect example of adjuvant therapy
這是輔助療法的完美例子
This was a study that was published the same year as the Liu study was published, just four years ago
該研究的發布同Liu的研究一樣，都是四年前
