Can thi???p dinh d?????ng s???m v???i K???m, Selen v?? Vitamin D n??ng cao s???c ????? kh??ng ch???ng l???i s??? ph??t tri???n c???a COVID-19

T??m l?????c: Nhi???m tr??ng do coronavirus (COVID-19) g??y ra m???t m???i ??e d???a nghi??m tr???ng ???nh h?????ng ?????n s???c kh???e v?? kinh t??? tr??n to??n c???u v?? thi???u vaccin v?? c??c ph????ng ph??p ??i???u tr??? c??? th???. Y???u t??? khi???n b???nh ti???n tri???n n???ng l??n th?????ng l?? do c??c b???nh m???n t??nh trong c??c h???i ch???ng chuy???n h??a, nh?? ti???u ???????ng v?? suy tim, m?? trong ???? c?? th??? do thi???u h???t c??c ch???t dinh d?????ng g??y n??n. M???c ????ch c???a b??i vi???t n??y l?? t??m ra nh???ng h???u ??ch c???a vi???c can thi???p dinh d?????ng s???m b???ng c??c y???u t??? vi l?????ng, ?????c bi???t l?? k???m, selen v?? vitamin D ????? l??m gi???m s??? gia t??ng c???a Covid-19. Ph????ng ph??p: Ch??ng t??i ???? ti???n h??nh t??m ki???m c??c b??o c??o ???????c xu???t b???n t??? 2010 ??? 2020 v??? k???m, selen v?? vitamin D, corona, nhi???m tr??ng do virus. K???t qu???: C?? m???t s??? nghi??n c???u ???? cung c???p c??c b???ng ch???ng tr???c ti???p v??? m???i li??n quan gi???a k???m, selen, vitamin D v?? Covid-19. ???? l??, cung c???p ?????y ????? k???m, selen v?? vitamin D c???n thi???t ????? ch???ng l???i c??c b???nh nhi???m tr??ng do c??c lo???i virus kh??c, do t??ng c?????ng ch???c n??ng mi???n d???ch v?? gi???m vi??m. Do ????, ng?????i ta ????? xu???t can thi???p dinh d?????ng ????? ?????m b???o cho c?? th??? lu??n ???????c cung c???p ?????y ????? d?????ng ch???t ????? ch???ng l???i coronavirus m???i SARS-CoV-2 (H???i ch???ng h?? h???p c???p t??nh n???ng-coronavirus-2) v?? l??m gi???m nh??? t??nh tr???ng b???nh khi m???c Covid-19. K???t lu???n: Ch??ng t??i khuy???n ngh??? b???t ?????u b??? sung ?????y ????? c??c vi ch???t dinh d?????ng ??? nh???ng v??ng c?? nguy c?? cao v??/ ho???c ngay sau khi nghi nhi???m SARS-CoV-2. C??c ?????i t?????ng thu???c nh??m nguy c?? cao n??n ch?? tr???ng li???u ph??p can thi???p dinh d?????ng n??y, n??n b???t ?????u s??? d???ng tr?????c khi ??p d???ng c??c bi???n ph??p y t??? h??? tr??? v?? ??i???u tr??? c??? th???.

1. Gi???i thi???u

Coronavirus m???i SARS-CoV-2 (H???i ch???ng h?? h???p c???p t??nh n???ng-coronavirus-2) g??y ra Covid-19, l?? lo???i coronavirus nguy hi???m nh???t t???ng ???????c x??c ?????nh, c?? kh??? n??ng l??y nhi???m kh??ng ch??? ??? ?????ng v???t m?? c??? ??? ng?????i, ??? m???i n??i tr??n tr??i ?????t. M???c ????? nghi??m tr???ng c???a ?????i d???ch Covid-19 th??? hi???n qua s??? ph??n b??? c??c v??ng d???ch h??n nhi???u l???n so v???i h???i ch???ng h?? h???p c???p t??nh n???ng (SARS-CoV) v?? h???i ch???ng h?? h???p Trung ????ng do coronavirus (MERS-CoV), t????ng ???ng v??o n??m 2003 v?? 2012. RNA s???i ????n ch???a c??? c???u tr??c b??? gen c???a SARS-CoV-2. Trong nh???ng ca b???nh n???ng, COVID-19 ??i k??m v???i s??? ho???t h??a qu?? m???c c???a h??? th???ng mi???n d???ch v???i t??nh tr???ng vi??m ti???n tri???n v?? c??n b??o cytokine t??? c??c t??? b??o ???????c k??ch ho???t, ?????c bi???t l?? trong ???????ng th???, d???n ?????n h???i ch???ng gi???i ph??ng cytokine. Th???t kh??ng may, corticosteroid v???i t??c d???ng ch???ng vi??m, ???????c d??ng trong qu?? tr??nh ??i???u tr??? l??m tr???m tr???ng th??m c??c tri???u ch???ng l??m s??ng c???a b???nh nh??n SARS ho???c c??c b???nh do nhi???m virus li??n quan. S??? d???ng huy???t t????ng t??? b???nh nh??n ???? h???i ph???c ???????c th??? nh?? m???t c??ch ti???p c???n kh??? thi, nh??ng kinh nghi???m v??? ph????ng ph??p n??y c??n h???n ch???. Ngo???i tr??? vi???c s??? d???ng huy???t t????ng t??? b???nh nh??n ???? h???i ph???c, hi???n t???i ch??a c?? ph????ng ph??p ??i???u tr??? c??? th??? n??o ???????c ch???p thu???n trong ??i???u tr??? Covid-19. Do ????, nhu c???u c???p thi???t ?????i v???i y t??? c??ng c???ng kh??ng ch??? ????? h???n ch??? s??? l??y lan c???a virus m?? c??n ph???i t??m ra c??c bi???n ph??p ph??ng ng???a ????? l??m gi???m m???c ????? nghi??m tr???ng c???a Covid-19, nh?? c??c c??ch l??m gi???m ph???n ???ng vi??m qu?? m???c. Qu?? tr??nh trao ?????i ch???t c???a v???t ch??? b??? ???nh h?????ng b???i tu???i, ti???p c???n y t???, l???i s???ng c?? th??? x??c ?????nh m???c ????? n???ng tr??n l??m s??ng c???a Covid-19. ??? nh???ng b???nh nh??n n???ng th?????ng ??i k??m v???i c??c b???nh n???n nh?? ????i th??o ???????ng type 2, t??ng huy???t ??p v?? b???nh tim. Ng?????i cao tu???i d??? b??? nhi???m tr??ng ???????ng h?? h???p n???ng h??n ng?????i tr???, t??? ???? c?? th??? th???y ???????c m???i li??n h??? gi???a tu???i v???i s??? thi???u h???t dinh d?????ng v?? kh??? n??ng mi???n d???ch. S??? thi???u h???t c??c vi ch???t dinh d?????ng ???????c th???y tr??n l??m s??ng v?? c???n l??m s??ng th?????ng g???p ??? ng?????i cao tu???i ???????c cho l?? nguy??n nh??n g??p ph???n l??m gi???m kh??? n??ng mi???n d???ch v?? t??ng c??c b???nh li??n quan ?????n tu???i, c?? th??? hi???u r???ng qu???n l?? dinh d?????ng l?? c???n thi???t ????? gi???m nguy c?? nhi???m tr??ng n???ng. Do thi???u d??? li???u l??m s??ng v??? hi???u qu??? ph??ng v??/ ho???c ??i???u tr??? ?????i v???i vi???c cung c???p ?????y ????? selen, k???m v?? vitamin D trong Covid-19, hi???n t???i ch??ng t??i ???? th???o lu???n v??? d??? li???u l??m s??ng t???ng quan g???n ????y v??? vai tr?? c???a nh???ng vi ch???t dinh d?????ng n??y trong vi???c b???o v??? c?? th??? ch???ng l???i nhi???m tr??ng ph??? qu???n – ph???i, c??ng nh?? c??c s??? li???u hi???n c?? v??? t??c ?????ng c???a ch??ng v???i Covid-19. M???c d??, c??c ch???t dinh d?????ng kh??c, ch???ng h???n nh?? vitamin C v?? A c??ng c?? th??? ????ng m???t vai tr?? n??o ???? nh??ng ch??ng kh??ng ph???i v???n ????? ?????t ra trong b??i vi???t n??y. Ch??ng t??i ???? th???c hi???n m???t cu???c t??m ki???m t??i li???u trong giai ??o???n 2010 ??? 2020 tr??n PubMed, Medline v?? Google Scholar v???i c??c t??? kh??a SARS, SARS-CoV-2, COVID 19, coronavirus, vi ch???t dinh d?????ng (k???m, selen, vitamin D), h??? mi???n d???ch, vi??m, ph??ng ng???a v?? ??i???u tr???. D???a tr??n c??c th??ng tin thu ???????c, ??? ????y ch??ng t??i th???o lu???n v??? vai tr?? c???a dinh d?????ng m???t s??? nguy??n t??? vi l?????ng v?? vitamin D theo quan ??i???m c???a c??c bi???n ph??p ph??ng ch???ng virus RNA.

2. Can thi???p dinh d?????ng nh?? m???t ph????ng ph??p ph??ng ng???a

Thi???u vi ch???t dinh d?????ng tr??n l??m s??ng ho???c c???n l??m s??ng, ch???ng h???n nh?? thi???u k???m, selen v?? vitamin D, th?????ng x???y ra ??? ng?????i cao tu???i v?? c??c b???nh li??n quan ?????n tu???i t??c nh?? ti???u ???????ng, t??ng huy???t ??p v?? b???nh tim m???ch. Nh???ng b???nh n??y h???u h???t l?? c??c b???nh li??n quan ?????n r???i lo???n chuy???n h??a ???????c ?????c tr??ng b???i c??c d???u hi???u vi??m m???n t??nh, c??ng c?? th??? l?? k???t qu??? c???a qu?? tr??nh l??o h??a. C??c d???u hi???u vi??m, nh?? gi?? tr??? CRP (protein ph???n ???ng C) t??ng cao c??ng l?? m???t y???u t??? l??m n???ng th??m t??nh tr???ng b???nh. B??? sung ?????y ????? k???m, selen v?? vitamin D l?? c???n thi???t trong suy gi???m mi???n d???ch, ??? m???t m???c ????? n??o ???? c?? th??? ch???ng l???i s??? ti???n tri???n c???a nhi???m tr??ng. Ch??? l???i khuy??n v??? ch??? ????? ??n u???ng trong m???t s??? ??i???u ki???n nh???t ?????nh c?? th??? l?? kh??ng ????? ?????m b???o c??c ch???t dinh d?????ng n??y, ?????c bi???t l?? ??? ng?????i cao tu???i, v?? m???t b??? ph???n qu???n th??? d??? m???c b???nh.

2.1 K???m

L?? th??nh ph???n thi???t y???u c???a nhi???u enzyme, nh?? superoxide dismutase 1 v?? 3, k???m l?? nguy??n t??? vi l?????ng r???t quan tr???ng ?????i v???i s??? ph??t tri???n v?? duy tr?? c???a c??c t??? b??o mi???n d???ch v?? c??c t??? b??o kh??c. Thi???u k???m d???n ?????n r???i lo???n ch???c n??ng mi???n d???ch qua trung gian t??? b??o v?? mi???n d???ch d???ch th???. ??? ng?????i cao tu???i, Zn th???p (gi?? tr??? Zn huy???t thanh < 0.7 mg/L) ???????c ph??t hi???n l?? m???t y???u t??? nguy c?? g??y vi??m ph???i. Thi???u k???m trong th???i gian d??i l??m t??ng t??nh tr???ng vi??m v?? c??c ch???t trung gian h??a h???c g??y vi??m. H???u h???t c??c th??nh ph???n c???a h??? th???ng mi???n d???ch b??? ???nh h?????ng b???i s??? thi???u h???t k???m, ?????c bi???t l?? ch???c n??ng c???a t??? b??o T. Thi???u k???m c??ng th??c ?????y ph???n ???ng Th17, c?? li??n quan l??m t??ng m???c ????? vi??m. ??? nh???ng ng?????i cao tu???i, gi???m n???ng ????? k???m trong tu???n ho??n t????ng quan v???i vi???c t??ng n???ng ????? c??c cytokine IL-6 (interleukine???6), IL-8, v?? TNF-?? (Y???u t??? ho???i t??? kh???i u-??).

Trong m???t ca l??m s??ng ???????c b??o c??o, b???n b???nh nh??n Covid-19 ngo???i tr?? t??? 26 ??? 63 tu???i ???? ???????c ??i???u tr??? b???ng vi??n ng???m mu???i k???m. H??? ng???m nhi???u l???n m???i ng??y, l??n ?????n li???u t??? 115 ??? 184mg Zn/ng??y trong 10 ?????n 14 ng??y, v?? t???t c??? nh???ng b???nh nh??n n??y ?????u kh???i b???nh. Trong m???t b??o c??o kh??c, ba b???nh nh??n Covid-19 t??? 38 ??? 74 tu???i c?? th??m c??c tri???u ch???ng ??? ???????ng ru???t ???????c b??? sung k???m sulphat ( 220mg Zn/ng??y trong 5 ng??y), c??ng v???i hydroxychloroquine v?? azithromycine, sau c?? c??c b???nh nh??n ?????u h???i ph???c. C??c tr?????ng h???p ???????c b??o c??o ch??a ????? ????? k???t lu???n v??? hi???u qu??? c???a k???m.

?????i v???i c??c b???nh truy???n nhi???m kh??c, nhi???u nghi??n c???u cho th???y t??nh tr???ng k???m trong c?? th??? c?? th??? ???nh h?????ng ?????n k???t qu??? c???a qu?? tr??nh nghi??n c???u. M???t s??? th??? nghi???m l??m s??ng ?????i ch???ng ng???u nhi??n (RCT) cho th???y ???????c b??? sung k???m trong ?????t ti??u ch???y c???p l??m gi???m th???i gian v?? nguy c?? m???c b???nh k??o d??i. Do ????, T??? ch???c Y t??? Th??? gi???i ???? thay ?????i c??c khuy???n ngh??? c???a h??? ?????i v???i vi???c ??i???u tr??? ti??u ch???y ??? tr??? em v?? b??? sung th??m k???m. K???m c??ng c?? vai tr?? trong nhi???m tr??ng ???????ng h?? h???p c???p t??nh, b??? sung k???m th?????ng xuy??n gi???m t??? l??? nhi???m tr??ng ???????ng h?? h???p d?????i c???p t??nh ??? tr??? em t???i c??c qu???c gia c?? thu nh???p trung b??nh ??? th???p. M???t s??? nghi??n c???u g???n ????y ???? s??? d???ng k???m nh?? m???t ph????ng ph??p ??i???u tr??? h??? tr??? cho c??c b???nh nhi???m tr??ng ???????ng h?? h???p d?????i, m???c d?? v???i k???t qu??? ch??a r?? r??ng. Trong m???t RCT l???n t??? ???n ????? tr??n tr??? c?? d???u hi???u c???a nhi???m khu???n n???ng, ng?????i ta ???? kh???o s??t xem li???u k???m c?? th??? l??m gi???m nguy c?? th???t b???i trong ??i???u tr??? hay kh??ng. C??c t??c gi??? nh???n th???y r???ng tr??? em ???????c ch??? ?????nh k???m gi???m 40% t??? l??? th???t b???i trong ??i???u tr??? v?? t??? l??? t??? vong so v???i nh??m d??ng gi??? d?????c. Nhi???u RCT ???? xem x??t vai tr?? c???a vi???c b??? sung k???m trong b???nh c???m c??m th??ng th?????ng, k???t qu??? cho th???y r???ng, ???????c cung c???p k???m s???m ngay khi b??? b???nh, ???? c?? kh??? n??ng gi???m th???i gian m???c b???nh t??? 1 ?????n 3 ng??y. H??n n???a, t??c d???ng t??ch c???c c???a vi???c b??? sung k???m ???? ???????c quan s??t th???y trong m???t s??? nghi??n c???u v??? vi??m gan C, g??y ra b???i nhi???m tr??ng do virus RNA s???i ????n. Trong b???i c???nh n??y, ??i???u ????ng quan t??m l?? n??ng cao n???ng ????? k???m trong t??? b??o v???i ion k???m nh?? pyrithione ho???c chloroquin c?? th??? tr???c ti???p l??m gi???m s??? nh??n l??n c???a nhi???u lo???i virus RNA trong ???ng nghi???m th??ng qua ???c ch??? ho???t ?????ng RNA polymerase c???a ch??ng. S??? d???ng k???t h???p k???m v?? pyrithione, ngay c??? ??? n???ng ????? th???p, ???? c?? th??? ???c ch??? s??? nh??n l??n c???a SARS coronavirus (SARS-CoV) trong ???ng nghi???m. Do ????, vi???c b??? sung k???m c?? th??? c?? t??c d???ng, kh??ng ch??? ?????i v???i ch???ng vi??m qu?? ph??t li??n quan ?????n Covid-19, m?? c?? l??? c??n ?????i v???i c??? ch??nh t??c nh??n SARS-CoV-2. ?????i v???i c??c li???u d??? ph??ng ???????c s??? d???ng, c???n l??u ?? r???ng, s??? d???ng l??u d??i n??n d??ng ??? 25 mg/ng??y, v?? l?????ng k???m cao c?? th??? l??m r???i lo???n dung n???p ?????ng.

2.2 Selen

Selen l?? m???t nguy??n t??? vi l?????ng c???n thi???t cho qu?? tr??nh oxy h??a kh??? c???a ?????ng v???t c?? v??, t???n t???i d?????i d???ng selenocysteine trong c??c trung t??m x??c t??c c???a nhi???u selenoprotein. Cung c???p ?????y ????? axid amin Serin l?? c???n thi???t ????? t???ng h???p selenocysteine, l?? th??nh ph???n c???a selenoprotein. S??? thi???u h???t selen c?? th??? ???nh h?????ng kh??ng ch??? ?????n ph???n ???ng mi???n d???ch m?? c??n ?????n kh??? n??ng g??y b???nh c???a virus.

????ng ch?? ??, m???t nghi??n c???u ???????c b??o c??o ??? Trung Qu???c g???n ????y cho th???y m???i li??n quan gi???a t??? l??? ch???a kh???i c???a b???nh nh??n nhi???m CoV-2 v?? t??nh tr???ng selen, ???????c l???y t??? tr??n t??c c???a ng?????i d??n ??? ngo???i th??nh H??? B???c, t??? c??c khu v???c c?? l?????ng selen th???p v?? ?????. Trong nghi??n c???u, t??nh tr???ng selen (selen v?? SELENOP) ??? nh???ng b???nh nh??n n???i tr?? Covid-19 ??? b???nh nh??n s???ng cao h??n ????ng k??? (n = 27) so v???i nh???ng ng?????i ch???t (n = 6). C??c nghi??n c???u s??u h??n c?? ki???m so??t nhi???u v?? c??c th??? nghi???m l??m s??ng r???t c???n thi???t ????? x??c nh???n m???i li??n quan n??y. V???i nghi??n c???u c??? th??? ???? ph??t hi???n ra protease ch??nh c???a SARS-CoV-2 ch???u tr??ch nhi???m cho s??? nh??n l??n c???a virus, t????ng t??c v???i enzyme glutathione peroxidase1 (GPX1) – ph??? thu???c ch???t ch??? v???i vi???c cung c???p selen. GPX t????ng t??? ebselen (m???t h???p ch???t selen t???ng h???p) l?? m???t ch???t ???c ch??? m???nh ?????i v???i protease ch??nh c???a SARS-CoV-2. Vi???c s??ng l???c ?????nh d???ng sinh h???c gen SARS-CoV-2 ???? cung c???p th??m b???ng ch???ng v??? t????ng t??c gi???a protein v?? gi???a phi??n m?? c???a m???ch khu??n mRNA v???i mRNA b??? sung x???y ra t???i c??c ??i???m ch??n li??n quan ?????n selenocysteine trong virus RNA.

S??? thi???u h???t Selen trong ch??? ????? ??n u???ng, c??ng v???i s??? gia t??ng stress oxy h??a trong v???t ch???, c?? th??? l??m thay ?????i b??? gen c???a virus t??? m???t lo???i virus g??y b???nh nh??? c?? th??? th??nh m???t t??c nh??n c?? ?????c l???c cao sau khi x??m nh???p v??o c?? th??? v???t ch???, ??i???u n??y ???? x???y ra v???i Coxsackievirus B3 trong b???nh Keshan t???i m???t v??ng thi???u selen ??? Trung Qu???c. C?? gi??? thi???t cho r???ng s??? thi???u h???t Selen c?? th??? ????ng vai tr?? nh???t ?????nh trong vi???c ph??t tri???n SARS-CoV. T??c d???ng b???o v??? ti???m n??ng c???a Selen ???????c gi???i th??ch qua vai tr?? nh?? y???u t??? thi???t y???u trong m???t nh??m c??c enzyme, k???t h???p v???i vitamin E c?? t??c d???ng l??m gi???m s??? h??nh th??nh c??c lo???i oxygen ph???n ???ng (ROS). ROS v?????t qu?? ng?????ng c?? th??? k??ch ho???t c??c thay ?????i oxy h??a ??? c??? vi sinh v???t x??m nh???p v?? c??? trong t??? b??o v???t ch???.

Vi???c ch???ng oxy h??a b??? suy y???u c??ng c?? th??? ??i k??m v???i c??c ph???n ???ng vi??m qu?? m???c ??? v???t ch???, ngay c??? khi kh??ng c?? nhi???m tr??ng ho???t ?????ng. Trong s??? c??c selenoenzyme, ch???t ch???ng oxy h??a m???nh nh???t l?? glutathione peroxidases (GPXs) v?? thioredoxin reductases (TXNRDs), c???n h???p th??? ??t nh???t 100??g Se/ng??y ????? ch??ng ho???t ?????ng t???i ??u.

C??c selenoprotein kh??c, t???c l?? selenoprotein K (SELENOK) v?? selenoprotein S (SELENOS), c??ng ????ng vai tr?? quan tr???ng trong vi???c ??i???u h??a c??c ph???n ???ng mi???n d???ch.

Trong nhi???u b???nh truy???n nhi???m, selen d?????ng nh?? ????ng m???t vai tr?? quan tr???ng trong vi???c b???o v??? h??? h?? h???p, ?????c bi???t l?? ?????i v???i c??c b???nh nhi???m tr??ng do virus. Beck v?? c???ng s??? nh???n th???y r???ng s??? thi???u h???t Se l??m t??ng ????ng k??? t??nh nh???y c???m v???i b???nh l?? ??? ph???i do c??m, li??n quan ?????n s??? bi???u hi???n qu?? m???c c???a c??c cytokine ti???n vi??m. M???t t??nh tr???ng t????ng t??? ???? ???????c quan s??t th???y khi cho nhi???m virus Coxsackie, d???n ?????n s??? ph??t tri???n c???a vi??m c?? tim ??? chu???t thi???u Se. Nh???ng ph??t hi???n n??y t????ng t??? vi???c quan s??t th???y m???c interferon-?? (IFN-??) v?? TNF-?? th???p h??n, c??ng nh?? t??? l??? s???ng gi???m ??? nh???ng con chu???t thi???u Se nhi???m virus c??m so v???i nh???ng con ?????i ch???ng c?? ????? Se. Tr??i l???i, ??i???u tr??? b???ng selen ???? ???????c ch???ng minh l?? c?? hi???u qu??? ??i???u ch???nh s??? bi???u hi???n c???a c??c gen ?????i v???i interferon (IFN-??, IFN-?? v?? IFN-??) ph???n ???ng v???i virus c??m gia c???m (H9N2).

??? ng?????i cao tu???i, vi???c ??i???u tr??? b???ng Se ???????c ch???ng minh l?? c?? th??? l??m t??ng ????p ???ng v???i vi???c ti??m ph??ng c??m, ??i k??m v???i vi???c t??ng n???ng ????? IFN-?? sau khi ti??m ph??ng. Do ????, vi???c b??? sung selen cho c??c qu???n th??? c?? nguy c?? v???i li???u d?????i m???c t???i ??u ???? ???????c coi l?? m???t li???u ph??p b??? tr??? an to??n trong c??c bi???n ph??p d??? ph??ng ch???ng l???i nhi???m virus. T??nh tr???ng selen c??ng kh??c nhau gi???a c??c khu v???c tr??n th??? gi???i. So v???i B???c M???, m???c selen trong c??c qu???n th??? ??? ph???n l???n c??c n?????c ch??u ??u th???p h??n nhi???u so v???i ng?????ng c???n thi???t kho???ng 100 ??g/L ????? ?????t m???c ????? selenoprotein tr??n c???n l??m s??ng. L?????ng selen kh??ng ????? l?? do c?? h??m l?????ng th???p trong ?????t, trong ng?? c???c v?? c??c c??y l????ng th???c kh??c c??ng nh?? trong th???c ??n gia s??c.

2.3 Cofactor Selen+

Ch???c n??ng t???i ??u c???a GPX c??ng ph??? thu???c v??o n???ng ????? cofactor glutathione (GSH) th??ch h???p ??? n???i b??o, t??? ???? gi???i th??ch ???????c t???m quan tr???ng c???a vi???c h???p th??? ?????y ????? c??c protein c?? ch???a th??nh ph???n l??u hu???nh c???a tripeptide n??y, viz. cysteine ??????ho???c methionine. GSH gi???m c?? li??n quan ?????n s??? l??o h??a ??? m???t s??? lo??i, bao g???m c??? con ng?????i. R?? r??ng nh???ng ng?????i cao tu???i kh???e m???nh ??? nh??m tu???i 60 ??? 79 c?? GSH trong h???ng c???u th???p h??n ????ng k??? so v???i nh???ng ng?????i tr??? tu???i. H??n n???a, nh???ng ng?????i m???c c??c b???nh m???n t??nh, nh?? t??ng huy???t ??p, c?? s??? thi???u h???t GSH ??? tr???ng th??i ho???t ?????ng. Trong tr?????ng h???p h???p th??? ??t sulfur amino acid, vi???c b??? sung acetylcysteine s??? ph???c h???i m???c GSH n???i b??o, c?? vai tr?? thi???t y???u trong t??? b??o ph??? qu???n v?? ph???i. N-acetylcysteine ???? ???????c ph?? duy???t v?? s??? d???ng r???ng r??i trong vi??m ph??? qu???n t???c ngh???n, v?? ???? ???????c ch???ng minh l?? h???u ??ch trong vi???c ch???ng l???i nhi???m tr??ng n???ng. Vi???c s??? d???ng glutathione c??ng ???????c ch???ng minh l?? l??m gi???m ch???ng kh?? th??? li??n quan ?????n vi??m ph???i do Covid-19.

M???t y???u t??? kh??c ??i k??m v???i selenoenzyme l?? coenzyme ??(Co). Trong m???t nghi??n c???u ng???u nhi??n c?? ?????i ch???ng v???i gi??? d?????c t???i Th???y ??i???n,?? nh???ng ng?????i cao tu???i kh???e m???nh thi???u selen ???????c b??? sung selen k???t h???p v???i coenzyme . Vi???c b??? sung n??y ???? ???????c ch???ng minh gi??p l??m gi???m ph???n ???ng vi??m kh??ng ?????c hi???u, ???????c ??o b???ng CRP huy???t t????ng v?? c??c d???u ???n sinh h???c kh??c c???a t??nh tr???ng vi??m, v?? l??m gi???m c??? t??? l??? t??? vong do b???nh tim m???ch. V?? c??c tr?????ng h???p nhi???m coronavirus n???ng ???????c ?????c tr??ng b???i t??nh tr???ng vi??m ho???t ?????ng qu?? m???c, n??n vi???c gi???m ph???n ???ng vi??m b???ng c??ch t???i ??u h??a t??nh tr???ng selen ???????c quan t??m ????ng k???. Qua ???? c??ng th???y r???ng, ch???t b??? sung Co, ngay c??? khi ch??? s??? d???ng m???t m??nh c??ng c?? th??? ph??t huy ???????c t??c d???ng ch???ng vi??m. T??c d???ng ch???ng vi??m c???a Co??ngo???i sinh c?? th??? th???y r?? h??n ??? tu???i gi?? khi s???n xu???t n???i sinh c???a n?? gi???m ????ng k???.

??i???u tr??? b???ng selen s??? d???ng ????n l???, kh??ng k???t h???p v???i acetylcysteine ??????ho???c Co, ??? nh???ng b???nh nh??n n???ng ???????c ????a v??o ICU (b???nh nh??n kh??ng nhi???m tr??ng v?? nhi???m tr??ng) ???? ???????c s??? d???ng. ??? nh???ng b???nh nh??n b??? nhi???m tr??ng giai ??o???n n???ng, Manzanares v?? ?????ng nghi???p, trong m???t ph??n t??ch t???ng h???p, kh??ng t??m th???y t??c d???ng c?? l???i r?? r???t gi???m t??? l??? t??? vong, nh??ng trong m???t ph??n t??ch ph??n nh??m, h??? ???? t??m th???y s??? gi???m nguy c?? nhi???m tr??ng ??? nh???ng b???nh nh??n vi??m v?? khu???n. Khi xem x??t nh???ng t??c ?????ng t??ch c???c c???a selen ?????i v???i ??i???u h??a mi???n d???ch v?? gi???m t??nh tr???ng vi??m ??? nh???ng qu???n th??? c?? h??m l?????ng selen th???p, c?? th??? k???t lu???n r???ng selen s??? ?????i di???n cho m???t bi???n ph??p b???o v??? c?? th??? ch???ng l???i hi???n t?????ng vi??m qu?? m???c ?????c tr??ng c???a virus corona. D?? ????, ??? nh???ng ?????i t?????ng c?? n???ng ????? th???p h??n m???c t???i ??u (selen huy???t t????ng <100 ??g/L), vi???c b??? sung v???i li???u 100 ??? 200??g Se/ng??y, c?? ho???c kh??ng c?? cofactor, ????? ?????t ???????c ????? b??o h??a c???a selenoprotein nhanh ch??ng, n??n c?? th??? ?????i di???n cho m???t ph????ng ph??p b??? tr??? ????? ng??n ng???a nhi???m SARS-CoV-2 m???t c??ch t??ch c???c. Tuy nhi??n, khuy???n ngh??? t???ng l?????ng selen ???????c s??? d???ng trong th???i gian d??i t??? th???c ph???m v?? ch???t b??? sung ??? 300??g Se/ng??y, v?? l?????ng h???p th??? cao h??n c?? th??? g??y c??c t??c d???ng kh??ng mong mu???n.

2.4 Vitamin D

Ai c??ng bi???t r???ng cholecalciferol (vitamin ) c?? th??? ???????c t???ng h???p t??? cholesterol trong da khi ti???p x??c v???i ??nh s??ng m???t tr???i. Ho???t t??nh sinh h???c c???a n?? ph??? thu???c v??o qu?? tr??nh hydroxyl h??a li??n ti???p ??? gan v?? th???n th??nh 1,2- (OH??-, li??n k???t v???i c??c th??? th??? vitamin D. Ngo??i vai tr?? trong vi???c c??n b???ng n???i m??i canxi v?? duy tr?? s??? to??n v???n c???a x????ng, n?? c??n k??ch th??ch s??? tr?????ng th??nh c???a c??c t??? b??o mi???n d???ch. C??c nghi??n c???u d???ch t??? h???c cho th???y m???i quan h??? ngh???ch gi???a n???ng ????? 25 (OH) – l??u h??nh, m???t d???u ???n sinh h???c v??? t??nh tr???ng vitamin D, v???i c??c d???u ???n sinh h???c vi??m, bao g???m CRP v?? IL-6. N???ng ????? vitamin D xu???ng d?????i m???c t???i ??u, ?????c bi???t l?? v??o cu???i m??a ????ng, ???? ???????c b??o c??o ??? m???t s??? l?????ng l???n ng?????i tr?????ng th??nh kh???e m???nh. Nh???ng ng?????i h???n ch??? ti???p c???n v???i ??nh s??ng m???t tr???i v?? ng?????i gi?? suy gi???m kh??? n??ng t???ng h???p c?? th??? b??? thi???u vitamin D.

Vitamin D ???????c cho l?? h???u ??ch trong Covid-19, v?? c?? 2 nghi??n c???u v??? sinh th??i h???c ch??? ra r???ng t??? l??? nhi???m b???nh cao h??n ??? c??c n?????c ??? v?? ????? cao v??/ ho???c t??nh tr???ng vitamin D th???p h??n. Trong m???t nghi??n c???u ch??a ???????c th???m ?????nh t??? Los Angeles, thi???u h???t vitamin D ???????c x??c ?????nh l?? m???t y???u t??? nguy c?? ?????i v???i c??c x??t nghi???m Covid-19 d????ng t??nh. M???t nghi??n c???u g???n ????y tr??n b???nh nh??n n???i tr?? Covid-19 (n = 134) cho th???y m???t s??? ??t b???nh nh??n trong ICU c?? 25 OH-D tr??n 50 nmol/L (19%) so v???i nh???ng b???nh nh??n ??? c??c ph??ng y t??? th??ng th?????ng (39.1%). Trong m???t nghi??n c???u ch??a ???????c th???m ?????nh t??? Cincinnati, c??c nh?? nghi??n c???u ???? t??m th???y m???i li??n quan gi???a s??? thi???u h???t vitamin D v???i s??? l?????ng nh???p vi???n, m???c ????? nghi??m tr???ng c???a b???nh v?? t??? vong, gi???a nh???ng b???nh nh??n ?????n ph??ng kh??m ban ?????u v?? ph??ng kh??m chuy??n khoa (n = 691).

Vitamin D ???????c ch???ng minh l?? m???t y???u t??? c???n thi???t ????? b???o v??? c?? th??? ch???ng l???i c??c b???nh truy???n nhi???m qua ???????ng h?? h???p. Thi???u vitamin D tr???m tr???ng th?????ng th???y ??? nh???ng b???nh nh??n n???ng v?? li??n quan ?????n ti??n l?????ng x???u. ??? nh???ng b???nh nh??n l???n tu???i, thi???u vitamin D n???ng ???????c coi l?? m???t y???u t??? d??? b??o cho b???nh vi??m ph???i m???c ph???i t???i c???ng ?????ng, c??ng li??n quan ?????n vi???c t??ng nguy c?? nh???p vi???n ph???i s??? d???ng ICU, v?? t??? vong. S??? thi???u h???t vitamin D ???????c ch???ng minh l?? c?? li??n quan ?????n t??nh tr???ng vi??m ph???i n???ng, d???n ?????n h???i ch???ng suy h?? h???p c???p t??nh (ARDS) v???i t???n th????ng bi???u m?? ???????ng h?? h???p v?? t??nh tr???ng thi???u oxy m??u. Ng?????i ta ???? quan s??t th???y m???i quan h??? ngh???ch gi???a l?????ng cholecalciferol 25-OH v?? nguy c?? suy h?? h???p c???p t??nh ??? nh???ng b???nh nh??n n???ng, ?????c bi???t c?? ?? ngh??a nh???t ?????i v???i nh???ng ?????i t?????ng c?? 25-OH-cholecalciferol <25 nmol/L.

D??? li???u th???c nghi???m ng??y c??ng t??ng tr??n c??c t??? b??o trong ???ng nghi???m, ???? ch???ng minh t??c d???ng c?? l???i c???a vitamin D ?????i v???i c?? ch??? b???nh sinh c???a c??c b???nh nhi???m tr??ng ???????ng h?? h???p. Do ????, ??i???u tr??? b???ng vitamin D ???? ???????c ch???ng minh l?? l??m gi???m s??? nh??n l??n c???a virus h???p b??o h?? h???p (RSV) v?? rhinovirus (RV) trong t??? b??o bi???u m?? th??ng qua vi???c t??ng c?????ng c??c gen k??ch th??ch interferon v?? t???ng h???p protein kh??ng virus LL-37. ??i???u tr??? v???i 1,25 (OH)-D c???i thi???n ????p ???ng mi???n d???ch kh??ng virus ??? ???????ng h?? h???p ?????i v???i nhi???m tr??ng RV ???????c ?????c tr??ng b???i s??? t??ng IL-8 v?? CXCL-10 (m???t chemokine li??n quan ?????n nhi???u d???u hi???u vi??m C-X-C 10 c??n ???????c g???i l?? Interferon gamma-induced protein 10).

Ngo??i ra, ng?????i ta ???? ch???ng minh r???ng vitamin D c?? kh??? n??ng l??m gi???m ph???n ???ng vi??m m?? kh??ng l??m thay ?????i ho???t t??nh kh??ng virus v?? thanh th???i virus trong c??c t??? b??o bi???u m?? ???????ng th??? b??? nhi???m RSV. H??n n???a, t??? l??? m???c b???nh x?? ph???i cao l?? m???t di ch???ng ?????c tr??ng c???a COVID-19, ??i???u quan tr???ng c???n l??u ?? l?? vitamin D ???? ng??n ch???n TGF-??1 g??y ra x?? h??a t??? b??o ph???i.

Tuy nhi??n, ch??a c?? t??c d???ng ph??ng ng???a n??o c???a vitamin D ?????i v???i b???nh vi??m ph???i ???????c quan s??t th???y trong ba nghi??n c???u b???nh ch???ng ?????c l???p, nh??ng vi???c gi???i th??ch c??c k???t qu??? n??y c???n t??nh ?????n s??? thi???u h???t vitamin D r?? r??ng ???? c?? t??? tr?????c. H??n n???a, l???i ??ch c???a vi???c s??? d???ng vitamin D trong giai ??o???n n???ng ??? c??c b???nh nguy hi???m c??n g??y tranh c??i, v?? m???t s??? nghi??n c???u kh??ng cho th???y l???i ??ch khi d??ng vitamin D giai ??o???n mu???n ??? c??c b???nh n??y.

T??nh tr???ng vitamin D c?? th??? d??? d??ng ???????c x??c ?????nh d?????i d???ng 25-OH-cholecalciferol trong huy???t t????ng. Do ????, trong tr?????ng h???p n???ng ????? th???p, <50 nmol/L trong huy???t t????ng, c???n b??? sung vitamin D (40 ??g /ng??y) c?? th??? ng??n ng???a ?????t vi??m qu?? m???c do coronavirus m???i n??y g??y ra. ?????i v???i c??c li???u d??? ph??ng ???????c s??? d???ng, khuy???n c??o r???ng, trong th???i gian d??i, l?????ng vitamin D n???p v??o ph???i ??? 100 ??g /ng??y ????? tr??nh t??ng calci ni???u d???n ?????n nguy c?? s???i th???n v?? t??ng calci huy???t.

3. Th???o lu???n v?? k???t lu???n

B???ng ch???ng tr???c ti???p cho th???y c??c vi ch???t dinh d?????ng k???m, selen v?? vitamin D c?? th??? tham gia v??o qu?? tr??nh n??ng cao k???t qu??? ??i???u tr??? c???a b???nh COVID-19 ch??? y???u nh??? v??o vi???c quan s??t v?? ch??a ???????c th???m ?????nh. Tuy nhi??n, d???a tr??n kinh nghi???m t??? c??c ph????ng ph??p ??i???u tr??? SARS v?? c??c b???nh nhi???m virus kh??c, ch??ng t??i ph??t hi???n th???y r???ng c??c ch???t gi??p b??? sung dinh d?????ng ???????c s??? d???ng ??? giai ??o???n ?????u c???a b???nh r???t quan tr???ng ????? t??ng c?????ng s???c ????? kh??ng c???a v???t ch??? ch???ng l???i vi???c nhi???m virus RNA, c??ng c?? th??? bao g???m c??? Covid-19 n???ng. Ch??ng t??i ????a ra gi??? thuy???t r???ng, c?? th??? gia t??ng s???c ????? kh??ng c???a c?? th??? ch???ng l???i s??? ph??t tri???n c???a Covid-19 th??nh c??n b??o cytokine ??e d???a ?????n t??nh m???ng. T??nh tr???ng dinh d?????ng c???a v???t ch??? v???n ch??a ???????c coi l?? m???t y???u t??? quan tr???ng trong c??c tr?????ng h???p nhi???m virus n???ng, v?? hi???u qu??? c???a vi???c b??? sung ch???t dinh d?????ng khi ???????c s??? d???ng ??? giai ??o???n n???ng ch??a ???????c th???y r??. Tuy nhi??n, c?? th??? h??nh dung r???ng n???u t??nh tr???ng dinh d?????ng t???t ??? c??c nh??m d??n s??? d??? b??? t???n th????ng t??? tr?????c khi b???nh, s??? c?? t??c d???ng t??ng c?????ng mi???n d???ch v?? ch???ng vi??m. Ch??ng t??i bi???t v??? vi???c ??i???u tr??? b???ng vitamin C li???u cao (6-8 g/ng??y) b??? l??n ??n trong c??c b???nh nhi???m tr??ng do virus, nh??ng v?? ????y l?? m???t ph????ng ph??p ti???p c???n d?????c l??, ch??ng t??i kh??ng th???o lu???n th??m v??? v???n ????? n??y. Ch??ng t??i xem x??t ????? xu???t can thi???p v???i protein v?? c??c vitamin t???ng h???p, ???????c s??? d???ng ngay sau khi nh???p vi???n ????? l??m gi???m nhi???m tr??ng do Covid-19 s??? l?? m???t thay ?????i th?? v??? trong c??ch ti???p c???n. Tuy nhi??n, c??c nghi??n c???u s??u h??n v?? th??? nghi???m l??m s??ng y??u c???u c??? v??? vai tr?? ??i???u tr??? v?? ph??ng ng???a c???a c??c ch???t dinh d?????ng ???????c b??? sung. D???a tr??n c??c t??i li???u hi???n c??, m???t gi??? ?????nh l?? vai tr?? trong ti???n nhi???m tr??ng c???a k???m, selen v?? vitamin D c?? t???m quan tr???ng ?????c bi???t ?????i v???i vi???c ch???ng l???i qu?? tr??nh ph??t tri???n c???a Covid-19.

C??c khuy???n ngh??? c???a ch??ng t??i l?? c???n can thi???p dinh d?????ng s???m cho c??c ?????i t?????ng c?? nguy c?? cao ho???c ph??i nhi???m v???i SARS-CoV-2 ??i???u tr??? ngo???i tr??, t???t nh???t l?? tr?????c khi ??i???u tr??? c??? th??? v?? h??? tr???. Can thi???p dinh d?????ng s???m c?? ?? ngh??a ?????c bi???t ?????i v???i c??c nh??m d??n c?? d??? b??? t???n th????ng ?????c bi???t ??? c??c n?????c ??ang ph??t tri???n. C??ch ti???p c???n n??y ????n gi???n, r??? v?? v?? h???i. M???c d?? c???n s??? d???ng li???u cao c??c ch???t dinh d?????ng chuy??n bi???t ????? ph???c h???i s??? thi???u h???t, nh??ng b???n n??n tu??n theo ch??? d???n c???a b??c s?? khuy???n c??o, m???t s??? b??c s?? cho s??? d???ng li???u cao h??n ????? c?? th??? dung n???p ???????c v?? h???p th??? l??u d??i c??c vi ch???t dinh d?????ng. Song v???i b???t k??? ph????ng ph??p ti???p c???n dinh d?????ng n??o, c??c nghi??n c???u c?? ?????i ch???ng v??? hi???u qu??? c???a c??c bi???n ph??p ch???ng virus v?? ch???ng nhi???m tr??ng l?? r???t quan tr???ng. ????? c?? ???????c kh??? n??ng mi???n d???ch n??i chung th?? vaccin ph??ng Covid-19 ???????c ????nh gi?? cao h??n.

H??nh 1. T??c d???ng gi??? thuy???t c???a c??c vi ch???t dinh d?????ng (Zn, Se v?? vitamin D) ?????i v???i m???c ????? vi??m ??? b???nh nh??n Covid-19: M???t ?????t b???nh n???ng, c?? th??? x???y ra ??? c??c tr?????ng h???p vi??m m???c ????? nh??? tr?????c khi nhi???m tr??ng c??ng v???i t??nh tr???ng kh??ng ????? vi ch???t dinh d?????ng, ???????c ?????c tr??ng b???i s??? ph??t tri???n c???a vi??m th??nh c??n b??o cytokine (???????ng ch???m). Vi???c b??? sung Se, Zn v?? c??c vitamin ???????c b??? sung ??? giai ??o???n s???m sau khi nhi???m tr??ng c?? t??c d???ng b???o v??? c?? th??? th??ng qua ph???n ???ng mi???n d???ch v?? h??? tr??? ph???n ???ng vi??m, gi??p gi???m nguy c?? ph??t tri???n th??nh c??n b??o cytokine v?? ??t nghi??m tr???ng h??n c???a Covid-19, ???????c bi???u th??? b???i ???????ng ?????t n??t.

Ngu???n: Alexander J, Tinkov A, Strand TA, Alehagen U, Skalny A, Aaseth J. Early Nutritional Interventions with Zinc, Selenium and Vitamin D for Raising Anti-Viral Resistance Against Progressive COVID-19. Nutrients. 2020 Aug 7;12(8):2358. doi: 10.3390/nu12082358. PMID: 32784601; PMCID: PMC7468884.

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