維生素D佐治老年人社區獲得性肺炎的臨床研究_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

王豐 ,  劉萍

自貢市第四人民醫院呼吸內科（四川自貢 643000）;

Corresponding?author：

劉萍, Email: liuping150103@163.com

Keywords：

維生素D; 社區獲得性肺炎; 老年人

DOI：

10.7507/1671-6205.2015119

Video：

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目的探討維生素D(VitD)佐治老年人社區獲得性肺炎(CAP)的臨床療效。方法選擇老年CAP患者104例, 隨機分為VitD治療組和安慰劑對照組, 每組各52例, 以同期體檢的78例健康老年人作對照。應用酶聯免疫吸附法檢測血清中25羥維生素D₃[25-(OH)D₃]水平, 應用免疫透射比濁法檢測血清中免疫球蛋白A(IgA)及C反應蛋白(CRP)水平, 記錄和比較CAP患者的臨床癥狀、體征、實驗室、影像學檢查的變化情況及住院天數。結果 CAP患者治療前血清25-(OH)D₃、IgA和CRP水平分別為(25.22±8.68) nmol/L、(0.28±0.06) g/L和(119.50±21.76) mg/L, 其中血清25-(OH)D₃和IgA水平均明顯低于正常對照組(t=25.213, P＜0.05;t=22.280, P＜0.05), 而血清CRP水平顯著高于正常對照組(t=-47.114, P＜0.05), 且CAP患者血清25-(OH)D₃水平與血清IgA水平呈正相關(r=0.829, P＜0.05)。同安慰劑對照組相比, VitD治療組患者血清CRP水平降低, 臨床總有效率提高了34.4%, 住院天數縮短了25.1%, 且三項指標組間比較差異均有統計學意義(t=5.017, P＜0.05;χ²=4.248, P＜0.05;t=6.321, P＜0.05)。VitD治療組患者治療后血清25-(OH)D₃和IgA水平分別為治療前的2.84倍和1.96倍。安慰劑對照組患者治療前后血清25-(OH)D₃和IgA水平差異無統計學意義。結論 VitD缺乏可能是老年CAP的潛在病因, 補充足量VitD可緩解CAP患者臨床癥狀, 明顯縮短病程。

Citation： 王豐, 劉萍. 維生素D佐治老年人社區獲得性肺炎的臨床研究. Chinese Journal of Respiratory and Critical Care Medicine, 2015, 14(5): 490-493. doi: 10.7507/1671-6205.2015119 Copy

1.	Bergman P, Lindh AU, Bj?rkhem-Bergman L, et al.Vitamin D and respiratory tract infections:a systematic review and meta-analysis of randomized controlled trials. PLoS One, 2013, 8:e65835.
2.	中華醫學會呼吸病學分會, 社區獲得性肺炎診斷和治療指南.中華結核和呼吸雜志, 2006, 29:651-655.
3.	陳慶青, 宋志芳.經驗性抗感染治療急診病房社區獲得性肺炎療效評價.中華肺部疾病雜志(電子版), 2012, 5:203-208.
4.	Holick MF, Binkley NC, Bischoff-Ferrari HA, et al. Evaluation, treatment, and prevention of vitamin D deficiency:an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab, 2011, 96:1911-1930.
5.	Borella E, Nesher G, Israeli E, et al. Vitamin D:a new anti-infective agent? Ann N Y Acad Sci, 2014, 1317:76-83.
6.	Li W, Guo L, Li H, et al. Polymorphism rs2239185 in vitamin D receptor gene is associated with severe community-acquired pneumonia of children in Chinese Han population:a case-control study. Eur J Pediatr, 2015, 174:621-629.
7.	馬秀麗, 甄艷芬.1, 25-二羥維生素D3與小兒呼吸系統疾病研究進展.內蒙古醫學院學報, 2010.32:36-40.
8.	Remmelts HH, Spoorenberg SM, Oosterheert JJ, et al. The role of vitamin D supplementation in the risk of developing pneumonia:three independent case-control studies. Thorax, 2013, 68:990-996.
9.	Liu PT, Stenger S, Tang DH, et al. Cutting edge:vitamin D-mediated human antimicrobial activity against Mycobacterium tuberculosis is dependent on the induction of cathelicidin. J Immunol, 2007, 179:2060-2063.
10.	王朋, 陳佳琦, 宋志純, 等.血清25-羥基維生素D檢測在兒童社區獲得性肺炎中的應用及意義.檢驗醫學, 2014, 29:727-729.
11.	葛楠.老年人社區獲得性肺炎的診治和預防.中華老年醫學雜志, 2012, 31:261-262.
12.	丁國鋒, 顧振鵬, 張清潭, 等.老年人社區獲得性肺炎感染狀況.中國老年學雜志, 2013, 33:5143-5144.
13.	阮學東.反復呼吸道感染患兒血清維生素D與IgA水平分析.中國鄉村醫藥雜志, 2013, 20:14-15.
14.	Berry DJ, Hesketh K, Power C, et al. Vitamin D status has a linear association with seasonal infections and lung function in British adults. Br J Nutr, 2011, 106:1433-1440.
15.	Jovanovich AJ, Ginde AA, Holmen J, et al. Vitamin D level and risk of community-acquired pneumonia and sepsis. Nutrients, 2014, 6:2196-2205.

1. Bergman P, Lindh AU, Bj?rkhem-Bergman L, et al.Vitamin D and respiratory tract infections:a systematic review and meta-analysis of randomized controlled trials. PLoS One, 2013, 8:e65835.
2. 中華醫學會呼吸病學分會, 社區獲得性肺炎診斷和治療指南.中華結核和呼吸雜志, 2006, 29:651-655.
3. 陳慶青, 宋志芳.經驗性抗感染治療急診病房社區獲得性肺炎療效評價.中華肺部疾病雜志(電子版), 2012, 5:203-208.
4. Holick MF, Binkley NC, Bischoff-Ferrari HA, et al. Evaluation, treatment, and prevention of vitamin D deficiency:an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab, 2011, 96:1911-1930.
5. Borella E, Nesher G, Israeli E, et al. Vitamin D:a new anti-infective agent? Ann N Y Acad Sci, 2014, 1317:76-83.
6. Li W, Guo L, Li H, et al. Polymorphism rs2239185 in vitamin D receptor gene is associated with severe community-acquired pneumonia of children in Chinese Han population:a case-control study. Eur J Pediatr, 2015, 174:621-629.
7. 馬秀麗, 甄艷芬.1, 25-二羥維生素D3與小兒呼吸系統疾病研究進展.內蒙古醫學院學報, 2010.32:36-40.
8. Remmelts HH, Spoorenberg SM, Oosterheert JJ, et al. The role of vitamin D supplementation in the risk of developing pneumonia:three independent case-control studies. Thorax, 2013, 68:990-996.
9. Liu PT, Stenger S, Tang DH, et al. Cutting edge:vitamin D-mediated human antimicrobial activity against Mycobacterium tuberculosis is dependent on the induction of cathelicidin. J Immunol, 2007, 179:2060-2063.
10. 王朋, 陳佳琦, 宋志純, 等.血清25-羥基維生素D檢測在兒童社區獲得性肺炎中的應用及意義.檢驗醫學, 2014, 29:727-729.
11. 葛楠.老年人社區獲得性肺炎的診治和預防.中華老年醫學雜志, 2012, 31:261-262.
12. 丁國鋒, 顧振鵬, 張清潭, 等.老年人社區獲得性肺炎感染狀況.中國老年學雜志, 2013, 33:5143-5144.
13. 阮學東.反復呼吸道感染患兒血清維生素D與IgA水平分析.中國鄉村醫藥雜志, 2013, 20:14-15.
14. Berry DJ, Hesketh K, Power C, et al. Vitamin D status has a linear association with seasonal infections and lung function in British adults. Br J Nutr, 2011, 106:1433-1440.
15. Jovanovich AJ, Ginde AA, Holmen J, et al. Vitamin D level and risk of community-acquired pneumonia and sepsis. Nutrients, 2014, 6:2196-2205.

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Chinese Journal of Respiratory and Critical Care Medicine

維生素D佐治老年人社區獲得性肺炎的臨床研究

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