静注维生素A辅助治疗新生儿感染性肺炎的研究

Effect of intravenously administered liposomal vitamin A in neonatal pneumonia

目的:观察住院新生儿肺炎静脉补充维生素A(VitA)的相关生化指标变化及临床效果。方法:30例新生儿感染性肺炎随机分为静注组和口服组。静注组给予脂溶性VitA330IU/(kg·d),qd×3d;口服组给予VitA1800IU/次,qod×3次。住院次日及第6～7d各取静脉血1.5ml,用反相高效液相色谱法测VitA,酶联免疫法测视黄醇结合蛋白(RBP)。观察两组VitA、RBP水平和临床疗效。结果:两组组内极期和恢复期VitA和RBP水平有显著性差异,VitA水平静注组从(0.62±0.21)μmol/L上升到(0.97±0.21)μmol/L(t=4.805,P=0.003),口服组从(0.65±0.16)μmol/L上升到(1.00±0.34)μmol/L(t=3.274,P=0.017);RBP静注组从(23.51±11.73)mg/L上升到(38.59±14.82)mg/L(t=4.356,P=0.005),口服组从(31.73±14.56)mg/L上升到(52.20±16.15)mg/L(t=3.869,P=0.008);恢复期组间VitA和RBP水平差异无显著性,VitA水平静注组和口服组分别为(0.97±0.21)μmol/L和(1.00±0.34)μmol/L(t=0.172,P=0.869),RBP分别为(38.59±14.82)mg/L和(52.20±16.15)mg/L(t=1.577,P=0.166);两组临床转归无显著性差异。结论:新生儿感染性肺炎静注补充VitA能改善相关生化指标,临床效果与口服组相似的,且依从性较好。

Objective： To assess the efficacy and biochemical evidence of vitamin A（VA） administered intravenously for neonatal pneumonia. Methods： This was a clinical trial in which 30 cases were randomized into intravenously administered group with 330 IU/kg i.v. the VA （Vitalipid） mixed with liposomal （Intralipid） （ 15 cases） daily over 3 days （L-VA） and orally administered group with VA 1,800 IU （15 cases, control group）every other day. Serum VA and retinol binding protein （RBP） concentration were measured by high performance liquid chromatography and enzyme-laheled immunosorbent assay on the second day of hospitalization and 6 or 7 days after,respectively, Results： Fourteen cases （7 eases in both the L-VA group and oral VA group）completed the study and were evaluated. Serum VA and RBP values were low on second day and increased significantly in both.the L-VA and oral VA groups on the 6th or 7th day. There was a significant increase in the levels of VA （L-VA group： 0.62±0.21 to 0.97±0.21 μmol/L, t = 4.805, P = 0,003; oral VA group： 0.65±0.16 to 1.00±0.34 μmol/L, t, = 3.274, P = 0.017）and RBP （L-VA group： 23.51±11.73 to 38.59±14.82 mg/L, t = 4.356, P = 0.005; oral VA group： 31.73±14.56 to 52.20±16.15 mg/L, t = 3.869, P = 0.008） in both groups as compared with the baseline. On the 6th or 7th day of the treatment when the average levels of serum VA （0.97±0.21 and 1.00±0.34 μmol/L, t = 0.172, P = 0.869）and RBP （38.59±14.82 and 52.20±16.15 mg/L, t = 1.577, P = 0.166）were compared, there was no statistically significant difference between the groups. Clinical outcomes did not differ significantly among the groups. Conclusions： These findings suggest that receiving VA in intravenous lipids in neonatal oneumonia may be more efficacious and comoliant in the adiunctive treatment of neonatal pneumonia.