肌注维生素D3对儿童支气管哮喘小气道病变的影响

Effects of intramuscular injection of Vitamin D3 for small airway disease in children with asthma

目的对于初治的儿童支气管哮喘（简称哮喘）患儿规范吸入ICS＋LABA治疗同时，给予一次性肌注维生素D3（7.5mg）干预，观察其对完全控制率及其肺通气功能，尤其是小气道功能改善的影响。方法2012年10月至2014年4月在成都市妇女儿童中心医院哮喘门诊就诊的哮喘急性发作患儿，采用随机表分为对照组（36例）和观察组（33例）；治疗前和治疗后3个月检测肺功能。结果2组治疗的1、2和3个月完全控制率差异均无统计学意义（χ^2=0．287、0．77、0．004，P值均〉0．05）；2组治疗前后大、小气道功能指标（％预计值）的比值均有提高，观察组的FVC％pred、FEV1／FVC％、FEF75%pred、FEF25％pred、MMEF％pred与对照组比较差异均有统计学意义，表现为反映小气道的指标改善尤其明显；2组治疗后大小气道功能指标恢复正常比较：2组的FEV1％pred、FEV1／FVC％、FEF50％pred指标差异无统计学意义，观察组的FEF25％pred[28（84．8％）]、FEF50％pred[26（78．8％）]、FEF75％pred[31（93．9％）]和MMEF％pred[29（87．7％）]比较对照组FEF25％pred[20（55．6％）]、FEF50％pred[20（55．6％）]、FEF75％pred[22（61．1％）]和MMEF％pred[23（63．9％）]的恢复正常率都有提高，差异有统计学意义（χ^2=6．978、4．182、10．418、5．337，P值均〈0.05）。结论一次性肌注维生素D3（7．5mg），可以更好地改善在规范化吸入治疗的儿童哮喘患儿进入缓解期后小气道功能指标，该剂量对于儿童哮喘是安全可行的。

Objective After standardized inhalation therapy by ICS ＋ LABA in children with bronchial asthma （asthma）, using one-time intramuscular injection of vitamin D3 （7.5 mg） to observe the control rate and lung function, especially the improvement of small airway function. Methods Children with acute asthma exacerbations visiting the asthma outpatient of the Chengdu Women - Children Central Hospital from October 2012 to April 2014 were randomly divided into control group （36 cases） and observation group （33 cases）, before treatment and three months after treatment to detect lung function. Results The fully control rate of January, February and March of the two groups was no statistical significant （χ^2 = 0. 287,0.77,0. 004, all P 〉0.05 ）;before and after treatment, the large and small airway function index （expected value%） ratio were improved, the comparison of index of FVC% pred, FEV1/FVC%, FEF75% pred, FEF25% pred, MMEF% pred between the observation group and the control group were statistically significant, improvements of indicators reflecting small airway were particularly evident. After treatment, the comparison of the lung function index restoring to normal of small and large airway between the two groups： FEV1% pred, FEV1/FVC% FEF50% pred showed no statistical significance, comparing the index of FEF25% pred [（28 （ 84.8%）], FEF50% pred [（ 26（78.8%）], FEF75% pred [31（93.9%0）1 and MMEF% pred[29 （87.7%）] of observation group to the index of FEF25% pred[20（55.6%）],FEF50% pred[20（55.6%）],FEF75% pred[22（61.1%）] and MMEF%pred [23（63.9%）] of control group, the recovery ratio were improve, which was statistical significant （χ^2=6.978,4.182, 10.418,5.337, P 〈0.05）. Conclusions One-time intramuscular injection of vitamin D3 （7.5 mg） can improves small airway function indicators of children with childhood asthma with normalization inhalation therapy after remission, the dose for children with asthma is safe and feasible.