维生素D2预防儿童社区获得性肺炎的效果

Prevention effect for Vitamin D_2 on childhood community acquired pneumonia

目的探讨维生素D_2注射剂对儿童社区获得性肺炎的预防效果。方法用随机单盲试验法将2~4岁儿童随机分为观察组(534例)和对照组(526例)。两组儿童均给予常规健康指导,观察组儿童在常规健康指导基础上给予维生素D_2注射剂5 000 IU/kg,肌肉注射、1次/月,疗程为3个月。分别于疗程开始、疗程结束及1年后各检测1次血清中25(OH)D水平,记录发生社区获得性肺炎住院的频次,1年后评估疗效。血清25(OH)D水平、社区获得性肺炎年住院率以及不良反应发生率为评估指标。结果入组儿童治疗前血清平均25(OH)D水平为42.5 nmol/L,维生素D缺乏和不足率为62.4%(661/1 060);疗程结束后对照组与观察组儿童血清平均25(OH)D水平分别为45.7 nmol/L和79.7 nmol/L,差异具有统计学意义(t=28.69、P<0.001),维生素D缺乏和不足率为分别为60.1%和9.7%,差异有统计学意义(χ2=282.93、P<0.001)。疗程结束1年后对照组与观察组儿童血清平均25(OH)D水平分别为44.6 nmol/L和75.4 nmol/L(t=28.79、P<0.001);维生素D缺乏和不足率分别为60.7%和19.4%(χ2=187.87、P<0.001);社区获得性肺炎住院率为分别为23.6%(126/534例)和6.8%(36/526例)(χ2=61.7、P<0.001),差异均具有统计学意义。对照组儿童无明显不良反应,而观察组患儿出现口渴、无力各1例,不良反应发生率为0.38%,两组差异无统计学意义(χ2=2.07、P=0.19)。结论 2~4岁社区儿童存在维生素D缺乏和不足的高发生率。常规给予1次/月维生素D_2注射剂5 000 IU/kg,安全有效,且能够改善维生素D缺乏和不足,预防和减少儿童社区获得性肺炎的发生。

Objective To investigate the prevention effect of Vitamin D2 on childhood community acquired pneumonia. Methods Total of 320 cases of normal children aged from 2 to 4 years old were divided into the control group （526 cases） and observation group （534 cases）, randomly. Both with general health guidance in two groups, children in observation group were given vitamin D2 injection with a dose of 5000 IU/kg according to body weight per month, within a treatment period of 3 months. Childhood＆#39;s serum 25 （OH） D levels were detected one time separately at the beginning of treatment, 3 months after treatment and 1 year follow-up, respectively. The frequency of hospitalization was recorded due to childhood community acquired pneumonia with a clinical endpoint of 1 year after treatment follow-up. Childhood＆#39;s serum 25 （OH） D level, annual occurrence frequency and rates, side-effect occurrence rate were set as evaluation index. Results Among all the children, the average serum 25 （OH） D level was 42.5 nmol/L, the deficiency and insufficiency of Vitamin D was 62.4% （661/1060）. Comparison between the two groups, the serum 25 （OH） D levels after treatment were 45.7 nmol/L and 79.7 nmol/L, with significant difference （t = 28.69, P 〈 0.001）, were 44.6 nmol/L and 75.4 nmol/L after 1 year follow-up, with significant difference （t = 28.79, P 〈 0.001）. Vitamin D deficiency and insufficiency were 60.1% and 9.7% after treatment （χ2 = 282.93, P 〈 0.001）, and were 60.7%versus 19.4 after 1 year follow-up （χ2 = 187.87, P 〈 0.001）, both with significant differences. Hospitalization rates for community-acquired pneumonia were 23.6% （126/534） and 6.8% （36/526） of children in the two groups, with significant difference （χ2 = 61.7, P 〈 0.001）. No significant adverse reaction of children in the control group, there were 2 children had thirst, atony in the observation group with a incidence rate of 0.38%（χ2 = 2.07, P = 0.19） . Conclusions The community children aged from 2 to 4 obtain high occurrence rate for Vitamin D deficiency and insufficiency. This deficiency and insufficiency could be improved by giving 5000 IU/kg of Vitamin D2 per month. With safety and effective, the occurrence of childhood community acquired pneumonia could be prevented and shrinked by giving Vitamin D2 supply.