维生素D补充在治疗患儿反复呼吸道感染中的临床效果

The clinical effect of the vitamin D supplementation in the treatment of recurrent respiratory tract infections in children

目的探讨维生素D补充在治疗患儿反复呼吸道感染中的临床效果。方法选取广西桂东人民医院儿科收治的反复呼吸道感染患儿200例，采用随机数表法随机分为两组，每组100例。常规治疗组采取常规治疗，维生素D组在常规治疗基础上，给予维生素D补充治疗，根据给药途径将维生素D组分成3组，注射组30例患儿注射维生素D，联合组40例患儿先注射后口服维生素D，口服组30例患儿口服维生素D。选取同期体检健康小儿100例为健康组，均进行维生素D、免疫球蛋白G（IgG）、免疫球蛋白M（IgM）、免疫球蛋白A（IgA）水平检测，比较维生素D、免疫球蛋白水平。结果治疗前，常规治疗组与维生素D组血清25．（OH）D，水平[（31．30±5．26）ng／ml、（31．20±5．44）rig／m1]均低于健康组[（61．25±10．18）ng／m1]，且3组的25一（OH）D，水平比较，差异有统计学意义（P〈0．05）；治疗后，常规治疗组与维生素D组血清25．（OH）D，水平[（32．13±5．63）n∥ml、（54．30±10．26）ng／~]仍低于健康组[（61．25±10．18）rig／m1]，但维生素D组的25一（OH）D，水平较治疗前有明显的提升，差异有统计学意义（P〈0．05）；常规治疗组治疗前、后血清25一（OH）D，水平比较，差异无统计学意义（P〉0．05）。维生素D组治疗后血清25一（OH）D，水平[（54．30±10．26）ng／m1]高于治疗前[（31．20±5．44）ng／m1]，差异有统计学意义（P〈0．05）。维生素D组问3种给药途径治疗前、后血清25一（OH）D，水平比较，差异无统计学意义（P〉0．05）；．治疗前，常规治疗组与维生素D组IgG[（7．87±1．67）∥L、（7．86±1．53）∥L]、IgA[（2．01±0．53）∥L、（2．01±0．57）∥L]水平均低于健康组的IgG[（12．04士1．74）∥L]、IgA[（3．20±0．74）g／L]水平，差异有统计学意义（P〈0．05）。3组治疗前、后IgM水平比较，差异无统计学意义（P〉0．05）。常规治疗组、维生素D组治疗后IgG[（11．04±1．78）g／L、（11．93±1．87）∥L]、IgA[（2．49±0．60）g／L、（299±0．50）g／L]水平高于治疗前IgG[（7．87±1．67）g／L、（7．86±1．53）∥L]、IgA[（2．014-0．53）g／l,、（2．01±0．57）∥L]水平，差异有统计学意义（P〈0．05）。常规治疗组、维生素D组治疗前、后IgM水平比较，差异无统计学意义（P〉0．05）。维生素D组间，3种给药途径治疗前、后IgG、IgM、IgA水平比较，差异无统计学意义（P〉0．05）。维生素D组问，3种给药途径治疗后IgG[（12．34±1．87）g／L、（12．01±1．87）g／L、（11．91±1．87）g／Ll、IgA[（3．06±0．53）g／L、（3．01±0．49）g／L、（2．91±-0．47）g／L]水平均高于治疗前IgG[（7．89±1．59）g／L、（7．83±1．50）g／L、（7．81±1．48）g/L]、IgA[（2．21±0．61）g／L、（2．11±0．58）g／L、（2．00±0．54）g／L]水平，差异有统计学意义（P〈0．05）。维生素D组间，3种给药途径治疗后IgM水平与治疗前比较，差异无统计学意义（P〉0．05）。结论反复呼吸道感染患儿多存在维生素D、免疫球蛋白水平低下的问题，在治疗过程中适量给予维生素D可能对疾病的恢复有一定的帮助。

Objective To investigate the clinical effect of vitamin D supplementation in the treatment of children with recurrent respiratory tract infection. Methods A total of 200 cases of 200 children with recurrent respiratory tract infection were randomly divided into two groups, 100 cases in each group. Children in the routine treatment group were given routine treatment, and the others in the vitamin D group were given vitamin D supplementary treatment on the basis of routine treatment, and children in the vitamin D group were subdivided into three groups according to the route of administration. The vitamin D was injec- ted into 30 children in the injection group,40 children in the combined group were given vitamin D after in- jection, and 30 children in the oral group were given vitamin D orally, on the meanwhile, 100 healthy chil- dren were in the healthy group. The levels of vitamin D, immunoglobulin G （ IgG）, immunoglobulin M （IgM） and inununoglobulin A （IgA）were detected in 100 healthy children in the same period,the levels of vitamin D and immunoglobulin levels were compared among the 3 groups. Reults Before treatment, serum 25- （OH） D3 levels in the conventional treatment group and the vitamin D group [ （ 31.30 ± 5.26 ） ng/ml, （31.20 ±5.44）ng/ml] were lower than those in the healthy group [ （61.25 ± 10. 18 ）ng/ml], and the difference of 25- （OH） D3 levels in 3 the groups was statistically significant （P 〈 0.05 ）. After treatment, the serum 25-（OH） D3 level in the conventional treatment group and the vitamin D group [ （32. 13 ±5. 63） ） ng/ml, （ 54. 30 ± 10. 26 ） ng/ml ] was still lower than that in the healthy group [ （ 61.25 ± 10. 18 ） ng/ml ], while the level of 25- （OH） D3 in the vitamin D group was significantly higher than that before treatment, and the difference was statistically significant （P 〈 0. 05）. There was no significant difference in serum 25-（OH） D3 levels between the conventional treatment group before and after treatment （ P 〉 0. 05）. Serum 25-（OH）D3 level[ （54. 30± 10. 26） ng/ml] was higher in the vitamin D group than before treatment （ （31.20 ± 5.44） ng/ml ], and the difference was statistically significant （ P 〈 0.05 ）. There were no statistically significant differences in serum 25-（OH） D3 levels between the three groups of vitamin D groups before and after treatment （ P 〉 0. 05 ）. Before treatment, IgG/L （7.87±1.67） g/L, （7.86 ± 1.53 ） g/L）, IgA （2.01± 0. 53 ） g/L, （2. 01 ± 0. 57 ） g/L） and IgA （3.20 ± 0. 74 ） g/L） in the conventional treatment group and the vitamin D group were all lower than those in the healthy group IgG[ （ 12. 04 ± 1.74） g/ L] ,IgA[ （3.20 ±0. 74） g/L] （P 〈 0. 05 ）. The IgM levels of the three groups before and after treatment showed no significant difference （ P 〉 0. 05）. IgG/L （ 11.04±1.78 ）, （ 11.93 ± 1.87 ） g/L）, IgA [ （ 2. 49 ± 0. 60）g/L, （2. 99± 0. 50）g/L] were higher in the conventional treatment group and the vitamin D group than in the pre-treatment group （7.87 ± 1.67 ） g/L, （7. 86 ± 1.53 ） g/L, and （ 2.01 ± 0. 53 ） g/L, （ 2. 01 ± 0. 57） g/L] ,with statistically significant differences （ P 〈 0. 05 ）. The IgM level of the conventional treatment group and the vitamin D group before and after treatment showed no significant difference （P 〉 0.05 ）. The levels of IgG, IgM and IgA before and after the three administration approaches were compared between vitamin D groups, and the differences were not statistically significant （ P 〉 0. 05 ）. Between vitamin D groups, IgG [ （ 12. 34 ± 1.87 ） g/L, （ 12.01 ± 1.87 ） g/L, （ 11.91 ± 1.87 ） g/L ], IgA [ （ 3.06 ± 0. 53 ） g/L, （ 3.01 ± 0. 49 ） g/L, （ 2. 91 ± 0.47 ） g/L ] were all higher than the pre-treatment IgG [ （ 7. 89 ± 1.59 ） g/L, （7. 83 ± 1.50）g/L, （7.81 ± 1.48）g/L] ,IgA[ （2. 21 ± 0. 61 ）g/L, （2. 11 ± 0. 58）g/L, （2. 00 ± 0. 54）g/ L, and the difference was statistically significant （ P 〈 0.05 ）. There was no statistically significant differ- ence （ P 〉 0. 05 ） in IgM level between the vitamin D group and the pre-treatment group after 3 administration pathways. Conclusion Low levels of vitamin D and immunoglobulin are common in children with re- current respiratory tract infection. Appropriate administration of vitamin D may be helpful to the recovery of the disease.