不同剂量维生素D辅助治疗小儿RRTI的疗效比较

Comparison of different doses of vitamin D as adjuvant treatment for children with recurrent respiratory infections

目的探索不同剂量维生素D辅助治疗小儿反复呼吸道感染(RRTI)的临床疗效。方法选取2016年3月至2017年3月咸阳市第一人民医院收治的1~6岁RRTI患儿183例为研究对象,按随机数字表法将其分为对照组63例及补充维生素D低剂量组61例、高剂量组59例,三组均进行常规治疗,低剂量组、高剂量组在常规治疗的基础上给予阿法骨化醇软胶囊0.25μg/次和0.5μg/次,3次/周,疗程3个月,比较治疗前和治疗3个月后维生素D、免疫球蛋白IgA、IgG和IgM水平,同时随访1年,观察其呼吸道感染发作情况。结果低剂量组、高剂量组和对照组治疗总有效率分别为86.89%、77.97%和58.73%,组间比较差异有统计学意义(χ~2=25.257,P <0.001),其中低剂量组和高剂量组治疗总有效率均高于对照组(χ~2值分别为18.654、17.985,均P <0.001),而低剂量组与高剂量组比较治疗总有效率差异无统计学意义(χ~2=1.653,P=0.199)。低剂量组和高剂量组呼吸道感染急性发作次数均低于对照组(t值分别为4.485、5.905,均P <0.05),低剂量组与高剂量组比较差异无统计学意义(t=1.192,P=0.264);三组治疗后退热时间、咳嗽消失时间、肺啰音消失时间比较差异均无统计学意义(均P>0.05)。低剂量组和高剂量组治疗后IgA、IgG、IgM和维生素D水平均高于对照组(低剂量组与对照组比较:t值分别为4.485、5.952、7.904、5.673,均P <0.05;高剂量组与对照组比较:t值分别为6.950、5.832,6.261、5.893,均P <0.05),而低剂量组与高剂量组比较差异均无统计学意义(t值分别为1.183、0.894、1.263、2.337,均P>0.05)。结论维生素D能提高RRTI患儿的免疫功能,降低急性发作次数,低剂量组与高剂量组治疗效果相当,建议临床首选低剂量方案。

Objective To explore the clinical efficacy of different doses of vitamin D in children with recurrent respiratory tract infection(RRTI). Methods 183 RRTI children hospitalized in our hospital during the period from March 2016 to March 2017 were selected as research subjects. According to the random number table method, they were divided into low-dose group(n = 61), highdose group(n = 59), and the control group(n = 63). All children were given routine treatment. The low-dose group and high-dose group were given alfacalciferol soft capsule at a dose of 0.25 ug/time and 0.5 ug/time, respectively, 3 times/week, for three months. The levels of vitamin D, immunoglobulin A(IgA), IgG and IgM were compared before and after the treatment of 3 months, and the incidence of respiratory tract infection was observed during 1 year follow-up. Results The total effective rates of low dose group, high dose group and the control group were 86.89%, 77.97% and 58.73%, respectively,(χ~2 = 25.257, P<0.001). The total effective rates of low dose group and high dose group were higher than those of the control group(χ~2 = 18.654, 17.985, P<0.001), but there was no significant difference between the low dose group and the high dose group(χ~2 = 1.653, P = 0.199). The number of acute attacks in low-dose group and high-dose group was lower than thosei in the control group(t = 4.485, 5.905, respectively, P<0.05). But there was no significant difference between low-dose group and high-dose group(t = 1.192, P = 0.264). There was no significant difference in fever abatement time, cough disappearance time and lung rales disappearance time among the three groups after the treatment(P>0.05). IgA, IgG, IgM, and vitamin D levels after the treatment in low dose group and high dose group were higher than those in the control group(Low dose group vs. control group: t = 4.485, 5.952, 7.904, 5.673, respectively, P<0.05 for all;high dose group vs. control group: t = 6.950, 5.832, 6.261, 5.893, respectively, P<0.05 for all). But there was no significant difference between the low dose group and the high dose group(t = 1.183, 0.894, 1.263, 2.337, respectively, P>0.05 for all). Conclusion Vitamin D can improve immune function of RRTI children and reduce the number of acute episodes. The therapeutic effect of low dose group is similar to that of high dose group. It is suggested that low dose be the first option in clinical treatment.