维生素D3治疗未控制的儿童哮喘初步研究
2016/08/22
摘要
背景：观察和机械的数据表明了维生素D在儿童哮喘中的作用。然而，随后的介入试验结果与之矛盾。我们的目的是评估在爱尔兰哮喘儿童中，与安慰剂相比，维生素D3补充治疗15周的效果。
方法：我们对44个城市、高纬度的白人儿童进行了一项双盲、随机、安慰剂对照的维生素D补充试验（2000 IU /天）。在最开始和补充维生素D 15周后进行评估。观察指标为肺功能、主观哮喘控制情况和总维生素D、过敏、免疫、气道炎症和全身炎症反应的生化指标。最后，家长/监护人在实验过程中需完成周记。
结果：在基线25（OH）D水平无显著差异，但与安慰组(52.5-57.5 nmol/l)相比，维生素D3组的中位数25（OH）D（57.5-105 nmol/L）有显著增长（P＜0.0001）。主观哮喘控制情况组间无显著性差异。与安慰组相比，在维生素D3组，由于哮喘（1 vs 5天，P = 0.04）和碱性磷酸酶（-3.4 vs +16；P = 0.037）导致未到校的日子明显减少，但对于其他几个次要终点，没有有益的影响。然而，与维生素D3组相比，安慰组没有明显的、有利的主观哮喘控制情况、肺功能，特别是1秒钟用力呼气量占预计值百分比（2.5 vs 4；P = 0.06）的变化。
结论：维生素D3的补充导致血清中25（OH）D显著增加，并减少未到校的时间（P = 0.04），但与安慰组相比，在哮喘参数上没有其它有利的变化。维生素D缺乏对生长的影响，以及高血清25（OH）D对肺功能的的潜在负面影响需要进一步调查。
（苏欣 审校）
Pediatr Allergy Immunol. 2016 Jun;27(4):404-12. doi: 10.1111/pai.12547. Epub 2016 Mar 21.
Vitamin D3 for uncontrolled childhood asthma: A pilot study.
Kerley CP1,2,3, Hutchinson K4, Cormican L3, Faul J3, Greally P1, Coghlan D5, Elnazir B1.
Author information
Abstract
BACKGROUND:Observational and mechanistic data suggest a role for vitamin D in childhood asthma. However, subsequent interventional trials have been inconsistent. We aimed to assess the effect of 15 weeks of vitamin D3 supplementation compared with placebo (PL) in Irish children with asthma.
METHODS:We conducted a double-blind, randomized, PL-controlled trial of vitamin D supplementation (2000 IU/day) in 44 urban, Caucasian children at high latitude. Assessments were completed at baseline and after 15 weeks of supplementation. Outcome measures were lung function, subjective asthma control and biochemical parameters of total vitamin D, allergy, immunity, airway inflammation, and systemic inflammation. Finally, parents/guardians completed a weekly diary during the trial.
RESULTS:There was no significant difference in baseline 25(OH)D levels, but there was a significant increase in median 25(OH)D in the vitamin D3 group (57.5-105 nmol/l) compared with the PL group (52.5-57.5 nmol/l) (p < 0.0001). There was no significant difference between groups regarding subjective asthma control. Compared with PL, there was a significant decrease in school days missed due to asthma (1 vs. 5 days, p = 0.04) and alkaline phosphatase (-3.4 vs. +16; p = 0.037) in the vitamin D3 group, but there were no beneficial effects regarding several other secondary end-points. However, there were non-significant, advantageous changes in the PL group compared with the vitamin D3 group in subjective asthma control and lung function, particularly percentage of predicted forced expiratory volume in 1 s (+2.5 vs. -4; p = 0.06).
CONCLUSION:Vitamin D3 supplementation led to a significant increase in serum 25(OH)D and decreased school days missed (p = 0.04), but no other advantageous changes in asthma parameters compared with PL. The potential adverse effect of vitamin D deficiency on growth and the potential negative effect of high serum 25(OH)D on pulmonary function warrant further investigation.
© 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
KEYWORDS:allergy; asthma; bone; infection; pediatric; pulmonary function; vitamin D
Pediatr Allergy Immunol. 2016 Jun;27(4):404-12. doi: 10.1111/pai.12547. Epub 2016 Mar 21.
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对哮喘持续状态的孕妇使用救命的体外膜肺氧合（ECMO）
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老年人哮喘的补充和替代疗法的特点
