维生素D佐治老年人社区获得性肺炎的临床研究_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

王丰 ,  刘萍

自贡市第四人民医院呼吸内科（四川自贡 643000）;

Corresponding author：

刘萍, Email: liuping150103@163.com

Keywords：

维生素D; 社区获得性肺炎; 老年人

DOI：

10.7507/1671-6205.2015119

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目的探讨维生素D(VitD)佐治老年人社区获得性肺炎(CAP)的临床疗效。方法选择老年CAP患者104例, 随机分为VitD治疗组和安慰剂对照组, 每组各52例, 以同期体检的78例健康老年人作对照。应用酶联免疫吸附法检测血清中25羟维生素D₃[25-(OH)D₃]水平, 应用免疫透射比浊法检测血清中免疫球蛋白A(IgA)及C反应蛋白(CRP)水平, 记录和比较CAP患者的临床症状、体征、实验室、影像学检查的变化情况及住院天数。结果 CAP患者治疗前血清25-(OH)D₃、IgA和CRP水平分别为(25.22±8.68) nmol/L、(0.28±0.06) g/L和(119.50±21.76) mg/L, 其中血清25-(OH)D₃和IgA水平均明显低于正常对照组(t=25.213, P＜0.05;t=22.280, P＜0.05), 而血清CRP水平显著高于正常对照组(t=-47.114, P＜0.05), 且CAP患者血清25-(OH)D₃水平与血清IgA水平呈正相关(r=0.829, P＜0.05)。同安慰剂对照组相比, VitD治疗组患者血清CRP水平降低, 临床总有效率提高了34.4%, 住院天数缩短了25.1%, 且三项指标组间比较差异均有统计学意义(t=5.017, P＜0.05;χ²=4.248, P＜0.05;t=6.321, P＜0.05)。VitD治疗组患者治疗后血清25-(OH)D₃和IgA水平分别为治疗前的2.84倍和1.96倍。安慰剂对照组患者治疗前后血清25-(OH)D₃和IgA水平差异无统计学意义。结论 VitD缺乏可能是老年CAP的潜在病因, 补充足量VitD可缓解CAP患者临床症状, 明显缩短病程。

Citation： 王丰, 刘萍. 维生素D佐治老年人社区获得性肺炎的临床研究. Chinese Journal of Respiratory and Critical Care Medicine, 2015, 14(5): 490-493. doi: 10.7507/1671-6205.2015119 Copy

1.	Bergman P, Lindh AU, Björkhem-Bergman L, et al.Vitamin D and respiratory tract infections:a systematic review and meta-analysis of randomized controlled trials. PLoS One, 2013, 8:e65835.
2.	中华医学会呼吸病学分会, 社区获得性肺炎诊断和治疗指南.中华结核和呼吸杂志, 2006, 29:651-655.
3.	陈庆青, 宋志芳.经验性抗感染治疗急诊病房社区获得性肺炎疗效评价.中华肺部疾病杂志(电子版), 2012, 5:203-208.
4.	Holick MF, Binkley NC, Bischoff-Ferrari HA, et al. Evaluation, treatment, and prevention of vitamin D deficiency:an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab, 2011, 96:1911-1930.
5.	Borella E, Nesher G, Israeli E, et al. Vitamin D:a new anti-infective agent? Ann N Y Acad Sci, 2014, 1317:76-83.
6.	Li W, Guo L, Li H, et al. Polymorphism rs2239185 in vitamin D receptor gene is associated with severe community-acquired pneumonia of children in Chinese Han population:a case-control study. Eur J Pediatr, 2015, 174:621-629.
7.	马秀丽, 甄艳芬.1, 25-二羟维生素D3与小儿呼吸系统疾病研究进展.内蒙古医学院学报, 2010.32:36-40.
8.	Remmelts HH, Spoorenberg SM, Oosterheert JJ, et al. The role of vitamin D supplementation in the risk of developing pneumonia:three independent case-control studies. Thorax, 2013, 68:990-996.
9.	Liu PT, Stenger S, Tang DH, et al. Cutting edge:vitamin D-mediated human antimicrobial activity against Mycobacterium tuberculosis is dependent on the induction of cathelicidin. J Immunol, 2007, 179:2060-2063.
10.	王朋, 陈佳琦, 宋志纯, 等.血清25-羟基维生素D检测在儿童社区获得性肺炎中的应用及意义.检验医学, 2014, 29:727-729.
11.	葛楠.老年人社区获得性肺炎的诊治和预防.中华老年医学杂志, 2012, 31:261-262.
12.	丁国锋, 顾振鹏, 张清潭, 等.老年人社区获得性肺炎感染状况.中国老年学杂志, 2013, 33:5143-5144.
13.	阮学东.反复呼吸道感染患儿血清维生素D与IgA水平分析.中国乡村医药杂志, 2013, 20:14-15.
14.	Berry DJ, Hesketh K, Power C, et al. Vitamin D status has a linear association with seasonal infections and lung function in British adults. Br J Nutr, 2011, 106:1433-1440.
15.	Jovanovich AJ, Ginde AA, Holmen J, et al. Vitamin D level and risk of community-acquired pneumonia and sepsis. Nutrients, 2014, 6:2196-2205.

1. Bergman P, Lindh AU, Björkhem-Bergman L, et al.Vitamin D and respiratory tract infections:a systematic review and meta-analysis of randomized controlled trials. PLoS One, 2013, 8:e65835.
2. 中华医学会呼吸病学分会, 社区获得性肺炎诊断和治疗指南.中华结核和呼吸杂志, 2006, 29:651-655.
3. 陈庆青, 宋志芳.经验性抗感染治疗急诊病房社区获得性肺炎疗效评价.中华肺部疾病杂志(电子版), 2012, 5:203-208.
4. Holick MF, Binkley NC, Bischoff-Ferrari HA, et al. Evaluation, treatment, and prevention of vitamin D deficiency:an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab, 2011, 96:1911-1930.
5. Borella E, Nesher G, Israeli E, et al. Vitamin D:a new anti-infective agent? Ann N Y Acad Sci, 2014, 1317:76-83.
6. Li W, Guo L, Li H, et al. Polymorphism rs2239185 in vitamin D receptor gene is associated with severe community-acquired pneumonia of children in Chinese Han population:a case-control study. Eur J Pediatr, 2015, 174:621-629.
7. 马秀丽, 甄艳芬.1, 25-二羟维生素D3与小儿呼吸系统疾病研究进展.内蒙古医学院学报, 2010.32:36-40.
8. Remmelts HH, Spoorenberg SM, Oosterheert JJ, et al. The role of vitamin D supplementation in the risk of developing pneumonia:three independent case-control studies. Thorax, 2013, 68:990-996.
9. Liu PT, Stenger S, Tang DH, et al. Cutting edge:vitamin D-mediated human antimicrobial activity against Mycobacterium tuberculosis is dependent on the induction of cathelicidin. J Immunol, 2007, 179:2060-2063.
10. 王朋, 陈佳琦, 宋志纯, 等.血清25-羟基维生素D检测在儿童社区获得性肺炎中的应用及意义.检验医学, 2014, 29:727-729.
11. 葛楠.老年人社区获得性肺炎的诊治和预防.中华老年医学杂志, 2012, 31:261-262.
12. 丁国锋, 顾振鹏, 张清潭, 等.老年人社区获得性肺炎感染状况.中国老年学杂志, 2013, 33:5143-5144.
13. 阮学东.反复呼吸道感染患儿血清维生素D与IgA水平分析.中国乡村医药杂志, 2013, 20:14-15.
14. Berry DJ, Hesketh K, Power C, et al. Vitamin D status has a linear association with seasonal infections and lung function in British adults. Br J Nutr, 2011, 106:1433-1440.
15. Jovanovich AJ, Ginde AA, Holmen J, et al. Vitamin D level and risk of community-acquired pneumonia and sepsis. Nutrients, 2014, 6:2196-2205.

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维生素D佐治老年人社区获得性肺炎的临床研究

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