维生素D对老年社区获得性肺炎的辅助治疗作用

目的探讨维生素D(Vitamin D,Vit D)佐治老年人社区获得性肺炎(community acquired pneumonia,CAP)的临床疗效。方法选择老年CAP患者104例,随机分为Vit D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-(OH)D_3水平,应用免疫透射比浊法检测血清中Ig A及CRP水平,并记录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患者组治疗前,血清25-(OH)D_3、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)D_3和Ig A水平均明显低于正常对照组(t=25.213,P0.01;t=22.280,P0.01),而血清CRP水平显著高于正常对照组(t=-47.114,P0.01),且CAP患者血清25-(OH)D_3水平与血清IgA水平呈正相关(r=0.829,P0.05)。同安慰剂对照组相比,Vit D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%,且三项值组间比较均有统计学意义(t=5.017,P0.01;χ~2=4.248,P0.05;t=6.321,P0.05)。Vit D治疗组患者治疗后血清25-(OH)D3和Ig A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)D_3和IgA水平差异无统计学意义。结论 VitD缺乏可能是老年人CAP的潜在病因,补充足量Vit D可缓解CAP患者临床症状,明显缩短病程。

Clinical study on the efficacy of vitamin D in the treatment of elderly patients with community-acquired pneumonia

Objective To investigate the clinical efficacy of Vitamin D(VitD)for adjuvant treatment of eld-erly patients with community acquired pneumonia(CAP). Methods 104 elderly patients with CAP were randomly divided into the VitD treatment group and the placebo group, 52 cases in each group. Another 78 healthy elders were chosen as volunteers in the control group. The level of serum 25-hydroxy vitamin D was detected by enzyme linked immunosorbent assay. The levels of serum IgA and CRP were detected by immune turbidimetric analysis. Moreover, their clinical symptoms, signs, laboratory, and imaging examination and hospital stay were recorded. Results The levels of serum 25-hydroxy vitamin D and IgA was [(25. 22 ± 8. 68)nmol/L and(0. 28 ± 0. 06)g/L respectively in the CAP group, which were significantly lower than those in the healthy control group(t=25. 213, P<0. 01 and t=22. 280, P<0. 01, respectively). The level of serum CRP in the CAP group [(119. 50 ± 21. 76)mg/L] was sig-nificantly higher than that in healthy control group(t= -47. 114, P<0. 01). Compared with the placebo group, the level of serum CRP in the VitD treatment group reduced, and the clinical total effective rate was raised by 34. 4%and the hospitalization was shorted by 21. 5%(t=5. 017, P<0. 01;χ2 =4. 248, P<0. 05;t=6. 321, P<0. 05). After VitD treatment, the levels of serum 25-hydroxy vitamin D and IgA in the VitD treatment group were 2. 84 times and 1. 96 times greater than those values before the VitD treatment, respectively. The levels of serum 25-hydroxy vi-tamin D and IgA had no statistical significance before and after the treatment. Conclusion VitD deficiency may be the underlying pathogenesis of CAP in elderly patients. Adequate supplementation of VitD for the elderly patients with CAP can alleviate the clinical symptoms and shorten the course of the treatment.