维生素D辅助治疗在儿童不同严重程度支气管哮喘患儿中的应用效果

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摘要目的探讨维生素D辅助治疗儿童不同严重程度支气管哮喘的效果及其可能的作用机制。方法选择2015年1月~2017年1月朝阳市第二医院儿科收治的支气管哮喘患儿90例，采用以随机区组设计的方式，先以病情严重程度为区组因素，将患儿分为轻度发作30例、中重度发作60例；再按随机数字表法将患儿分为治疗组和对照组2个亚组，各45例，包括轻度、中重度哮喘患者分别为15例和30例。对照组给予硫酸沙丁胺醇气雾剂吸入和丙酸氟替卡松气雾剂治疗，治疗组患儿在对照组治疗的基础上口服维生素D3，800 U/d。两组均治疗3个月。治疗3个月后采用儿童哮喘控制测试量表评价患儿的哮喘病情控制情况。比较各组治疗前和治疗3个月后25-羟维生素D3[25（OH）D3]、特异性IgE、嗜酸细胞阳离子蛋白水平。结果治疗组轻度发作患儿病情控制率明显高于对照组，差异有统计学意义（P < 0.05）。治疗组轻度发作患儿血清25（OH）D3水平明显高于对照组轻度发作哮喘患儿（P < 0.05），而特异性IgE和嗜酸细胞阳离子蛋白水平明显低于对照组轻度发作患儿（P < 0.05）。治疗后各组哮喘患儿血清25（OH）D3水平均较治疗前明显提升（P < 0.05），除了对照组轻度发作患儿。治疗后各组哮喘患儿血清特异性IgE和嗜酸细胞阳离子蛋白水平均较治疗前明显下降，差异有统计学意义（P < 0.05）。结论补充维生素D对患儿不同严重程度哮喘治疗效果不尽相同，相较对于中重度发作哮喘患儿，其对于轻度发作哮喘症状的控制效果更为明显，作用机制可能与提高血清25（OH）D3水平、降低特异性IgE、嗜酸细胞阳离子蛋白水平有关。

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	王志华

关键词 ：维生素D, 哮喘, 25-羟维生素D3, 降低特异性IgE, 嗜酸细胞阳离子蛋白

Abstract：Objectives To explore the effects of vitamin D supplementation on symptoms of children with bronchial asthma of different severity and relevant mechanisms. Methods Ninety children with bronchial asthma were included from the Second Hospital of Chaoyang from January 2015 to January 2017. Random blocks design was used in this study, the children were assigned to mild (n = 30), moderate and severe attack (n = 60) groups, then they were assigned to the treatment and control subgroups with 45 for each with random number table. The children in the control group were treated with Salbutamol Sulfate Aerosol Inhalation and Fluticasone Propionate Aerosol, and the children received additionally oral vitamin D3 at dose of 800 U daily in the treatment group. All children were treated for 3 months. The childhood asthma control test was used to assess the state of illness of children with bronchial asthma at 3 months after treatment. In addition, serum levels of 25(OH)D3, specific IgE and eosinophil cationic protein were determined before and 3 months after treatment. Results Illness control rate and serum level of 25(OH)D3 in the children with mild attack in the treatment group were significantly higher than those of the control group, the differences were statistically significant (P < 0.05). Conversely, serum levels of specific IgE and eosinophil cationic protein in the children with mild attack in the treatment group were significantly lower than the control group (P < 0.05). Compared with before treatment, serum levels of 25(OH)D3 of children with bronchial asthma in each group was significantly decreased after treatment (P < 0.05) with the exception of mild attack children, but specific IgE and eosinophil cationic protein were significantly increased after treatment (P < 0.05). Conclusion Effects of vitamin D supplementation on symptoms of children with bronchial asthma of different severity are varied, those are more obvious in mild asthmatic attack children, and the underlying mechanisms may involve the increased serum level of 25(OH)D3 and the decreased serum levels of specific IgE and eosinophil cationic protein.

Key words： Vitamin D Asthma 25(OH)D3 Specific IgE Eosinophil cationic protein

基金资助:国家卫生计生委医药卫生科技发展研究中心项目（w2015E4E121）。

作者简介: 王志华（1977.10-），女，副主任医师；研究方向：新生儿。

引用本文:

王志华. 维生素D辅助治疗在儿童不同严重程度支气管哮喘患儿中的应用效果[J]. 中国医药导报, 2018, 15(3): 85-88.
WANG Zhihua. Effects of vitamin D supplementation on bronchial asthma of different severity in children. 中国医药导报, 2018, 15(3): 85-88.

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http://www.yiyaodaobao.com.cn/CN/ 或 http://www.yiyaodaobao.com.cn/CN/Y2018/V15/I3/85

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