营养性佝偻病和维生素 D 缺乏症与儿童重症肺炎结局的关系：一项前瞻性队列研究。

Nutritional rickets and vitamin D deficiency--association with the outcomes of childhood very severe pneumonia: a prospective cohort study.

机构信息

Sana'a University, Sana'a, Yemen.

出版信息

Pediatr Pulmonol. 2009 Dec;44(12):1207-15. doi: 10.1002/ppul.21121.

DOI:10.1002/ppul.21121

PMID:19911367

Abstract

BACKGROUND

The association of rickets and vitamin D deficiency (VDD) with pneumonia is well documented, but not with its outcomes.

OBJECTIVES

To investigate whether rickets and VDD predict the outcomes in very severe pneumonia (VSP).

DESIGN

A prospective cohort study conducted at Al-Sabeen hospital in Sana'a, Yemen. A total of 152 children aged 2-59 months with WHO-defined VSP were enrolled, managed, and followed for up to 30 days. Treatment outcome was either successful or failure (antibiotic modification for clinical worsening, death, relapse after 10-day antibiotics, or development of complications). Serum vitamin D (25OHD) was measured in 79 cases. A concentration of <or=30 nmol/L defines VDD.

MAIN OUTCOME MEASURES

Association of rickets with treatment outcome; and VDD with the circulating neutrophils (PMNs), and oxygen saturation% (SpO(2)%), respectively.

RESULTS

Treatment failure occurred in 24 (15.8%), all aged 2-12 months, and 21 (87.5%) were rachitic. Of the 79 subset, 29 had VDD of which 23 (79.3%) had rickets. Treatment failure was significantly higher in the rachitic compared to non-rachitic [20.6% (21/102) vs. 6% (3/50); OR 1.38 (95% CI 1.13-1.69), P = 0.031]. In multivariate regression, rickets significantly predict a reduced successful treatment compared with non-rachitic [79.4% (81/102) vs. 94% (47/50); Adjusted OR 0.41 (95% CI 0.20-0.85); P = 0.02]. VDD was strongly associated with reduced PMNs% [Mean (SD) 37 (17) vs. 47 (17); Adjusted OR 0.71 (95% CI 0.53-0.95), P = 0.02], and reduced SpO(2)% [Mean (SD) 85.9 (7.9) vs. 89.8 (7.1); OR 0.96 (95% CI 0.93-0.99), P = 0.021].

CONCLUSIONS

In VSP, rickets was significantly associated with treatment outcome and VDD significantly predict both reduced circulating PMNs, and Day-5 hypoxemia (SpO(2)%, <88%).

摘要

背景

佝偻病和维生素 D 缺乏症（VDD）与肺炎的相关性已有充分的文献记载，但与肺炎的结局无关。

目的

研究佝偻病和 VDD 是否可以预测重症肺炎（VSP）的结局。

设计

在也门萨那的 Al-Sabeen 医院进行的一项前瞻性队列研究。共纳入了 152 名年龄在 2-59 个月、符合世界卫生组织定义的 VSP 的儿童，对其进行治疗并随访 30 天。治疗结局为成功或失败（因临床恶化、死亡、抗生素治疗 10 天后复发或出现并发症而改变抗生素治疗）。对 79 例患儿测量血清维生素 D（25OHD）。血清 25OHD 浓度<或=30 nmol/L 定义为 VDD。

主要观察指标

佝偻病与治疗结局的关系；VDD 与循环中性粒细胞（PMNs）和氧饱和度（SpO2%）的关系。

结果

24 例（15.8%）患儿治疗失败，年龄均为 2-12 个月，21 例（87.5%）患有佝偻病。在 79 例亚组中，29 例患有 VDD，其中 23 例（79.3%）患有佝偻病。与非佝偻病患儿相比，佝偻病患儿治疗失败的发生率更高[20.6%（21/102）vs. 6%（3/50）；OR 1.38（95%CI 1.13-1.69），P=0.031]。多变量回归分析显示，与非佝偻病患儿相比，佝偻病患儿治疗成功的可能性显著降低[79.4%（81/102）vs. 94%（47/50）；校正后 OR 0.41（95%CI 0.20-0.85）；P=0.02]。VDD 与 PMNs%降低显著相关[均值（标准差）37（17）% vs. 47（17）%；校正后 OR 0.71（95%CI 0.53-0.95），P=0.02]，与 SpO2%降低显著相关[均值（标准差）85.9（7.9）% vs. 89.8（7.1）%；OR 0.96（95%CI 0.93-0.99），P=0.021]。