Hussey G D, Klein M
Department of Paediatrics and Child Health, University of Cape Town, South Africa.
N Engl J Med. 1990 Jul 19;323(3):160-4. doi: 10.1056/NEJM199007193230304.
Measles kills about 2 million children annually, and there is no specific therapy for the disease. It has been suggested that vitamin A may be of benefit in the treatment of measles.
We conducted a randomized, double-blind trial involving 189 children who were hospitalized at a regional center in South Africa because of measles complicated by pneumonia, diarrhea, or croup. The children (median age, 10 months) were assigned to receive either vitamin A (total dose, 400,000 IU of retinyl palmitate, given orally; n = 92) or placebo (n = 97), beginning within five days of the onset of the rash. At base line, the characteristics of the two groups were similar.
Although clinically apparent vitamin A deficiency is rare in this population, the children's serum retinol levels were markedly depressed (mean [+/- SEM], 0.405 +/- 0.021 mumols per liter [11.6 +/- 0.6 micrograms per deciliter]), and 92 percent of them had hyporetinemia (serum retinol level less than 0.7 mumols per liter [20 micrograms per deciliter]). Serum concentrations of retinol-binding protein (mean, 30.1 +/- 2.0 mg per liter) and albumin (mean, 33.4 +/- 0.5 g per liter) were also low. As compared with the placebo group, the children who received vitamin A recovered more rapidly from pneumonia (mean, 6.3 vs. 12.4 days, respectively; P less than 0.001) and diarrhea (mean, 5.6 vs. 8.5 days; P less than 0.001), had less croup (13 vs. 27 cases; P = 0.03), and spent fewer days in the hospital (mean, 10.6 vs. 14.8 days; P = 0.01). Of the 12 children who died, 10 were among those given placebo (P = 0.05). For the group treated with vitamin A, the risk of death or a major complication during the hospital stay was half that of the control group (relative risk, 0.51; 95 percent confidence interval, 0.35 to 0.74).
Treatment with vitamin A reduces morbidity and mortality in measles, and all children with severe measles should be given vitamin A supplements, whether or not they are thought to have a nutritional deficiency.
麻疹每年导致约200万儿童死亡，且该疾病没有特效治疗方法。有人提出维生素A可能对麻疹治疗有益。
我们进行了一项随机双盲试验，涉及189名因麻疹并发肺炎、腹泻或哮吼而在南非一个地区中心住院的儿童。这些儿童（中位年龄10个月）在出疹后5天内被随机分配接受维生素A（口服全反式视黄醇棕榈酸酯，总剂量400,000国际单位；n = 92）或安慰剂（n = 97）。基线时，两组儿童的特征相似。
尽管该人群中临床上明显的维生素A缺乏症很少见，但这些儿童的血清视黄醇水平显著降低（平均值[±标准误]，0.405±0.021微摩尔/升[11.6±0.6微克/分升]），92%的儿童患有低视黄醇血症（血清视黄醇水平低于0.7微摩尔/升[20微克/分升]）。视黄醇结合蛋白的血清浓度（平均值，30.1±2.0毫克/升）和白蛋白（平均值，33.4±0.5克/升）也较低。与安慰剂组相比，接受维生素A治疗的儿童肺炎恢复更快（分别为平均6.3天和12.4天；P<0.001）、腹泻恢复更快（平均5.6天和8.5天；P<0.001）、哮吼病例更少（13例对27例；P = 0.03），住院天数更少（平均10.6天和14.8天；P = 0.01）。在12名死亡儿童中，10名在接受安慰剂治疗组（P = 0.05）。对于接受维生素A治疗的组，住院期间死亡或发生重大并发症的风险是对照组的一半（相对风险，0.51；95%置信区间，0.35至0.74）。
维生素A治疗可降低麻疹的发病率和死亡率，所有患严重麻疹的儿童都应补充维生素A，无论他们是否被认为存在营养缺乏。
