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辅助性单次高剂量维生素 D 对住院成人社区获得性肺炎结局的影响:VIDCAPS 随机对照试验。

Effect of adjunctive single high-dose vitamin D on outcome of community-acquired pneumonia in hospitalised adults: The VIDCAPS randomised controlled trial.

机构信息

Department of Pathology and Biomedical Science, University of Otago, Christchurch, New Zealand.

Canterbury Respiratory Research Group, Canterbury District Health Board, Christchurch, New Zealand.

出版信息

Sci Rep. 2018 Sep 14;8(1):13829. doi: 10.1038/s41598-018-32162-2.

Abstract

Low vitamin D status is associated with increased risk of pneumonia, greater disease severity and poorer outcome. However, no trials have examined the effect of adjunctive vitamin D therapy on outcomes in adults with community-acquired pneumonia (CAP). We conducted a randomised, double-blind, placebo-controlled trial examining the effects of adjunctive vitamin D in adults hospitalised with CAP. Participants were randomised to either a single oral dose of 200,000 IU vitamin D or placebo. The primary outcome was the complete resolution of chest radiograph infiltrate at 6 weeks post-study treatment. Secondary outcomes included length of hospital stay, intensive care admission and return to normal activity. Only participants who completed the study or died within the 6 week period were included in the analysis (n = 60 vitamin D, n = 57 placebo). Adjunctive vitamin D did not have any effect on the primary outcome (OR 0.78, 95% CI 0.31 to 1.86, p = 0.548). However, there was evidence it increased the complete resolution of pneumonia in participants with baseline vitamin D levels <25 nmol/L (OR 17.0, 95% CI 1.40-549.45, P = 0.043), but this did not reach statistical significance using exact methods (OR 13.0, 95%CI 0.7-960.4, P = 0.083). There were no significant effects for any secondary outcome.

摘要

维生素 D 水平低与肺炎风险增加、疾病严重程度增加和预后不良有关。然而,尚无试验研究过辅助维生素 D 治疗对社区获得性肺炎(CAP)成人患者结局的影响。我们进行了一项随机、双盲、安慰剂对照试验,以检验辅助维生素 D 在 CAP 住院成人中的疗效。参与者被随机分配至单次口服 20 万 IU 维生素 D 或安慰剂。主要结局是研究治疗后 6 周时胸部 X 线浸润完全消退。次要结局包括住院时间、入住重症监护病房和恢复正常活动。仅纳入完成研究或在 6 周内死亡的参与者进行分析(n=60 例维生素 D,n=57 例安慰剂)。辅助维生素 D 对主要结局没有任何影响(OR 0.78,95%CI 0.31-1.86,p=0.548)。然而,有证据表明,对于基线维生素 D 水平 <25nmol/L 的参与者,它增加了肺炎的完全消退(OR 17.0,95%CI 1.40-549.45,P=0.043),但使用确切方法未达到统计学意义(OR 13.0,95%CI 0.7-960.4,P=0.083)。任何次要结局均无显著影响。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3aeb/6138743/25e093d00c7f/41598_2018_32162_Fig1_HTML.jpg

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