队列研究评估维生素 D、镁和维生素 B 联合应用对老年冠状病毒（COVID-19）患者进展为严重结局的影响。
Cohort study to evaluate the effect of vitamin D, magnesium, and vitamin B in combination on progression to severe outcomes in older patients with coronavirus (COVID-19).
机构信息
Department of Hematology, Singapore General Hospital, Singapore.
Department of Hematology, Singapore General Hospital, Singapore; Department of Clinical Pathology, Singapore General Hospital, Singapore; Department of Pathology, Sengkang General Hospital, Singapore.
出版信息
Nutrition. 2020 Nov-Dec;79-80:111017. doi: 10.1016/j.nut.2020.111017. Epub 2020 Sep 8.
OBJECTIVES
The aim of this study was to determine clinical outcomes of older patients with coronavirus (COVID-19) who received a combination of vitamin D, magnesium, and vitamin B (DMB) compared with those who did not. We hypothesized that fewer patients administered this combination would require oxygen therapy, intensive care support, or a combination of both than those who did not.
METHODS
This was a cohort observational study of all consecutive hospitalized patients ≥50 y of age with COVID-19 in a tertiary academic hospital. Before April 6, 2020, no patients received the (DMB) combination. After this date, patients were administered 1000 IU/d oral vitamin D, 150 mg/d oral magnesium, and 500 mcg/d oral vitamin B upon admission if they did not require oxygen therapy. Primary outcome was deterioration leading to any form of oxygen therapy, intensive care support, or both.
RESULTS
Between January 15 and April 15, 2020, we identified 43 consecutive patients ≥50 y of age with COVID-19. Seventeen patients received DMB before onset of primary outcome and 26 patients did not. Baseline demographic characteristics between the two groups were significantly different by age. In univariate analysis, age and hypertension had a significant influence on outcome. After adjusting for age or hypertension separately in a multivariate analysis, the intervention group retained protective significance. Fewer treated patients than controls required initiation of oxygen therapy during hospitalization (17.6 vs 61.5%, P = 0.006). DMB exposure was associated with odds ratios of 0.13 (95% confidence interval [CI], 0.03-0.59) and 0.20 (95% CI, 0.04-0.93) for oxygen therapy, intensive care support, or both on univariate and multivariate analyses, respectively.
CONCLUSIONS
A vitamin D / magnesium / vitamin B combination in older COVID-19 patients was associated with a significant reduction in the proportion of patients with clinical deterioration requiring oxygen support, intensive care support, or both. This study supports further larger randomized controlled trials to ascertain the full benefit of this combination in ameliorating the severity of COVID-19.
目的
本研究旨在比较接受维生素 D、镁和维生素 B（DMB）联合治疗的老年冠状病毒（COVID-19）患者与未接受治疗的患者的临床结局。我们假设，与未接受治疗的患者相比，接受联合治疗的患者需要氧疗、重症监护支持或两者结合的比例会更低。
方法
这是一项对三级学术医院所有连续住院的≥50 岁 COVID-19 患者进行的队列观察性研究。在 2020 年 4 月 6 日之前，没有患者接受 DMB 联合治疗。在此日期之后，如果患者不需要氧疗，他们将在入院时接受 1000 IU/d 口服维生素 D、150 mg/d 口服镁和 500 mcg/d 口服维生素 B。主要结局是病情恶化导致任何形式的氧疗、重症监护支持或两者结合。
结果
在 2020 年 1 月 15 日至 4 月 15 日期间，我们确定了 43 名连续住院的≥50 岁 COVID-19 患者。17 名患者在主要结局发生前接受了 DMB 治疗，而 26 名患者未接受。两组之间的基线人口统计学特征存在显著差异，主要是年龄。在单因素分析中，年龄和高血压对结局有显著影响。在多变量分析中分别调整年龄或高血压后，干预组仍具有保护意义。与对照组相比，接受治疗的患者在住院期间需要开始氧疗的比例较低（17.6% vs 61.5%，P=0.006）。在单因素和多因素分析中，DMB 暴露的比值比分别为 0.13（95%置信区间 [CI]，0.03-0.59）和 0.20（95% CI，0.04-0.93），分别用于氧疗、重症监护支持或两者的联合治疗。
结论
在老年 COVID-19 患者中使用维生素 D/镁/维生素 B 联合治疗与临床恶化需要氧支持、重症监护支持或两者结合的患者比例显著降低有关。这项研究支持进一步进行更大规模的随机对照试验，以确定这种联合治疗在减轻 COVID-19 严重程度方面的全部益处。
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