Li Qinyuan, Zhou Qi, Zhang Guangli, Tian Xiaoyin, Chen Yaolong, Cun Yupeng, Xu Ximing, Luo Zhengxiu
Department of Respiratory Medicine, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China.
Evidence-based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China.
Ann Transl Med. 2022 Oct;10(20):1094. doi: 10.21037/atm-22-2750.
Asthma exacerbations lead to unplanned health care utilization and reduced lung function in children. Sufficient vitamin D level has been found to have a short-term protective effect against asthma exacerbation in children. However, it is unclear whether this effect remains in the long term. We evaluated the long-term effects of vitamin D levels on the occurrence of asthma exacerbations, emergency department visits or hospitalizations, and lung function among children with asthma, and further investigated the temporal trends of the effects.
In this retrospective cohort study, children with asthma who were admitted to the Children's Hospital of Chongqing Medical University from 2017 to 2021 were enrolled. Negative binomial, Poisson, or logistic regression model was used for the multivariable analysis, adjusting for age, sex, body mass index z-score, and severity of asthma exacerbation.
Of the 370 children with asthma, 87.8% had vitamin D level less than or equal to 30 ng/mL. After adjustment for confounding factors, higher baseline vitamin D levels in asthma children were significantly associated with reduced occurrence of asthma exacerbations during the first [odds ratio 0.842, 95% confidence interval (CI): 0.805-0.881; P<0.001], second (odds ratio 0.848, 95% CI: 0.793-0.907; P<0.001) and third years (odds ratio 0.865, 95% CI: 0.811-0.922; P<0.001) of follow-up. Higher vitamin D levels in asthmatic children were also strongly associated with a reduced number of emergency department visits or hospitalizations during the first (odds ratio 0.880, 95% CI: 0.842-0.920; P<0.001), second (odds ratio 0.885, 95% CI: 0.832-0.941; P<0.001), and third years (odds ratio 0.922, 95% CI: 0.851-0.998; P=0.044) of follow-up. In addition, the vitamin D levels in asthmatic children were found to be negatively associated with the odds of large airway dysfunction (odds ratio 0.865, 95% CI: 0.771-0.970; P=0.013) and small airway dysfunction (odds ratio 0.922, 95% CI: 0.855-0.996; P=0.038) during the first year of follow-up.
Sufficient vitamin D level is associated with lower risk of asthma exacerbations and health care utilization over a 3-year period, and improved lung function over 1 year. The protective effects of vitamin D on asthmatic children decreased over time.
哮喘急性发作会导致儿童计划外的医疗保健利用，并降低其肺功能。已发现充足的维生素D水平对儿童哮喘急性发作具有短期保护作用。然而，这种作用在长期内是否仍然存在尚不清楚。我们评估了维生素D水平对哮喘儿童哮喘急性发作、急诊就诊或住院以及肺功能的长期影响，并进一步研究了这些影响的时间趋势。
在这项回顾性队列研究中，纳入了2017年至2021年在重庆医科大学附属儿童医院住院的哮喘儿童。采用负二项式、泊松或逻辑回归模型进行多变量分析，并对年龄、性别、体重指数z评分和哮喘急性发作的严重程度进行校正。
在370名哮喘儿童中，87.8%的儿童维生素D水平小于或等于30 ng/mL。在调整混杂因素后，哮喘儿童较高的基线维生素D水平与随访的第一年（比值比0.842，95%置信区间[CI]：0.805 - 0.881；P<0.001）、第二年（比值比0.848，95%CI：0.793 - 0.907；P<0.001）和第三年（比值比0.865，95%CI：0.811 - 0.922；P<0.001）哮喘急性发作次数的减少显著相关。哮喘儿童较高的维生素D水平也与随访的第一年（比值比0.880，95%CI：0.842 - 0.920；P<0.001）、第二年（比值比0.885，95%CI：0.832 - 0.941；P<0.001）和第三年（比值比0.922，95%CI：0.851 - 0.998；P = 0.044）急诊就诊或住院次数的减少密切相关。此外，发现哮喘儿童的维生素D水平与随访第一年大气道功能障碍（比值比0.865，95%CI：0.771 - 0.970；P = 0.013）和小气道功能障碍（比值比0.922，95%CI：0.855 - 0.996；P = 0.038）的几率呈负相关。
充足的维生素D水平与3年内哮喘急性发作和医疗保健利用风险较低以及1年内肺功能改善相关。维生素D对哮喘儿童的保护作用随时间推移而降低。
