Carr Anitra C, Vlasiuk Emma, Zawari Masuma, Scott-Thomas Amy, Storer Malina, Maze Michael, Chambers Stephen T
Department of Pathology and Biomedical Science, University of Otago, Christchurch 8011, New Zealand.
Respiratory Services, Christchurch Hospital, Christchurch 4710, New Zealand.
Antioxidants (Basel). 2023 Aug 14;12(8):1610. doi: 10.3390/antiox12081610.
Community-acquired pneumonia (CAP) is characterized by elevated markers of inflammation and oxidative stress and depleted circulating concentrations of the antioxidant nutrient vitamin C. A feasibility trial of intravenous and oral vitamin C supplementation, matched to the timing of intravenous and oral antibiotic formulations, was carried out and changes in vitamin C status were monitored to determine whether saturating status could be achieved throughout the administration period. Patients with moderate and severe CAP (CURB-65 ≥ 2; = 75) who were receiving intravenous antimicrobial therapy were randomized to placebo ( = 39) or intravenous vitamin C (2.5 g per 8 h; = 36) before moving to oral vitamin C (1 g three times daily) when prescribed oral antimicrobials. Blood samples were collected at baseline and then daily whilst in the hospital. Vitamin C concentrations were determined by high-performance liquid chromatography. The inflammatory and infection biomarkers C-reactive protein and procalcitonin were elevated at baseline (158 (61, 277) mg/L and 414 (155, 1708) ng/L, respectively), and vitamin C concentrations were depleted (15 (7, 25) µmol/L). There was an inverse association between vitamin C and C-reactive protein concentrations ( = -0.312, = 0.01). Within one day of intervention initiation, plasma vitamin C concentrations in the vitamin C group reached median concentrations of 227 (109, 422) µmol/L, and circulating concentrations remained at ≥150 µmol/L for the duration of the intervention, whilst median vitamin C concentrations in the placebo group remained low (≤35 µmol/L). There was a trend toward decreased duration of hospital stay ( = 0.07) and time to clinical stability ( = 0.08) in the vitamin C group. In conclusion, patients with moderate to severe CAP have inadequate plasma vitamin C concentrations for the duration of their hospital stay. The administration of intravenous or oral vitamin C, titrated to match the antimicrobial formulation, provided saturating plasma vitamin C concentrations whilst in the hospital. There were trends toward shorter duration of hospital stay and time to clinical stability. Thus, larger trials assessing the impact of intravenous and oral vitamin C intervention on CAP clinical outcomes are indicated.
社区获得性肺炎（CAP）的特征是炎症和氧化应激标志物升高，抗氧化营养素维生素C的循环浓度降低。开展了一项静脉和口服维生素C补充的可行性试验，使其与静脉和口服抗生素制剂的给药时间相匹配，并监测维生素C状态的变化，以确定在整个给药期间是否能达到饱和状态。接受静脉抗菌治疗的中重度CAP患者（CURB-65≥2；n = 75）在开始口服抗菌药物时，被随机分为安慰剂组（n = 39）或静脉注射维生素C组（每8小时2.5 g；n = 36），之后改为口服维生素C（每日三次，每次1 g）。在基线时以及住院期间每天采集血样。维生素C浓度通过高效液相色谱法测定。炎症和感染生物标志物C反应蛋白和降钙素原在基线时升高（分别为158（61，277）mg/L和414（155，1708）ng/L），维生素C浓度降低（15（7，25）µmol/L）。维生素C与C反应蛋白浓度之间存在负相关（r = -0.312，P = 0.01）。在干预开始后一天内，维生素C组的血浆维生素C浓度达到中位数227（109，422）µmol/L，并且在干预期间循环浓度保持在≥150 µmol/L，而安慰剂组的维生素C中位数浓度仍然较低（≤35 µmol/L）。维生素C组在住院时间（P = 0.07）和达到临床稳定的时间（P = 0.08）方面有缩短的趋势。总之，中重度CAP患者在住院期间血浆维生素C浓度不足。静脉或口服维生素C的给药，根据抗菌制剂进行调整，在住院期间可使血浆维生素C浓度达到饱和。在住院时间和达到临床稳定的时间方面有缩短的趋势。因此，需要开展更大规模的试验来评估静脉和口服维生素C干预对CAP临床结局的影响。
