Rosales F J, Kjolhede C, Goodman S
Department of International Health, Johns Hopkins School of Hygiene and Public Health, Baltimore, MD.
Am J Epidemiol. 1996 Mar 1;143(5):413-22. doi: 10.1093/oxfordjournals.aje.a008761.
The authors assessed the efficacy of the World Health Organization (WHO) recommendation of 200,000 IU of vitamin A in oil to treat acute non-xerophthalmic measles patients. Acute measles patients who did not require hospitalization were enrolled in a randomized, double-masked, clinical trial of vitamin A (n=90) versus placebo (n=110) carried out in Ndola, Zambia, in 1991. Measles-associated morbidity was defined by the presence of signs and symptoms of acute respiratory infection. Daily evaluations for the first 3 days were followed by weekly visits for a month at urban health centers. Baseline demographic, clinical, and biochemical characteristics were similar in both groups. Cross-sectional analysis of morbidity status, by group, at each weekly evaluation showed no significant differences until week 4, when more placebo-treated patients had cough or pneumonia (p=0.005). However, longitudinal analysis, which looked at changes among individuals and controlled for initial health status, showed more equivocal results. The odds ratio for the development of pneumonia in patients with measles cough in vitamin A-treated subjects was 0.73 (95% confidence interval (Cl) 0.30-1.80). The odds ratio for the development of measles-associated cough or pneumonia in asymptomatic measles patients was 0.52 (95% Cl 0.24-1.13), in favor of vitamin A, but the odds ratio for failing to improve from pneumonia in vitamin A-treated subjects was 1.23 (95% Cl 0.68-2.3), a result in favor of placebo. These results suggest that the evidence for the efficacy of one dose of vitamin A in oil to prevent measles complications is not as strong as that previously shown for two 200,000 IU doses of water-miscible vitamin A, and that the WHO recommendation may need to be reexamined.
作者评估了世界卫生组织（WHO）推荐的20万国际单位油剂维生素A治疗急性非干眼症麻疹患者的疗效。1991年，在赞比亚恩多拉对不需要住院治疗的急性麻疹患者进行了一项维生素A（n = 90）与安慰剂（n = 110）的随机、双盲临床试验。麻疹相关发病率由急性呼吸道感染的体征和症状确定。前3天每天进行评估，之后在城市卫生中心每周随访1个月。两组的基线人口统计学、临床和生化特征相似。在每次每周评估时按组对发病状况进行横断面分析，直到第4周均未显示出显著差异，此时接受安慰剂治疗的患者出现咳嗽或肺炎的更多（p = 0.005）。然而，纵向分析观察个体变化并控制初始健康状况，结果显示出更多不明确的结果。维生素A治疗组中患麻疹咳嗽的患者发生肺炎的优势比为0.73（95%置信区间（Cl）0.30 - 1.80）。无症状麻疹患者发生麻疹相关咳嗽或肺炎的优势比为0.52（95% Cl 0.24 - 1.13），支持维生素A，但维生素A治疗组中肺炎未改善的优势比为1.23（95% Cl 0.68 - 2.3），这一结果支持安慰剂。这些结果表明，一剂油剂维生素A预防麻疹并发症疗效的证据不如之前显示的两剂20万国际单位水溶性维生素A那么有力，WHO的这一推荐可能需要重新审视。
