目的 研究口服不同剂量维生素D3(VitD3)对支气管哮喘患儿T淋巴细胞的调节,及对哮喘控制水平的改善,进而分析VitD3治疗儿童哮喘的机理及最佳剂量。方法 选取6～13岁哮喘患儿120例,另外选择同期进行健康体检儿童30例作为正常对照。入选患儿随机分为4组,常规治疗组1组,VitD3治疗组3组,后者在常规治疗的基础上口服VitD3治疗,剂量分别为每日400 U、600 U、800 U,总疗程12个月。分别于治疗前、治疗后的1、3、6、12个月检测患儿血T淋巴细胞亚群。疗程达12个月时统计患儿的哮喘控制水平。结果 疗程12个月后各组CD4、CD4/CD8均较治疗前显著降低,CD8较前显著升高,但与正常对照组比较差异有统计学意义(P<0.05);疗程达6个月时,600 U及800 U治疗组CD4及CD4/CD8较另外两组显著降低。疗程达12个月时,600 U及800 U治疗组的哮喘控制水平显著高于另外两组,而600 U及800 U间差异无统计学意义(P>0.05)。结论 口服不同剂量VitD3均能调节哮喘患儿T淋巴细胞的失衡,这是VitD3治疗哮喘的机制之一,但需要较长期的过程;VitD3治疗显著改善哮喘的控制水平,每日600 U可能为最佳的治疗剂量。
Abstract
Objective To investigate the effect of different doses of vitamin D3 on T lymphocyte subsets in children with bronchial asthma and on the improvement of asthma control levels,and to explore the mechanism and optimal dose of vitamin D3 in the treatment of bronchial asthma in children. Methods A total of 120 children with bronchial asthma aged from 6 to 13 years were selected.In addition,30 healthy children were selected as the normal control group in the same period.The selected patients were randomly divided into 4 groups,including one group of conventional treatment and three groups of vitamin D3 treatment on the basis of conventional treatment.The doses of vitamin D3 were 400 U,600 U and 800 U per day,respectively,and the total course of treatment was 12 months.The T lymphocyte subsets were detected before treatment,1 month,3 months,6 months and 12 months after treatment.The control level of asthmatic children was counted at 12 months after treatment. Results After 12 months,the levels of CD4,CD4/CD8 in blood were significantly lower than those before treatment,and CD8 was significantly elevated,but compared with the control group,there were still significant differences.After 6 months of treatment,in the 600 U and 800 U treatment groups,the levels of CD4 and CD4/CD8 were decreased more significantly than the other two groups.The asthma control level of the 600 U and 800 U treatment group was significantly higher than that of the other two groups after treatment,but there was no significant difference between the 600 U and 800 U groups (P>0.05). Conclusions Oral intake of different doses of vitamin D3 can regulate the imbalance of T lymphocyte subsets,which is one of the mechanisms of vitamin D3 in the treatment of asthma,but it still requires a long process.Vitamin D3 treatment significantly improved the control level of asthma,daily intake of 600 U may be the best treatment dosage.
关键词
支气管哮喘 /
维生素D3 /
T淋巴细胞 /
儿童
Key words
bronchial asthma /
vitamin D3 /
T lymphocyte /
children
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参考文献
[1] 王慧燕,温怀凯,王玲莉,等.6651例0岁～16岁儿童维生素D营养状况调查分析[J].中国卫生检验杂志,2016,26(9):1325-1327.
[2] 李晓娅,王小妮,陆小霞.维生素D与儿童哮喘相关性的Meta分析[J].中国儿童保健杂志,2016,24(12):1290-1295.
[3] 陈杰,袁岳沙,李琦,等.支气管哮喘患儿T淋巴细胞亚群变化及相关细胞因子对Th细胞的调节[J].实用儿科临床杂志,2010,25(9):643-645.
[4] 中华医学会儿科学分会呼吸学组,《中华儿科杂志》编辑委员会.儿童支气管哮喘诊断与防治指南(2016年版)[J].中华儿科杂志,2016,54(3):167-181.
[5] Randolph AG,Yip WK,Falkenstein-Hagander K,et al.Vitamin D-binding protein haplotype is associated with hospitalization for RSV bronchiolitis[J].Clin Exp Allergy,2014,44(2):231-237.
[6] Majak P,Olszowiec-Chlebna M,Smejda K,et al.Vitamin D supplementation in children may prevent asthma exacerbation triggered by acute respiratory infection[J].J Allergy Clin Immunol,2011,127(5):1294-1296.
[7] Arshi S,Fallahpour M,Nabavi M,et al.The effects of vitamin D supplementation on airway functions in mild to moderate persistent asthma[J].Ann Allergy Asthma Immunol,2014,113(4):404-409.
[8] 莫丽亚,邓永超,黄彩芝,等.维生素D受体基因多态性与儿童哮喘相关性研究[J].中国儿童保健杂志,2015,23(7):742-744.
[9] 陈凌燕,周小建,李霞,等.孕期哺乳期大鼠补充维生素D3对子代大鼠哮喘模型肺组织维生素D受体表达的影响[J].临床儿科杂志,2012,30(5):470-473,479.
[10] 陈凌燕,周小建,李霞,等.孕期和哺乳期1,25-(OH)2D3干预对子代哮喘大鼠肺组织TGF-β1和Smad3表达的影响[J].中国当代儿科杂志,2012,14(5):366-370.
[11] 李霞,周小建,陈凌燕,等.不同剂量1,25-(OH)2D3对生命早期大鼠哮喘模型气道重塑的影响[J].临床儿科杂志,2013,31(2):170-174.
[12] Riverin BD,Maguire JL,Li P.Vitamin D supplementation for childhood asthma:a systematic review and Meta-analysis[J].PLoS One,2015,10(8):e0136841.
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