低剂量维生素A及多种微量营养素佐治新生儿肺炎随机双盲对照研究  

Oral supplementation of vitamins A and E,zinc,selenite for neonate with infection pneumonia:a randomized placebo-controlled clinical trial of 150 cases

作　　者：江伟[1] 房春晓[1] 瞿平[1] 刘星[1] 陈科[1] 黄鸿眉[1] 李廷玉[1] 

机构地区：[1]重庆医科大学附属儿童医院儿保科,重庆400014

出　　处：《第三军医大学学报》2009年第5期450-453,共4页Journal of Third Military Medical University

摘　　要：目的探讨临床常规应用低剂量维生素A(VA)、维生素E(VE)、锌(Zn)、硒(Se)对新生儿肺炎的佐治效果,了解相关生化、免疫指标的水平变化及对临床效果的影响。方法纳入新生儿肺炎患儿150例分为3组,实收111例。VA组口服低剂量VA,复合营养组口服低剂量VA、VE、Zn、Se,安慰组口服生理盐水。分别收集患儿背景资料和在入院时、干预7 d后静脉血3 ml,采用高效液相色谱法(HPLC)测VA、酶联免疫法(ELISA)测视黄醇结合蛋白(RBP)、免疫比浊法测IgM、硫代巴比妥酸比色法测丙二醛(MDA)。结果肺炎极期患儿严重VAD达13.8%,VAD达26.2%,边缘型VAD达36.9%,各型VAD合计76.9%。营养干预2组症状持续时间均短于安慰剂组(P<0.01);干预前后比较:血清VA在营养干预2组均显著升高(P<0.01),安慰剂组无明显变化(P>0.05);血清RBP在营养干预2组前后无差异(P>0.05),安慰剂组RBP显著升高(P<0.01);血清IgM、MDA营养2组显著降低(P<0.05),安慰剂组无明显变化(P>0.05);症状持续时间和实验室指标变化在营养干预2组间无差异(P>0.05)。结论新生儿肺炎患儿在患肺炎时多种营养素的缺乏比较广泛,临床给予低剂量多种营养素干预可有效减少症状持续时间,并能有效改善患儿营养水平和抗氧化功能;使用安全、简便易行,有较好的临床应用前景。Objective To assess the clinical efficacy of supplemental administration of vitamin A and E, zinc, and selenite for neonatal pneumonia by evaluating their effects on biochemical and immune indexes. Methods A total of 150 matched child （age 〈30 d） with neonatal pneumonia were recruited in this random- ized, double-blind, placebo-controlled, 7-day clinical trial. The cases were randomly and equally divided into 3 groups, that is, VA group （4 500 IU vitamin A once per day） , multinutrient group （daily 4 500 IU vitamin A, 20 mg vitamin E, 9 mg zinc, and 20 g selenite） and placebo group （daily 1 ml normal sodium）. Routine treatment for pneumonia were given to all patients. Before and 7 d after supplementation, their serum contents of vitamin A, retinol binding protein （RBP）, IgM and malondialdehyde （MOD） were tested by HPLC, ELISA, immunoturbidimetry, and spectrophotometry with thiobarbituric acid respectively. Vitamin A deficiency （VAD） was evaluated according to WHO standard. Results Only 111 neonates had all clinical data with VA group 37 children, muhinutrient group 39, and placebo group 35, and 65 patients had clinical data and labora- tory indexes, including 23 in VA group, 24 in multinutrient group and 18 in placebo group. VA group and multinutrient group had a shorter recovery time in signs and symptoms than placebo group （ P 〈 O. O1 ）, but no difference was seen in these 2 supplementation groups. Among the 65 patients, the prevalence rates of serious VAD, VAD, marginal form VAD were 13.8%, 26.2% and 36.9% respectively before supplementation, and the serum VA content in 2 supplementation groups were significantly higher after supplementation than before （ P 〈 O. O1 ） , but no such difference was seen in placebo group. After supplementation, there was no significant difference in serum RBP concentration in VA and multinutrient groups, but that of placebo group was obviously increased （ P 〈 0.01 ）. The serum IgM and MDA were significantly declined in VA group and m

关 键 词：维生素A 维生素E 锌 硒 新生儿 肺炎 

分 类 号：R722.135[医药卫生—儿科] R977.2[医药卫生—临床医学]