维生素A和D联合常规药物治疗小儿毛细支气管炎的效果及炎症因子变化  

Efficacy of Vitamins A and D Combined with Standard of Care Drugs in Children with Bronchiolitis and Changes of Inflammatory Factors

作　　者：张艳华 孙丽芳 李微 刘静炎 ZHANG Yan-hua;SUN Li-fang;LI Wei;LIU Jing-yan(Department of Pediatrics,Zhengzhou Central Hospital Affiliated to Zhengzhou University,Zhengzhou 450000,China)

机构地区：[1]郑州大学附属郑州中心医院儿科,郑州450000

出　　处：《中国合理用药探索》2023年第4期50-56,共7页Chinese Journal of Rational Drug Use

摘　　要：目的:观察维生素A和D联合常规药物治疗小儿毛细支气管炎的效果。方法:选取某院2017年1月~2019年11月收治的200例毛细支气管炎患儿,采用随机数字表法分为常规组(常规药物治疗)、维生素A组(常规药物+维生素A治疗)、维生素D组(常规药物+维生素D治疗)、联合组(常规药物+维生素A和D治疗),每组50例。比较4组治疗前后辅助性T淋巴细胞17(Th17)/调节性T淋巴细胞(Treg)、辅助性T细胞1(Th1)/辅助性T细胞2(Th2)相关细胞因子[白介素-17(IL-17)、干扰素-γ(IFN-γ)、白介素-10(IL-10)、白介素-4(IL-4)]水平变化,以及临床疗效和不良反应发生情况。结果:治疗后4组患儿血清IL-17、IL-4水平、IL-17/IL-10均下降(P<0.05),且血清IL-17、IL-17/IL-10水平:联合组<维生素A组<维生素D组<常规组(P<0.05);血清IL-4水平:联合组<维生素D组<维生素A组<常规组(P<0.05)。治疗后4组患儿血清IL-10、IFN-γ水平、IFN-γ/IL-4均升高(P<0.05),且血清IL-10水平:联合组>维生素A组>维生素D组>常规组(P<0.05);血清IFN-γ、IFN-γ/IL-4水平:联合组>维生素D组>维生素A组>常规组(P<0.05)。联合组总有效率高于常规组(P<0.01);4组患儿治疗期间不良反应发生率比较无统计学差异(P>0.05)。结论:对毛细支气管炎患儿实施维生素A和D联合常规药物治疗可增强疗效,维生素A和D主要调节Th17/Treg和Th1/Th2平衡,且维生素A和D联合常规药物的效果更佳,更安全可靠。Objective:To observe the efficacy of vitamins A and D combined with standard of care drugs in children with bronchiolitis.Methods:200 children with bronchiolitis treated in the hospital during January 2017 to November 2019 were randomly assigned into standard of care group(standard of care),vitamin A group(standard of care+vitamin A),vitamin D group(standard of care+vitamin D)and combined group(standard of care+vitamin A+vitamin D)with 50 patients in each group.The clinical efficacy,adverse reactions and changes of helper T lymphocyte 17(Th17)/regulatory T lymphocyte(Treg),helper T cell 1(Th1)/helper T cell 2(Th2)associated cytokines[interleukin-17(IL-17),interferon-γ(IFN-γ),interleukin-10(IL-10),interleukin-4(IL-4)]before and after treatment were compared among the four groups.Results:After treatment,the serum IL-17,IL-4 and IL-17/IL-10 in the four groups decreased(P<0.05),and for the IL-17 level and IL-17/IL-10:combined group<vitamin A group<vitamin D group<standard of care group(P<0.05),and for the IL-4 level:combined group<vitamin D group<vitamin A group<standard of care group(P<0.05).The serum IL-10,IFN-γand IFN-γ/IL-4 in the four groups increased after treatment(P<0.05),and for the IL-10 level:combined group>vitamin A group>vitamin D group>standard of care group(P<0.05),and for the serum IFN-γlevel and IFN-γ/IL-4:combined group>vitamin D group>vitamin A group>standard of care group(P<0.05).The total response rate of the combined group was higher than that of the standard of care group(P<0.01).There was no statistically significant difference in the incidences of adverse reactions between the four groups during treatment(P>0.05).Conclusion:Vitamins A and D combined with standard of care drugs can significantly improve the efficacy in children with bronchiolitis,and vitamin A and vitamin D mainly regulate Th17/Treg and Th1/Th2 balance respectively,and the combination of vitamin A and D with standard of care drugs improved treatment efficacy with safe and reliable profile.

关 键 词：维生素A 维生素D 毛细支气管炎 辅助性T淋巴细胞 调节性T淋巴细胞 

分 类 号：R725.6[医药卫生—儿科]