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目的探讨维生素D(VitD)佐治老年人社区获得性肺炎(CAP)的临床疗效。方法选择老年CAP患者104例,随机分为VitD治疗组和安慰剂对照组,每组各52例,以同期体检的78例健康老年人作对照。应用酶联免疫吸附法检测血清中25羟维生素D3[25-(OH)D3]水平,应用免疫透射比浊法检测血清中免疫球蛋白A(IgA)及C反应蛋白(CRP)水平,记录和比较CAP患者的临床症状、体征、实验室、影像学检查的变化情况及住院天数。结果 CAP患者治疗前血清25-(OH)D3、IgA和CRP水平分别为(25.22±8.68)nmol/L、(0.28±0.06)g/L和(119.50±21.76)mg/L,其中血清25-(OH)D3和IgA水平均明显低于正常对照组(t=25.213,P<0.05;t=22.280,P<0.05),而血清CRP水平显著高于正常对照组(t=-47.114,P<0.05),且CAP患者血清25-(OH)D3水平与血清IgA水平呈正相关(r=0.829,P<0.05)。同安慰剂对照组相比,VitD治疗组患者血清CRP水平降低,临床总有效率提高了34.4%,住院天数缩短了25.1%,且三项指标组间比较差异均有统计学意义(t=5.017,P<0.05;2=4.248,P<0.05;t=6.321,P<0.05)。VitD治疗组患者治疗后血清25-(OH)D3和IgA水平分别为治疗前的2.84倍和1.96倍。安慰剂对照组患者治疗前后血清25-(OH)D3和IgA水平差异无统计学意义。结论 VitD缺乏可能是老年CAP的潜在病因,补充足量VitD可缓解CAP患者临床症状,明显缩短病程。
Objective To investigate the clinical efficacy of vitamin D (vitamin D) in treating elderly patients with community-acquired pneumonia (CAP). Methods A total of 104 elderly patients with CAP were selected and randomly divided into VitD treatment group and placebo control group, 52 cases in each group. The control group consisted of 78 healthy elderly patients. Serum levels of 25-hydroxyvitamin D3 [25- (OH) D3] were measured by enzyme-linked immunosorbent assay (ELISA), and serum immunoglobulin A (IgA) and C-reactive protein (CRP) levels were measured by immunoturbidimetry. The clinical symptoms, signs, changes of laboratory and imaging examination and days of hospitalization were compared among CAP patients. Results The serum levels of 25- (OH) D3, IgA and CRP in CAP patients before treatment were (25.22 ± 8.68) nmol / L and (0.28 ± 0.06) g / L and (119.50 ± 21.76) mg / (OH) D3 and IgA were significantly lower than those in the normal control group (t = 25.213, P <0.05; t = 22.280, P <0.05), while serum CRP levels were significantly higher than those in the normal control group 0.05). Serum 25- (OH) D3 level in CAP patients was positively correlated with serum IgA level (r = 0.829, P <0.05). Compared with the placebo control group, serum CRP levels decreased in patients with VitD, the total effective rate was increased by 34.4%, hospital stay was shortened by 25.1%, and the three indicators were significantly different (t = 5.017 , P <0.05; 2 = 4.248, P <0.05; t = 6.321, P <0.05). The serum levels of 25- (OH) D3 and IgA in VitD group were 2.84 and 1.96 times higher than before treatment, respectively. There was no significant difference in serum 25- (OH) D3 and IgA before and after treatment in the placebo control group. Conclusion VitD deficiency may be the underlying cause of CAP in elderly patients. Supplementation of adequate dose of VitD can relieve the clinical symptoms of patients with CAP and significantly shorten the course of disease.