随机双盲临床对照研究口服低剂量维生素A及多种-第三军医大学学报.DOC

PAGE PAGE 1 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 江 伟,房春晓,瞿 平,刘星,陈 科,黄鸿眉,李廷玉（重庆医科大学附属儿童医院儿保科，重庆 400014） 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 随机纳入新生儿肺炎患儿150名分为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%。营养干预两组症状持续时间均短于安慰剂组(p0.01)；干预前后比较：血清VA在营养干预两组均显著升高(p0.01)，安慰剂组无明显变化(p0.05)；血清RBP在营养干预两组变化无差异(p0.05)，安慰剂组RBP显著升高(p0.01)；血清IgM、MDA营养两组显著降低(p0.05)，安慰剂组明显变化(p0.05)；症状持续时间和实验室指标变化在营养干预两组间无差异(p0.05)。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，临床给与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。 关键词:维生素A；维生素E；锌；硒；新生儿；肺炎 中图法分类号：R722.13 文献标识码：A Oral supplementation of vitamins A and E, zinc, selenite for neonate with infection pneumonia: a randomized placebo-controlled clinical trial of 150 cases JIANG Wei, FANG Chun-xiao, QU Ping, LIU Xing, CHEN Ke, HUANG Hong-mei, LI Ting-yu (Department of Children Healthcare, Children’s Hospital, Chongqing Medical University, Chongqing 400014, China) Abstract: 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 randomized, double-blind, placebo-controlled, 7-day clinical trial. The cases were randomly and equally divided into 3 groups, that is, VA group (4500 IU vitamin A once per day), multinutrient group (daily 4500IU vitamin A, 20 mg vitamin E, 9 mg zinc, and 20 μg 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