抗生素降阶梯治疗小儿重症喘息对血清维生素D的影响
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摘要
目的:探讨抗生素降阶梯治疗小儿重症喘息对血清维生素D的影响。方法:选择重症喘息患儿190例,根据随机抽签原则分为观察组与对照组各95例,对照组选择常规抗生素治疗,观察组采用抗生素降阶梯治疗,治疗观察时间为7 d。结果:观察组总有效率为97.9%,明显高于对照组的88.4%(P<0.01);观察组的喘息、肺部啰音消失时间与住院时间分别为(3.14±0.34)d、(4.63±0.45)d和(9.39±3.22)d,均明显短于对照组的(4.22±0.45)d、(7.82±0.56)d和(11.45±2.95)d(P<0.01);治疗后,2组患儿血清维生素25(OH)D含量分别为(53.24±9.45)ng/m L和(45.39±10.22)ng/m L,均明显高于治疗前的(28.24±9.33)ng/m L和(28.11±8.97)ng/m L(P<0.01),且观察组的上升幅度高于对照组(P<0.01)。结论:抗生素降阶梯治疗小儿重症喘息能提高血清维生素25(OH)D含量,提高总体治疗效果,促进患儿的康复。
Objective: To investigate the effects of de-escalation treatment of antibiotic on the serum vitamin D in children with severe asthmatic. Methods: One hundred and ninety children with severe asthmatic were randomly divided into the treatment group and control group according to the random draw principle( 95 cases each group). The control group and treatment group were treated with routine antibiotic and de-escalation of antibiotic for 7 days,respectively. Results: The total effective rate in treatment group( 97. 9%) was significantly higher than that in control group( 88. 4%)( P < 0. 01). The disappearance time of wheezing and pulmonary rale,and hospitalization time in treatment group[( 3. 14 ± 0. 34) d,( 4. 63 ± 0. 45) d and( 9. 39 ± 3. 22) d] were significantly less than those in control group[( 4. 22 ± 0. 45) d,( 7. 82 ± 0. 56) d and( 11. 45 ± 2. 95) d],respectively( P < 0. 01). The levels of serum vitamin 25( OH) D in treatment group and control group after treatment[( 53. 24 ± 9. 45) ng/m L and( 45. 39 ± 10. 22) ng/m L]were significantly higher than those before treatment[( 28. 24 ± 9. 33) ng/m L and( 28. 11 ± 8. 97) ng/m L],respectively( P < 0. 01),and the increasing degree of which in treatment group was higher than that in control group( P < 0. 01). Conclusions: The de-escalation treatment of antibiotic in children with severe asthmatic can increase the serum vitamin 25( OH) D content,improve the overall treatment effect,and promote the rehabilitation of children.
Objective: To investigate the effects of de-escalation treatment of antibiotic on the serum vitamin D in children with severe asthmatic. Methods: One hundred and ninety children with severe asthmatic were randomly divided into the treatment group and control group according to the random draw principle( 95 cases each group). The control group and treatment group were treated with routine antibiotic and de-escalation of antibiotic for 7 days,respectively. Results: The total effective rate in treatment group( 97. 9%) was significantly higher than that in control group( 88. 4%)( P < 0. 01). The disappearance time of wheezing and pulmonary rale,and hospitalization time in treatment group[( 3. 14 ± 0. 34) d,( 4. 63 ± 0. 45) d and( 9. 39 ± 3. 22) d] were significantly less than those in control group[( 4. 22 ± 0. 45) d,( 7. 82 ± 0. 56) d and( 11. 45 ± 2. 95) d],respectively( P < 0. 01). The levels of serum vitamin 25( OH) D in treatment group and control group after treatment[( 53. 24 ± 9. 45) ng/m L and( 45. 39 ± 10. 22) ng/m L]were significantly higher than those before treatment[( 28. 24 ± 9. 33) ng/m L and( 28. 11 ± 8. 97) ng/m L],respectively( P < 0. 01),and the increasing degree of which in treatment group was higher than that in control group( P < 0. 01). Conclusions: The de-escalation treatment of antibiotic in children with severe asthmatic can increase the serum vitamin 25( OH) D content,improve the overall treatment effect,and promote the rehabilitation of children.
引文
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[15]吴奎,袁北芳,侯学敬,等.毛细支气管炎患儿单核细胞Toll样受体-4的表达与维生素D水平变化的关系[J].中华实用儿科临床杂志,2015,30(12):938.
[16]冯伟静,张荣荣,李玉红.维生素D辅助治疗婴幼儿喘息性肺炎的临床研究[J].中国中西医结合儿科学,2014,5(13):451.
[17]DEREGNAUCOURT D,BUCHE S,COOPMAN S,et al.Pyoderma gangrenosum with lung involvement treated with infliximab[J].Ann Dermatol Venereol,2013,140(5):363.
[18]DI BELLA G,MASCIA F,RICCHI A,et al.Evaluation of the safety and efficacy of the first-line treatment with somatostatin combined with melatonin,retinoids,vitamin D3,and low doses of cyclophosphamide in 20 cases of breast cancer:a preliminary report[J].Neuro Endocrinol Lett,2013,34(7):660.
[2]LOO LW,LIEW YX,LEE W,et al.Impact of Antimicrobial Stewardship Program(ASP)on outcomes in patients with acute bacterial skin and skin structure infections(ABSSSIs)in an acute-tertiary care hospital[J].Infect Dis Ther,2015,4(Suppl1):15.
[3]陈金霞.抗生素降阶梯治疗小儿重症肺炎疗效观察[J].北方药学,2014,17(32):88.
[4]李萍.抗生素降阶梯治疗小儿重症肺炎的临床疗效[J].中国现代药物应用,2014,8(18):113.
[5]KORN KT,LEMENAGER RP,CLAEYS MC,et al.Supplemental vitamin D3 and zilpaterol hydrochloride.II.Effect on calcium concentration,muscle fiber type,and calpain gene expression of feedlot steers[J].J Anim Sci,2013,91(7):3332.
[6]张来,任海燕.维生素D水平与儿童哮喘的流行病学调查及其影响因素分析[J].中国农村卫生事业管理,2014,34(10):1245.
[7]丘冰青,杨鸣,欧琳华,等.抗生素降阶梯治疗小儿重症肺炎疗效观察[J].当代医学,2011,17(26):131.
[8]CARLIER M,ROBERTS JA,STOVE V,et al.A simulation study reveals lack of pharmacokinetic/pharmacodynamic target attainment in de-escalated antibiotic therapy in criticallyⅢpatients[J].Antimicrob Agents Chemother,2015,59(8):4689.
[9]盘洪兰.抗生素降阶梯治疗小儿重症肺炎疗效观察[J].北方药学,2013,10(6):30.
[10]白丽.抗生素降阶梯方案治疗重症监护病房重症肺炎32例[J].中国药业,2013,22(15):87.
[11]CHOI M,OZEKI J,HASHIZUME M,et al.Vitamin D receptor activation induces peptide YY transcription in pancreatic islets[J].Endocrinology,2012,153(11):5188.
[12]苗萍.抗生素降阶梯治疗小儿重症肺炎的临床疗效[J].中国实用医药,2014,10(15):162.
[13]MADARAS-KELLY K,JONES M,REMINGTON R,et al.Description and validation of a spectrum score method to measure antimicrobial de-escalation in healthcare associated pneumonia from electronic medical records data[J].BMC Infect Dis,2015,25(15):197.
[14]王秀芳,熊蕾蕾,杨慧彬,等.喘息型支气管炎患儿外周血25-(OH)D3和Ig E水平及意义[J].中国妇幼保健,2015,30(21):3600.
[15]吴奎,袁北芳,侯学敬,等.毛细支气管炎患儿单核细胞Toll样受体-4的表达与维生素D水平变化的关系[J].中华实用儿科临床杂志,2015,30(12):938.
[16]冯伟静,张荣荣,李玉红.维生素D辅助治疗婴幼儿喘息性肺炎的临床研究[J].中国中西医结合儿科学,2014,5(13):451.
[17]DEREGNAUCOURT D,BUCHE S,COOPMAN S,et al.Pyoderma gangrenosum with lung involvement treated with infliximab[J].Ann Dermatol Venereol,2013,140(5):363.
[18]DI BELLA G,MASCIA F,RICCHI A,et al.Evaluation of the safety and efficacy of the first-line treatment with somatostatin combined with melatonin,retinoids,vitamin D3,and low doses of cyclophosphamide in 20 cases of breast cancer:a preliminary report[J].Neuro Endocrinol Lett,2013,34(7):660.