【作者】 汪求真； 刘玉峰； 邹悦； 孙丽梅； 田红； 李同霞； 江国峰； 刘倩； 董春江； 牟宇泽； Frans J.Kok； Evert G.Schouten； 马爱国；

【Author】 Quzhen Wang;Yufeng Liu;Yue Zou;Limei Sun;Hong Tian;Tongxia Li;Guofeng Jiang;Qian Liu;Chunjiang Dong;Yuze Mou;Frans J.Kok;Evert G.Schouten;Aiguo Ma;School of Public Health/Institute of Nutrition and Health,Qingdao University;Tuberculosis Medicine Department,Chest Hospital,Qingdao city;Linyi Chest Hospital;Division of Human Nutrition,Wageningen University;

【机构】 青岛大学公共卫生学院/营养与健康研究院； 青岛市胸科医院结核内科； 临沂市胸科医院检验科； 瓦赫宁根大学人类营养学系；

【摘要】 合并糖尿病导致结核患者在抗结核治疗期间出现更多的症状、更易复发、治疗失败和死亡。因此,迫切需要新的TB治疗策略。维生素D已被证明对临床康复(如痰培养转化)具有有益作用。因此,我们进行这项干预研究的主要目的是探讨维生素D对治疗结果的可能影响。我们对患有和不患有糖尿病的结核病患者进行了药物治疗的同时以维生素D补充治疗的一项随机研究。这项研究纳入了358名年龄在18岁以上的新诊断肺结核患者,其中VD3补充组(800IU/d)174例,对照组184例。在合并症患者中,对年龄、性别进行调整后,在第4、6、8周补充维生素D3对改善结核病表现具有显著效果。但是,在未患糖尿病的患者中未发现维生素D的类似作用。我们的研究结果为维生素D在结核合并糖尿病患者的辅助治疗中的作用提供了重要线索,这可能为治疗提供了新的前景。但是,在进行因果推断时,需要考虑该试验的局限性,并且需要对补充维生素D的效果进行证实性的试验。更多还原

【Abstract】 Diabetes results in the presentation of more symptoms,more relapses,treatment failures and deaths during antituberculosis therapy in patients with combined diseases.Therefore,new treatment strategies are urgently needed.Vitamin D has been shown to have beneficial effects towards clinical recovery such as sputum culture conversion.Therefore,we carried out this intervention study with the main purpose to explore the possible effects of vitamin D on treatment outcomes.A cluster randomized trial of vitamin D supplementation added to pharmacotherapy in tuberculosis patients with and without diabetes was carried out in a city-level chest hospital.Three hundred and fifty eight newly diagnosed pulmonary tuberculosis patients aged≥18 y were included in this study,with 174 cases in VD3 supplementation group(800 IU/d) and 184 in control group.The supplementation of vitamin D3 in patients with combined diseases showed significant effects on the improvement of TB manifestation at 4 th,6 th,8 th week,adjusted for confounders as age,gender.However,no similar effects of vitamin D were found in patients without diabetes.Our results provide an important clue of the role of vitamin D in the adjunctive treatment in patients with combined tuberculosis and diabetes,which may indicate a new perspective for treatment.However,the limitations of the trial need to be considered when making causal inference and more confirmative trials of the effect of vitamin D supplementation are needed.更多还原