Randomized Trial of Vitamin D Supplementation to Prevent Seasonal Influenza and Upper Respiratory Infection in Patients With Inflammatory Bowel Disease
Randomized Trial of Vitamin D Supplementation to Prevent Seasonal Influenza and Upper Respiratory Infection in Patients With Inflammatory Bowel Disease
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DOI：
10.1093/ibd/izy346
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发表时间：
2019-06-01
影响因子：
4.9
通讯作者：
Urashima, Mitsuyoshi
中科院分区：
文献类型：
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作者：
Arihiro, Seiji;Nakashima, Akio;Urashima, Mitsuyoshi
背景：我们评估了冬季和早春口服维生素D是否可以降低炎症性肠病(IBD)患者流感和上呼吸道感染的发生率。方法：采用随机、双盲、对照试验，比较维生素D补充(500IU/d)和安慰剂的效果。主要结果是流感的发生率；次要结果是上呼吸道感染的发生率。根据25-羟基维生素D(25-OHD)水平(LOW=20 ng/mL)以及是否存在溃疡性结肠炎(UC)或克罗恩病(CD)进行预先指定的亚组分析。结果：223例IBD患者随机分为两组：维生素D补充组(n=108)和安慰剂组(n=115)。流感的发病率在不同的组之间没有差异。然而，维生素D组上呼吸道感染的发生率显著低于维生素D组(相对危险度[RR]，0.59；95%可信区间(CI)，0.35~0.98；P=0.042)。这种效应在低25-OHD水平亚组中增强(RR，0.36；95%CI，0.14-0.90；P=0.02)。在不良事件方面，维生素D组的LichTiger临床活动指数评分显著低于维生素D组(P=0.002)，仅在25-OHD水平较高的亚组仍有显著意义。结论：补充维生素D可能对IBD患者的上呼吸道感染有预防作用，但可能会加重UC的症状。
Background: We evaluated whether oral vitamin D supplementation during the winter and early spring reduces the incidence of influenza and upper respiratory infections in patients with inflammatory bowel disease (IBD).Methods: A randomized, double-blind, controlled trial was conducted to compare the effects of vitamin D supplementation (500 IU/day) and a placebo. The primary outcome was the incidence of influenza; the secondary outcome was the incidence of upper respiratory infection. Prespecified subgroup analyses were performed according to 25-hydroxyvitamin D (25-OHD) levels (low = 20 ng/mL) and whether ulcerative colitis (UC) or Crohn's disease (CD) was present. We also used the Lichtiger clinical activity index for patients with UC and the Crohn's Disease Activity Index (CDAI) for patients with CD before and after interventions.Results: We included 223 patients with IBD and randomized them into 2 groups: vitamin D supplementation (n = 108) and placebo (n = 115). The incidence of influenza did not differ between the groups. However, the incidence of upper respiratory infection was significantly lower in the vitamin D group (relative risk [RR], 0.59; 95% confidence interval (CI), 0.35-0.98; P = 0.042). This effect was enhanced in the low 25-OHD level subgroup (RR, 0.36; 95% CI, 0.14-0.90; P = 0.02). With respect to adverse events, the Lichtiger clinical activity index score was significantly worse in the vitamin D group (P = 0.002) and remained significant only in the high 25-OHD level subgroup.Conclusions: Vitamin D supplementation may have a preventative effect against upper respiratory infection in patients with IBD but may worsen the symptoms of UC.