Relationship between serum vitamin D, disease severity, and airway remodeling in children with asthma.
Relationship between serum vitamin D, disease severity, and airway remodeling in children with asthma.
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DOI：
10.1164/rccm.201107-1239oc
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发表时间：
2011-12-15
影响因子：
24.7
通讯作者：
Saglani S
中科院分区：
文献类型：
--
作者：
Gupta A;Sjoukes A;Richards D;Banya W;Hawrylowicz C;Bush A;Saglani S
对于维生素D状态及其对严重治疗性哮喘（STRA）患儿哮喘病理生理的影响知之甚少。研究了小儿STRA患者血清维生素D、肺功能和病理之间的关系。测定86例儿童（平均年龄11.7岁）血清25-羟基维生素D [25(OH)D3]，其中STRA患儿36例，中度哮喘（MA）患儿26例，非哮喘患儿24例（对照组）。评估25(OH)D3、哮喘控制试验（ACT）、肺活量测定、皮质类固醇使用和病情恶化之间的关系。36例STRA患儿中有22例接受纤维支气管镜检查、支气管肺泡灌洗和支气管内活检，评估气道炎症和重塑。STRA组25(OH)D3水平（中位数[IQR]） （28 [22-38] nmol/L）显著低于MA组（42.5 [29-63]nmol/L）和对照组（56.5 [45-67]nmol/L） （P < 0.001）。25(OH)D3水平与预测FEV1 （r = 0.4, P < 0.001）和FVC （r = 0.3, P = 0.002）百分比呈正相关。25(OH)D3水平与ACT呈正相关（r= 0.6, P < 0.001），与MA和STRA的加重（r= - 0.6, P < 0.001）和吸入类固醇剂量（r= - 0.39, P = 0.001）呈负相关。气道平滑肌（ASM）质量与25(OH)D3水平呈负相关（r= - 0.6, P = 0.008），而上皮脱落或网状基底膜厚度与此无关。ASM质量与支气管扩张剂可逆性呈正相关（r = 0.6, P = 0.009）， ASM质量与ACT呈负相关（r = - 0.7, P < 0.001）。STRA患儿较低的维生素D水平与ASM质量增加、哮喘控制和肺功能恶化有关。维生素D，气道结构和功能之间的联系表明补充维生素D可能对儿童STRA有用。
Little is known about vitamin D status and its effect on asthma pathophysiology in children with severe, therapy-resistant asthma (STRA). Relationships between serum vitamin D, lung function, and pathology were investigated in pediatric STRA. Serum 25-hydroxyvitamin D [25(OH)D3] was measured in 86 children (mean age, 11.7 yr): 36 with STRA, 26 with moderate asthma (MA), and 24 without asthma (control subjects). Relationships between 25(OH)D3, the asthma control test (ACT), spirometry, corticosteroid use, and exacerbations were assessed. Twenty-two of 36 children with STRA underwent fiberoptic bronchoscopy, bronchoalveolar lavage, and endobronchial biopsy with assessment of airway inflammation and remodeling. 25(OH)D3 levels (median [IQR]) were significantly lower in STRA (28 [22–38] nmol/L) than in MA (42.5 [29–63] nmol/L) and control subjects (56.5 [45–67] nmol/L) (P < 0.001). There was a positive relationship between 25(OH)D3 levels and percent predicted FEV1 (r = 0.4, P < 0.001) and FVC (r = 0.3, P = 0.002) in all subjects. 25(OH)D3 levels were positively associated with ACT (r = 0.6, P < 0.001), and inversely associated with exacerbations (r=−0.6, P < 0.001) and inhaled steroid dose (r=−0.39, P = 0.001) in MA and and STRA. Airway smooth muscle (ASM) mass, but not epithelial shedding or reticular basement membrane thickness, was inversely related to 25(OH)D3 levels (r=−0.6, P = 0.008). There was a positive correlation between ASM mass and bronchodilator reversibility (r = 0.6, P = 0.009) and an inverse correlation between ASM mass and ACT (r = −0.7, P < 0.001). Lower vitamin D levels in children with STRA were associated with increased ASM mass and worse asthma control and lung function. The link between vitamin D, airway structure, and function suggests vitamin D supplementation may be useful in pediatric STRA.