Vitamin D to Prevent Lung Injury Following Esophagectomy-A Randomized, Placebo-Controlled Trial.
Vitamin D to Prevent Lung Injury Following Esophagectomy-A Randomized, Placebo-Controlled Trial.
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DOI：
10.1097/ccm.0000000000003405
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发表时间：
2018-12
影响因子：
8.8
通讯作者：
Thickett DR
中科院分区：
文献类型：
--
作者：
Parekh D;Dancer RCA;Scott A;D'Souza VK;Howells PA;Mahida RY;Tang JCY;Cooper MS;Fraser WD;Tan L;Gao F;Martineau AR;Tucker O;Perkins GD;Thickett DR
补充数字内容可在文本中找到。观察性研究表明，维生素D缺乏与危重疾病的不良后果之间存在关联，并将其确定为肺损伤发展的潜在危险因素。目的：探讨术前口服大剂量胆骨化醇是否能改善成人择期食管切除术后早期急性肺损伤。一项双盲、随机、安慰剂对照试验。英国三所大型大学医院。79名接受择期食管切除术的成年患者被随机化。术前单次口服7.5 mg （300,000 IU; 15 mL）胆钙化醇或相应的安慰剂（3-14 d）。主要结局是食管切除术结束时血管外肺水指数的变化。次要结局包括Pao2:Fio2比率、肺损伤进展、无呼吸机和器官衰竭天数、28和90天生存、补充胆骨化醇的安全性、血浆维生素D状态(25（OH)D、1,25(OH)2D和维生素D结合蛋白）、肺血管通透性指数和术后第1天血管外肺水指数。一项探索性研究测量了肺泡毛细血管炎症和损伤的生物标志物。40名患者随机接受胆钙化醇治疗，39名接受安慰剂治疗。两组手术结束时血管外肺水指数无显著变化（安慰剂组中位数1.0[四分位数范围，0.4 - 1.8]vs胆骨化醇组中位数0.4 mL/kg[四分位数范围，0.4 - 1.2 mL/kg]; p = 0.059）。胆骨化醇治疗组肺血管通透性指数中位数显著降低（安慰剂0.4[四分位数范围，0-0.7]vs胆骨化醇0.1[四分位数范围，-0.15至-0.35];p = 0.027）。胆骨化醇治疗有效地增加了25(OH)D浓度，但手术导致两组在第3天25(OH)D浓度下降。临床结果没有差异。术前大剂量口服胆骨化醇可有效提高25(OH)D浓度，降低术后肺血管通透性指数的变化，但对血管外肺水指数无效。
Supplemental Digital Content is available in the text. Observational studies suggest an association between vitamin D deficiency and adverse outcomes of critical illness and identify it as a potential risk factor for the development of lung injury. To determine whether preoperative administration of oral high-dose cholecalciferol ameliorates early acute lung injury postoperatively in adults undergoing elective esophagectomy. A double-blind, randomized, placebo-controlled trial. Three large U.K. university hospitals. Seventy-nine adult patients undergoing elective esophagectomy were randomized. A single oral preoperative (3–14 d) dose of 7.5 mg (300,000 IU; 15 mL) cholecalciferol or matched placebo. Primary outcome was change in extravascular lung water index at the end of esophagectomy. Secondary outcomes included Pao2:Fio2 ratio, development of lung injury, ventilator and organ-failure free days, 28 and 90 day survival, safety of cholecalciferol supplementation, plasma vitamin D status (25(OH)D, 1,25(OH)2D, and vitamin D-binding protein), pulmonary vascular permeability index, and extravascular lung water index day 1 postoperatively. An exploratory study measured biomarkers of alveolar-capillary inflammation and injury. Forty patients were randomized to cholecalciferol and 39 to placebo. There was no significant change in extravascular lung water index at the end of the operation between treatment groups (placebo median 1.0 [interquartile range, 0.4–1.8] vs cholecalciferol median 0.4 mL/kg [interquartile range, 0.4–1.2 mL/kg]; p = 0.059). Median pulmonary vascular permeability index values were significantly lower in the cholecalciferol treatment group (placebo 0.4 [interquartile range, 0–0.7] vs cholecalciferol 0.1 [interquartile range, –0.15 to –0.35]; p = 0.027). Cholecalciferol treatment effectively increased 25(OH)D concentrations, but surgery resulted in a decrease in 25(OH)D concentrations at day 3 in both arms. There was no difference in clinical outcomes. High-dose preoperative treatment with oral cholecalciferol was effective at increasing 25(OH)D concentrations and reduced changes in postoperative pulmonary vascular permeability index, but not extravascular lung water index.