补充VD能改善幼年型狼疮患者的…

补充VD能改善幼年型狼疮患者的疾病活动度和疲劳

作者：Lima GL，et al.
翻译：北医三院 武东(misswudong@163.com)
审校：北医三院 金银姬

摘要 目的：维生素D有重要的免疫调节作用，但还没有研究直接涉及增加25羟维生素D水平对幼年型系统性红斑狼疮（SLE）有益性的研究。本研究的目的是评估维生素D补充治疗对幼年型SLE患者疾病活动度和疲劳感的影响。
方法：本研究是随机，双盲，安慰剂对照，为期24周的研究。40例幼年型SLE患者1：1比例被随机分配为两组，每周口服5万单位维生素D3组（幼年型SLE-VitD）或安慰剂组（幼年型SLE-PL）。药物在整个研究保持稳定，用放免法测定25（OH）D的血清水平。疾病活动评估用的是系统性红斑狼疮疾病活动指数（SLEDAI）和欧洲共识狼疮活动测量（ECLAM），疲劳评估使用儿童疲劳严重程度量表（K-FSS）。
结果：在基线，两组的年龄，体重指数BMI，脏器受累，激素剂量，免疫抑制剂的应用，SLEDAI, ECLAM, K-FSS,及25（OH）D水平等指标相似。24周后，幼年型SLE-VitD组的25（OH）D水平显著高于对照组（P<0.001）。在干预结束时，幼年型SLE-VitD组的SLEDAI和ECLAM较对照组显著改善（P值分别为0.010和0.006）。关于疲劳评估，与对照组相比，幼年型SLE-VitD组的疲劳分数下降（P=0.008）。维生素D3耐受性好，无严重副反应。
结论：研究显示，对于幼年型SLE患者，24周维生素D3补充对于缓解疾病活动度和改善疲劳方面是有效的。
附原文：Abstract OBJECTIVE:Vitamin D has an important immunomodulatory effect, but there are no trials that directly address the boosting of serum levels of 25-hydroxyvitamin D (25[OH]D) in juvenile-onset systemic lupus erythematosus (SLE). The aim of this study was to evaluate the effect of vitamin D supplementation on disease activity and fatigue in juvenile-onset SLE.METHODS:This study was a randomized, double-blind, placebo-controlled, 24-week trial. Forty juvenile-onset SLE patients were randomized (1:1) to receive oral cholecalciferol 50,000 IU/week (juvenile-onset SLE-VitD) or placebo (juvenile-onset SLE-PL). Medications remained stable throughout the study. Serum levels of 25(OH)D were measured using radioimmunoassay. Disease activity was assessed using the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) and the European Consensus Lupus Activity Measurement (ECLAM). Fatigue was assessed using the Kids Fatigue Severity Scale (K-FSS).RESULTS:At baseline, groups were similar regarding age, body mass index, organ involvement, glucocorticoid dose, use of immunosuppressive drugs, SLEDAI, ECLAM, K-FSS, and levels of 25(OH)D. After 24 weeks, the mean level of 25(OH)D was higher in the juvenile-onset SLE-VitD group than in the juvenile-onset SLE-PL group (P < 0.001). At the end of the intervention, a significant improvement in SLEDAI (P = 0.010) and in ECLAM (P = 0.006) was observed in the juvenile-onset SLE-VitD group compared to the juvenile-onset SLE-PL group. Regarding fatigue evaluation, a reduction of fatigue related to social life score was found in the juvenile-onset SLE-VitD group compared to the juvenile-onset SLE-PL group (P = 0.008). Cholecalciferol was well tolerated with no serious adverse events.CONCLUSION:This study suggests that cholecalciferol supplementation for 24 weeks is effective in decreasing disease activity and improving fatigue in juvenile-onset SLE patients.
引自：Lima GL, Paupitz J, Aikawa NE, et al. Vitamin D Supplementation in Adolescents and Young Adults With Juvenile Systemic Lupus Erythematosus for Improvement in Disease Activity and Fatigue Scores: A Randomized, Double-Blind, Placebo-Controlled Trial. Arthritis Care Res (Hoboken). 2016 Jan;68(1):91-8.