布拉氏酵母菌联合维生素D及钙剂治疗婴幼儿佝偻病的临床效果

摘要

目的 探讨布拉氏酵母菌联合维生素D(Vit D)及钙剂治疗婴幼儿佝偻病(维生素D缺乏性佝偻病)的临床效果.方法 选取2014年10月-2016年8月河北北方学院附属第二医院门诊及住院治疗的佝偻病患儿80例,随机分为观察组和对照组各40例.对照组给予Vit D330万IU肌注,间隔4周后口服维生素AD滴剂,＜1岁者给予500U·d-1,≥1岁者给予700 U·d-1,复方碳酸钙泡腾颗粒,4～7个月半袋/次,1次/d;7～12个月1袋/次,1次/d;12个月以上1袋/次,2次/d.观察组补充Vit D及钙剂方法同对照组,并于补充AD滴剂和钙剂时口服布拉氏酵母菌,＜1岁半袋/次,1次/d;≥1岁半袋/次,2次/d.两组于治疗4周后进行疗效评价.治疗前后采集两组患者组清晨空腹外周静脉血,采用全自动生化分析仪测定血钙(Ca)、磷(P)、锌(Zn);采用全血干化学免疫浓缩法测定血清骨碱性磷酸酶(NBAP),ELISA法测定血清25-羟维生素D3[25-(OH)D3]、脱氧吡啶啉(DPD);放射免疫法测定骨钙素(BGP);金氏法测定骨源性碱性磷酸酶(BALP);采用单光子吸收计测定尺骨、桡骨骨密度(BMD).结果 两组患儿组治疗后血Ca、P、Zn、25-(OH)D3、DPD、BGP、BALP水平均较治疗前升高(P均＜0.05),NBAP水平较治疗前降低(P＜0.05);两组患儿治疗后,观察组Ca、Zn、P、25-(OH)D3、DPD、BGP、BALP水平高于同期对照组,NBAP水平低于对照组(P均＜0.05);两组患儿治疗后尺骨、桡骨BMD水平均较治疗前升高(P均＜0.05);观察组治疗后尺骨、桡骨BMD水平均高于对照组(P均＜0.05).结论 布拉氏酵母菌可有效改善佝偻病患儿肠道对Vit D及钙剂的吸收,改善骨代谢状态,提高BMD水平.%Objective To explore the clinical effect of Saccharomyces boulardii in combined with Vit D and calcium preparation in the treatment of infant rickets. Methods A total of 80 children with rickets who were admitted in our hospital from October, 2014 to August, 2016 were included in the study and randomized into the observation group and the control group with 40 cases in each group. The patients in the control group were given intramuscular injection of Vit D3(300000 IU). Four weeks later, they were orally administrated with vitamin AD drops (＜1 years old, 500 U·d-1, ≥1 years old, 700 U·d-1) and compound calcium carbonate effervescent granules (4-7 months, half bag/time, 1 time/d;7-12 months, 1 bag/time, 1 time/d;more than 12 months, 1 bag/time, 2 times/d). The observation group was supplemented with Vit D and calcium as the control group. In the meantime, Saccharomyces brandti was orally administered (＜1 years old, half bag/time, 1 time/d;≥1 years old, half bag/time, 2 times/d). After 4 weeks' treatment, the efficacy was evaluated. The morning fasting peripheral venous blood before and after treatment in the two groups was collected. The full automatic biochemical analyzer was used to detect Ca, P, and Zn. The whole blood dry chemical immune concentration method was used to detect the serum NBAP. ELISA was used to detect the serum 25- (OH) D3 and DPD. RIA was used to detect BGP. King method was used to detect BALP. The single photon absorptiometry was used to measure BMD of ulna and radius. Results Ca, P, and Zn levels after treatment in the observation group were significantly higher than those in the control group (P＜0.05). BMD level of ulna and radius after treatment in the observation group was significantly higher than that in the control group (P＜0.05). NBAP level after treatment in the observation group was significantly lower than that in the control group (P＜0.05), while 25- (OH) D3, DPD, BGP, and BALP levels were significantly higher than those in the control group (P＜0.05).Conclusion Saccharomyces boulardii can effectively improve the absorption of Vit D and calcium by the intestine in patients with rickets, improve the bone metabolism and BMD level.