{"id":18090,"date":"2019-12-18T04:59:32","date_gmt":"2019-12-17T20:59:32","guid":{"rendered":"http:\/\/csccm.org.cn\/?p=18090"},"modified":"2019-12-24T05:46:18","modified_gmt":"2019-12-23T21:46:18","slug":"18090","status":"publish","type":"post","link":"https:\/\/csccm.org.cn\/?p=18090","title":{"rendered":"[NEJM\u53d1\u8868\u8bba\u6587]\uff1a\u65e9\u671f\u5927\u5242\u91cf\u7ef4\u751f\u7d20D\u6cbb\u7597\u7ef4\u751f\u7d20D\u7f3a\u4e4f\u7684\u5371\u91cd\u75c5\u60a3\u8005"},"content":{"rendered":"\n

ORIGINAL ARTICLE <\/a>FREE PREVIEW<\/strong><\/p>\n\n\n\n

Early High-Dose Vitamin D3<\/sub> for Critically Ill, Vitamin D\u2013Deficient Patients<\/h1>\n\n\n\n

The National Heart, Lung, and Blood Institute PETAL Clinical Trials Network<\/h3>\n\n\n\n

N Engl J Med December 11, 2019
DOI: 10.1056\/NEJMoa1911124<\/h3>\n\n\n\n

Abstract<\/h2>\n\n\n\n

BACKGROUND \u80cc\u666f<\/h3>\n\n\n\n

Vitamin D deficiency is a common, potentially reversible contributor to morbidity and mortality among critically ill patients. The potential benefits of vitamin D supplementation in acute critical illness require further study.<\/p>\n\n\n\n

\u7ef4\u751f\u7d20D\u7f3a\u4e4f\u662f\u9020\u6210\u5371\u91cd\u75c5\u60a3\u8005\u7f79\u60a3\u7387\u53ca\u75c5\u6b7b\u7387\u5e38\u89c1\u7684\u53ef\u9006\u8f6c\u7684\u539f\u56e0\u3002\u5728\u6025\u6027\u5371\u91cd\u75c5\u671f\u95f4\u8865\u5145\u7ef4\u751f\u7d20D\u7684\u6f5c\u5728\u83b7\u76ca\u9700\u8981\u8fdb\u4e00\u6b65\u7814\u7a76\u3002<\/p>\n\n\n\n

METHODS \u65b9\u6cd5<\/h3>\n\n\n\n

We conducted a randomized, double-blind, placebo-controlled, phase 3 trial of early vitamin D3<\/sub> supplementation in critically ill, vitamin D\u2013deficient patients who were at high risk for death. Randomization occurred within 12 hours after the decision to admit the patient to an intensive care unit. Eligible patients received a single enteral dose of 540,000 IU of vitamin D3<\/sub> or matched placebo. The primary end point was 90-day all-cause, all-location mortality.<\/p>\n\n\n\n

\u6211\u4eec\u8fdb\u884c\u4e86\u4e00\u9879\u968f\u673a\u3001\u53cc\u76f2\u3001\u5b89\u6170\u5242\u5bf9\u7167\u30013\u671f\u4e34\u5e8a\u8bd5\u9a8c\uff0c\u5bf9\u7ef4\u751f\u7d20D\u7f3a\u4e4f\u7684\u6b7b\u4ea1\u9ad8\u5371\u60a3\u8005\u65e9\u671f\u8865\u5145\u7ef4\u751f\u7d20D\u3002\u60a3\u8005\u5165\u4f4fICU\u540e12\u5c0f\u65f6\u5185\u8fdb\u884c\u968f\u673a\u5206\u7ec4\u3002\u7b26\u5408\u5165\u9009\u6807\u51c6\u7684\u60a3\u8005\u7ecf\u80a0\u9053\u4f7f\u7528\u5355\u5242540,000 IU\u7ef4\u751f\u7d20D\u6216\u5b89\u6170\u5242\u3002\u4e3b\u8981\u9884\u540e\u7ec8\u70b9\u4e3a90\u5929\u5168\u56e0\u75c5\u6b7b\u7387\u3002<\/p>\n\n\n\n

RESULTS \u7ed3\u679c<\/h3>\n\n\n\n

A total of 1360 patients were found to be vitamin D\u2013deficient during point-of-care screening and underwent randomization. Of these patients, 1078 had baseline vitamin D deficiency (25-hydroxyvitamin D level, <20 ng per milliliter [50 nmol per liter]) confirmed by subsequent testing and were included in the primary analysis population. The mean day 3 level of 25-hydroxyvitamin D was 46.9\u00b123.2 ng per milliliter (117\u00b158 nmol per liter) in the vitamin D group and 11.4\u00b15.6 ng per milliliter (28\u00b114 nmol per liter) in the placebo group (difference, 35.5 ng per milliliter; 95% confidence interval [CI], 31.5 to 39.6). The 90-day mortality was 23.5% in the vitamin D group (125 of 531 patients) and 20.6% in the placebo group (109 of 528 patients) (difference, 2.9 percentage points; 95% CI, \u22122.1 to 7.9; P=0.26). There were no clinically important differences between the groups with respect to secondary clinical, physiological, or safety end points. The severity of vitamin D deficiency at baseline did not affect the association between the treatment assignment and mortality.<\/p>\n\n\n\n

\u7ecf\u8fc7\u5e8a\u65c1\u7b5b\u67e5\uff0c\u5171\u67091360\u540d\u60a3\u8005\u7ef4\u751f\u7d20D\u7f3a\u4e4f\u5e76\u63a5\u53d7\u968f\u673a\u5206\u7ec4\u3002\u5176\u4e2d\uff0c\u540e\u7eed\u8bd5\u9a8c\u68c0\u67e5\u53d1\u73b01078\u540d\u60a3\u8005\u5b58\u5728\u57fa\u7ebf\u7ef4\u751f\u7d20D\u7f3a\u4e4f (25-\u7f9f\u7ef4\u751f\u7d20D \u6c34\u5e73 <20 ng\/ml [50 nmol\/L])\uff0c\u8fd9\u4e9b\u60a3\u8005\u7eb3\u5165\u4e3b\u8981\u5206\u6790\u4eba\u7fa4\u3002\u7b2c3\u5929\u65f6\uff0c\u7ef4\u751f\u7d20D\u7ec4\u60a3\u800525-\u7f9f\u7ef4\u751f\u7d20D\u5e73\u5747\u6c34\u5e73\u4e3a 46.9\u00b123.2 ng\/ml (117\u00b158 nmol\/L)\uff0c\u5b89\u6170\u5242\u7ec4\u60a3\u8005\u4e3a 11.4\u00b15.6 ng\/ml (28\u00b114 nmol\/L) (\u5dee\u5f02 35.5 ng\/ml; 95% \u53ef\u4fe1\u533a\u95f4 [CI], 31.5 to 39.6)\u3002\u7ef4\u751f\u7d20D\u7ec490\u5929\u75c5\u6b7b\u7387\u4e3a 23.5% (125\/531)\uff0c\u5b89\u6170\u5242\u7ec4\u4e3a 20.6% (109\/528) (\u5dee\u5f02, 2.9 \u4e2a\u767e\u5206\u70b9; 95% CI, \u22122.1 to 7.9; P=0.26)\u3002\u4e24\u7ec4\u95f4\u6b21\u8981\u4e34\u5e8a\u3001\u751f\u7406\u6216\u5b89\u5168\u6027\u7ec8\u70b9\u5747\u65e0\u4e34\u5e8a\u91cd\u8981\u5dee\u5f02\u3002\u57fa\u7ebf\u6c34\u5e73\u7ef4\u751f\u7d20D\u7f3a\u4e4f\u7684\u4e25\u91cd\u7a0b\u5ea6\u4e0d\u5f71\u54cd\u6cbb\u7597\u5206\u7ec4\u4e0e\u75c5\u6b7b\u7387\u7684\u76f8\u5173\u6027\u3002<\/p>\n\n\n\n

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CONCLUSIONS \u7ed3\u8bba<\/h3>\n\n\n\n

Early administration of high-dose enteral vitamin D3<\/sub> did not provide an advantage over placebo with respect to 90-day mortality or other, nonfatal outcomes among critically ill, vitamin D\u2013deficient patients.<\/p>\n\n\n\n

\u5bf9\u4e8e\u7ef4\u751f\u7d20D\u7f3a\u4e4f\u7684\u5371\u91cd\u75c5\u60a3\u8005\uff0c\u65e9\u671f\u7ecf\u80a0\u9053\u7ed9\u4e88\u5927\u5242\u91cf\u7ef4\u751f\u7d20D\u4e0d\u80fd\u6539\u558490\u5929\u75c5\u6b7b\u7387\u6216\u5176\u4ed6\u975e\u81f4\u6b7b\u9884\u540e\u6307\u6807\u3002<\/p>\n\n\n\n

(Funded by the National Heart, Lung, and Blood Institute; VIOLET ClinicalTrials.gov number, NCT03096314<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"

ORIGINAL ARTICLE FREE PREVIEW Early High-Dose Vitamin D […]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[32,23],"tags":[],"_links":{"self":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/18090"}],"collection":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=18090"}],"version-history":[{"count":4,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/18090\/revisions"}],"predecessor-version":[{"id":18105,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/18090\/revisions\/18105"}],"wp:attachment":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=18090"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=18090"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=18090"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}