| OBJECTIVE:1.To investigate the serum levels of vitamin A and vitamin E in children from Hunan,China with respiratory diseases,and to provide reference data for guiding prevention and treatment.2.To explore the role of vitamin A in the occurrence of recurrent respiratory tract infection through comparing the frequency of the recurrent respiratory tract infection before and after vitamin A supplementation in children with vitamin A deficiency.METHODS:1.From March 2017 to June 2017(6 months),708 children with respiratory diseases in pediatrics of Hunan People's Hospital,including respiratory infection(pneumonia,upper respiratory tract infection,otitis media,bronchitis,recurrent respiratory infection,asthma,chronic cough,etc.)were selected for respiratory diseases group..Exclude patients with malnutrition and severe chronic diarrhea,mal-absorption.2.Whereas 1898 healthy children were used as controls(control group).3.Blood samples were collected of all children to measure serum levels of vitamins A and E by HPLC.4.Vitamin A treatment(1800U/d)was given to the children with recurrent respiratory tract infection and vitamin A deficiency.The vitamin A level was rechecked after 1 month,and the frequency of the recurrent respiratory tract infection of each patient was investigated for next six months.Results:1.Demographics of the control group and respiratory disease groupA total of 1898 children of healthy physical examination were registered in control group(1043male,855 female).The median ages were 4.00 years,with the inter-quartile range at 0.18-13y.708 children with respiratory disease were registered in respiratory disease group(male 458.Female 250).The median ages were 4.06 years,with the inter-quartile range at 0.3-13y.The ages and genders in the respiratory disease group and the control groups were matched(Z ? 0.897,P = 0.370).2.Serum concentrations of vitamins A and E of control group and respiratory disease groupA.The concentration of vitamin A and vitamin E in control group were 0.31 ± 0.07 mg/L,9.72 ± 2.56 mg/L respectively.The concentration of vitamin A and vitamin E in the respiratory disease group were 0.25 ± 0.01 mg/L,9.54±2.99 mg/L respectively.Compared with those of the control group,the concentrations of vitamins A and E were significantly lower in the respiratory disease groups group(t=15.37 P=0.00 t=2.39 P=0.02).B.All the subjects were divided into four age groups:<1Y Subgroup,1-3Y Subgroup(>1Y,<3Y),3-6Y Subgroup(>3Y,?6Y)and>6Y Subgroup.Compared with those of control group,the levels of vitamins A of respiratory disease group were significantly lower in each age group.The levels of vitamins E were significantly lower in<1Y,3-6y>6y three age groups(P<0.05).There was no significant difference in that of the 1-3y group(P=0.08).3.Deficiency of vitamins A and E of control group and respiratory disease groupA.In respiratory disease group,511(72.13%)were reported with vitamin A deficiency.Among 511 vitamin A deficiency,patients,298(male 191,female 107,42.15%)patients were reported with vitamin A subclinical deficiency of high risk(VASCDR),followed by 191 patients(male 133,female 58,27.01%)were reported with vitamin A subclinical deficiency(VASCD),22 patients(male 11,female 11,3.11%)were reported with vitamin A clinical deficiency(VACD)and only 5 patients(0.7%)were reported with vitamin E deficiency and 6 patients(0.8%)had higher levels of vitamin E.The abnormal rate of vitamin E is 1.5%,whereas the 191 patients were reported with different respiratory disease but the vitamin A and E level was normal.B.Among the 1898 cases of healthy physical examination in the same period,the total vitamin A deficiency was 958 cases,and the overall vitamin A deficiency rate was 50.47%.5 patients(0.26%)were VACD,141 patients(7.40%)' were VASCD and 812 patients(42.78%)were VASCDR.C.Compared with those of control group,the Incidence of VACD,VASCD VASCDR in the respiratory disease group were significantly higher,?2=101.3,?2=98.7,?2=97.39,respectively P all<0.05.4.Demographics of subgroupsThe total 708 patients were divided into five subgroups on their diagnosis.There was no significant difference on age and sex in different subgroups.5.Serum concentrations of vitamins A and E of subgroupsCompared with those of control group,the total vitamin A deficiency rate of five subgroups were all significantly higher(P<0.05).The concentrations of vitamin A in five subgroups were 0.24 ±0.10mg/L,0.27 ± 0.10mg/L,0.26 ± 0.10mg/L,0.25 ± 0.09mg/L,0.25 ± 0.10mg/L respectively.Compared with those of control group,the concentrations of vitamin A were a significant decline in five subgroups,and the concentrations of vitamin E were a significant decline in asthma,pneumonia RRT three subgroups.There was no significant difference in vitamin A deficiency rate among subgroups.?2=4.16P=0.39.6.Deficiency of vitamins A and E of SubgroupA.The levels of vitamin A of 202 patients of pneumonia group were reported with vitamin A deficiency.The percentage was 74.72%(202/270).10 patients were VACD(3.70%),74 patients were VASCD(27.41%)and 118 patients were VASCDR(43.70%).Only 2 patients(0.75%)had lower levels and 2 patients(0.75%)had higher levels of vitamin E.The abnormal rate of vitamin E is 1.49%.B.The levels of vitamin A of 68 patients of asthma group were reported with vitamin A deficiency and the percentage was 75.5%.5 patients were VACD(5.56%),30 patients were VASCD(33.33%)and 33 patients were VASCDR(36.67%).All patients vitamin E were normal.C.The levels of vitamin A of 76 patients of chronic cough group were reported with vitamin A deficiency and the percentage was 65.5%.4 patients were VACD(3.44%),22 patients were VASCD(18.97%)and 50 patients were VASCDR(43.10%).Only 2 patients(1.80%)had lower levels of vitamin E.The rate of vitamin E deficiency is 1.80%.D.The levels of vitamin A of 51 patients of RRT group were reported with vitamin A deficiency and their percentage was 71.83%.1 patients were VACD(1.40%),25 patients were VASCD(35.21%)and 25 patients were VASCDR(35.21%).Only 1 patient(1.40%)had lower levels and 1 patient(1.40%)had a higher level of vitamin E.The abnormal rate of vitamin E is 2.81%.E.The levels of vitamin A of 114 patients of other disease group were reported with vitamin A deficiency and their percentage was 70.81%.2 patients were VACD(1.24%),40 patients were VASCD(24.84%)and 72 patients were VASCDR(44.72%).Only 2 patients(1.24%)had lower levels and 1 patient(0.62%)had a higher level of vitamin E.The abnormal rate of vitamin E is 1.86%.7.The concentration of vitamin A/E in infection and no-infection groupFurther analysis showed that the concentrations of vitamin A in the no-infection group were significantly higher than that:in the infected group(t=7.65 P=0.00)but there was no significant difference in the concentration of vitamin E between the two groups(t=0.35 P=0.13).Compared with those of no-infection group,the total vitamin A deficiency rate of infection group was significantly higher(?2=29.91 P=0.00).8.Compared the recurrence of respiratory tract infection in RRT Subgroup before and after treatment.44 children in group RRT were treated with vitamin A 1800u/d supplementation and rechecked vitamin A to normal levels.The recurrence of respiratory tract infection before and after treatment was compared.The data show that a after treatment,the number of respiratory tract infections was significantly decreased.Compared with those of control group the concentrations of vitamin A were significant decline P all<0.05.CONCLUSION:1.Low serum concentrations of vitamins A and E were associated with respiratory disease in children from Hunan China.Especially vitamin A deficiency.2.To children with recurrent respiratory tract infection,the frequency of recurrent respiratory tract infection decreased significantly after vitamin A treatment,suggesting that vitamin A may play an important role in the pathogenesis of recurrent respiratory tract infections. |
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