内科

目的探讨补充维生素D3治疗对成人支气管扩张症患者肺功能、生命质量、抗菌肽LL-37和IL-8水平的影响。方法选择2016年2月至2017年2月在我院住院治疗的支气管扩张症且血清25（OH）D≤30 ng/mL的患者97例,随机分为观察组49例和对照组48例。对照组患者均给予支气管扩张症常规治疗，观察组患者在对照组治疗的基础上补充维生素D3治疗，800 IU/d，连续治疗观察6个月。比较两组患者治疗前后的肺功能，莱塞斯特咳嗽生命质量问卷（LCQ）评分，血清25（OH）D、抗菌肽LL-37和IL-8水平。结果治疗前后，两组患者的FVC、FEV1%水平比较差异无统计学意义（P＞0.05）；治疗6个月后，观察组患者LCQ评分明显提高且显著高于对照组（P＜0.05）；观察组患者的血清25（OH）D、LL-37水平明显升高且显著高于对照组，血清IL-8水平明显降低且显著低于对照组，差异有统计学意义（P＜0.05）。观察组患者血清25（OH）D变化值与血清LL-37变化值呈弱正相关（r=0.662，P=0.001）。结论补充维生素D3治疗，可提高支气管扩张症患者血清25（OH）D水平，但不能明显改善其肺功能；可减少促炎介质的产生；随着血25（OH）D水平的升高，可以上调抗菌肽LL-37的表达，增强免疫应答反应，有助于患者防御病原微生物和促炎性细胞因子的攻击。

ObjectiveTo explore the effect of vitamin D3 supplementation on lung function, life quality, antimicrobial peptide LL-37 and IL-8 levels in adult patients with bronchiectasis. MethodsA total of 97 bronchiectasis patients with serum 25 (OH) D≤30 ng/mL admitted to our hospital from February 2016 to February 2017 were selected, and were randomly divided into observation group (49 cases) and control group (48 cases). The control group was administered bronchiectasis routine treatment, based on which the observation group was additionally administered vitamin D3 with 800 IU/d, for six-month continuous treatment and observation. Pulmonary function, the Leicester Cough Questionnaire (LCQ) score, serum 25 (OH) D, antimicrobial peptide LL-37 and IL-8 levels before and after treatment was compared between the two groups. ResultsThere were no statistically significant differences in pre-and post-treatment forced vital capacity (FVC) and forced expiratory volume in the first second reference percentiles (FEV1%iles) levels of patients between the two groups (P＞0.05). After 6 months of treatment, the LCQ score, serum 25 (OH) D and LL-37 levels of the observation group significantly increased, whereas the serum IL-8 level significantly decreased. Compared to the control group, the observation group yielded significantly higher LCQ score, serum 25 (OH) D and LL-37 levels, while a significantly lower level of IL-8, with the statistically significant differences (P＜0.05). The change of serum 25 (OH) D in the observation group was weakly positively correlated with the change of serum LL-37 (r=0.662, P=0.001). ConclusionVitamin D3 supplementation can increase serum 25 (OH) D level in patients with bronchiectasis, but it could not improve their pulmonary function prominently. This treatment can reduce the production of pro-inflammatory mediators. With the increase of serum 25 (OH) D level, the expression of antimicrobial peptide LL-37 can be up-regulated, and the immune response can be enhanced, and thus it is conducive for patients to defending against the attack by pathogenic microorganisms and pro-inflammatory cytokines.