目的 对维生素C、维生素D用于病毒性急性呼吸道感染的治疗与预防进行循证评价,以期为临床合理用药以及新型冠状病毒肺炎(COVID-19)可能的治疗方案提供循证依据。方法 计算机检索PubMed建库至2020年2月13日相关文献,手工检索综述中的参考文献及数据库中未收录的文献。结果 本研究共纳入8篇文献进行评价。目前对于COVID-19、中东呼吸综合征(MERS)、传染性非典型肺炎(SARS)的治疗与预防,维生素C、维生素D均无临床应用证据;对于流感治疗与预防,1篇前瞻性对照试验显示维生素C有效,1篇系统评价、1篇随机对照试验显示维生素D有效,3篇随机对照试验显示无效,1篇病例对照研究显示体内维生素D水平与流感发生风险无明显关联,另有1篇随机对照试验显示高剂量预防效果未显著优于常规剂量。结论 尚无证据支持维生素C与维生素D对COVID-19、MERS、SARS的治疗与预防效果,但有限的证据表明维生素C与维生素D用于流感或具有潜在获益。临床应用尤其大剂量维生素C或维生素D时,应充分考虑相关指南与临床研究证据,并注意密切监测药物不良反应与药物相互作用。
Abstract
OBJECTIVE To evaluate the evidence supporting vitamin C and D medication in the treatment and prevention of acute viral respiratory infectious disease, and to provide evidence for clinical rational medication and potential treatment option for COVID-19 especially. METHODS PubMed database was retrieved from inception to February 13, 2020, and the references in the reviews and those not included in the database were manually retrieved. RESULTS Eight literatures were included finally. In terms of COVID-19, MERS, and SARS, none literature about vitamin C and D medication was available. In terms of influenza, one prospective controlled trial proved vitamin C′s efficacy. For vitamin D in influenza, one systematic review and one randomized controlled trial proved its efficacy, while three randomized controlled trials showed no efficacy. Additionally, one case-control study showed no statistical association between vitamin D level and the risk of influenza, and one randomized controlled trial showed no significant difference between high-dose and standard-dose vitamin D supplementation. CONCLUSION Currently, no evidence supports the effectiveness of vitamin C and D medication in the prevention and treatment of COVID-19, MERS and SARS. However, limited evidence supports potential benefit of vitamin C and D medication in influenza. Physicians and pharmacists should take relevant clinical practice guidelines and supporting evidence into consideration when using vitamin C or D (especially high-dose medication), and pay attention to monitoring drug adverse reactions and drug interactions.
关键词
维生素 /
新型冠状病毒肺炎 /
病毒性急性呼吸道感染 /
循证评价
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Key words
vitamin /
COVID-19 /
acute viral respiratory infectious disease /
evidence-based evaluation
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中图分类号：
R969.3
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参考文献
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脚注
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基金
国家科技重大专项“重大新药创制专项课题”项目资助(2017ZX09304012-008)
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