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Vitamina D y neumonía

15.10.2018
Suplementacja witaminy D w chorobach płuc. Cz. 3b. Zapalenie płuc
Carolien Mathyssen, Ghislaine Gayan-Ramirez, Roger Bouillon, Wim Janssens
Polish Archives of Internal Medicine, 2017; http://dx.doi.org/10.20452/pamw.4134

Se han efectuado diversos estudios para evaluar la eficacia de la suplementación con vitamina D en el tratamiento de la neumonía en niños52-55 (véase tabla 2). Esta enfermedad sigue siendo una causa importante de muerte infantil.56 En ninguno de estos estudios se observó una influencia beneficiosa de la inclusión de la vitamina D al tratamiento antibacteriano contra la neumonía.52-54 En uno de los estudios realizado en niños, que adicionalmente recibieron vitamina D, el riesgo de la recaída de la neumonía en el período de 90 días fue menor.52 Gupta y cols. evidenciaron una probabilidad relativa mayor de remisión de la neumonía en el grupo que recibió vitamina D, si bien no se observó una diferencia estadísticamente significativa en cuanto al número de días de hospitalización, tiempo de curación, ni riesgo de recaída de la enfermedad.55 En el estudio de Choudhary y cols. se tuvieron en consideración puntos finales adicionales, pero no se demostró ninguna diferencia significativa en relación al tiempo de desaparición de la taquipnea, del tiraje intercostal, de la hipoxemia, la fiebre, de la incapacidad de comer de forma independiente, de la irritación o de la apatía. En el metaanálisis publicado por Das y cols., que abordó los ensayos de Manaseki-Holland y cols.52 y de Choudhary y cols.53, no se observaron beneficios de la suplementación con la vitamina D.57 Por lo tanto, en la actualidad no podemos sacar conclusiones de que la vitamina D afecte positivamente el proceso de curación de la neumonía. Se puede esperar que el estudio Lung VITAL (ClinicalTrials.gov, nr: NCT01728571) —en el que se evalúa la influencia que tiene el uso de vitamina D y/o suplementos de ácidos grasos omega 3 provenientes de peces marinos, en la aparición de exacerbaciones de las enfermedades crónicas del sistema respiratorio, en el control del asma, en el riesgo de aparición de neumonía y en la función pulmonar— aporte una respuesta definitiva sobre este asunto.

Tabla 2. Revisión de los ensayos clínicos sobre el uso de la vitamina D en enfermos con neumonía
AutorPoblaciónDosis de vitamina DDuración del ensayoResultados
Manaseki-Holland y cols.52224 niños 100 000 UI de la vitamina D3 en combinación con un antibiótico90 días – sin diferencias en el tiempo de curación de la neumonía
– riesgo menor de recaída en el período de 90 días
Choudhary y cols.53 200 niños 1000 (<1 año) / 2000 (>1 año) UI/d durante 5 días5 días – sin diferencias en el tiempo de curación de la neumonía, la taquipnea, el tiraje intercostal, incapacidad de comer
Rajshekhar y cols.54 96 niños 1000 (<1 año) / 2000 (>1 año) UI/d durante 5 días5 días – sin diferencias en el tiempo de remisión de la neumonía, tiempo de hospitalización y en la resolución de los síntomas individuales de neumonía
Gupta y cols.55 324 niños dosis única de 100 000 UI de la vitamina D36 meses – probabilidad relativa mayor de remisión de la neumonía aguda en enfermos que recibieron suplementación
– sin diferencias en el tiempo de la hospitalización, tiempo hasta la remisión de los síntomas y tiempo hasta la curación completa
– sin diferencias en cuanto al riesgo de recaída de la neumonía
– resultados parecidos en enfermos con déficit de vitamina D

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