生物与医学2020medrxiv.org
维生素 D、镁和维生素 B12 对 COVID-19 患者影响的研究
Study of the effect of Vitamin D, Magnesium and Vitamin B12 on Covid-19 patients
进阶 · 约 25 分钟读完前置知识：临床研究设计、基础统计学、维生素与免疫基础
导读
这篇预印本研究探讨维生素D、镁和维生素B12（DMB）组合对COVID-19患者的影响。小样本（43人）结果显示，接受DMB的患者需要吸氧的比例显著低于对照组（17.6% vs 61.5%），但研究未说明随机化且组间存在年龄和合并症差异，证据强度有限，作者呼吁开展更大规模的随机对照试验。
HN 关注点：维生素补充能否降低COVID-19严重程度，讨论焦点在于小样本研究的局限性（非随机、选择偏差）以及维生素缺乏是否是根本原因。
HN 评论精选
这几条评论里：支持 1 质疑 2 亲历 1
质疑质疑研究是否考虑了患者饮食和基线维生素水平，认为根本原因可能是饮食缺乏。
看到关于用基本营养素和维生素治疗患者的研究时，我怀疑是否应该考虑一个根本原因：我们的标准饮食严重缺乏必需维生素和矿物质，以至于用他们缺乏的东西‘治疗’他们，就能让身体正常运转。我还没读完整篇研究，但如果它考虑了治疗前饮食以及维生素和矿物质水平（不管怎么测量），那么比较维生素严重缺乏者与那些摄入‘适量’维生素但因疾病而补充的人，会更有意思。似乎我们在该领域了解得越多，就越显示出我们所知甚少。
mikece查看英文原文
I wonder, when I see stories about studies about treating patients with basic nutrients and vitamins, if a root-cause to consider is that our standard diets are so deprived of essential vitamins and minerals that "treating" someone with what they have been missing causes the body to simply function the way it's supposed to. I haven't read the full study but if it takes into account what someone's diet was prior to this treatment as well as their vitamin and mineral levels (however that is measured) I think it would be more interesting to see how such a vitamin boost affects those who are vitamin starved versus those who were taking a "decent amount" of vitamins but where given a boost because of an illness. It just seems the more we learn in this field the more it shows us what we don't know.
质疑批评方法学缺陷：非随机、组间差异、样本小，结论证据弱。
方法学部分完全没有提到随机化，所以不清楚是否存在选择偏差。看表2，对照组平均年龄大6岁，合并症更多。这表明存在选择偏差，其他未记录的因素可能极大影响实验。样本量这么小做多变量分析会产生巨大不确定性。总之，这项研究只是非常弱的证据。
barbegal查看英文原文
The methodology mentions nothing about randomization so its unclear if there was any selection bias here. If you look a table 2, the control group was on average 6 years older and had more co-morbidities. This suggests that there was some selection bias and that other undocumented factors could have greatly affected this experiment. Doing multi-variate analysis with such a small sample size gives rise to huge uncertainties. In all, this study is only very weak evidence.
支持解读数据并指出小样本但结果积极，建议补充维生素。
N=43（17人用维生素，26人不用）。亮点：“接受DMB的患者后续住院期间需要开始氧疗的比例显著低于对照组（17.6% vs 61.5%，P=0.006）”。“DMB组合与老年COVID-19患者临床恶化需要氧气和/或重症监护支持的比例显著降低相关。这项研究支持进一步开展更大规模的随机对照试验，以确认DMB在减轻COVID-19严重程度方面的全部益处。”所以虽然这项研究规模太小，只能呼吁更大规模研究，但它提供了额外证据表明维生素缺乏可能在COVID-19严重程度中起作用。既然服用基础复合维生素本来就有好处，这样做似乎是明智的。
ageitgey查看英文原文
N=43 (17 given vitamins vs 26 not) Highlights: "Significantly fewer DMB patients than controls required initiation of oxygen therapy subsequently throughout their hospitalization (17.6% vs 61.5%, P=0.006)." "DMB combination in older COVID-19 patients was associated with a significant reduction in proportion of patients with clinical deterioration requiring oxygen support and/or intensive care support. This study supports further larger randomized control trials to ascertain the full benefit of DMB in ameliorating COVID-19 severity." So while this is too small of a study to do anything but call for bigger studies, its additional evidence that vitamin deficiency may play a role in COVID-19 severity. Since taking a basic multi-vitamin is good anyway, it seems wise to do that.
亲历个人经历：补充维生素D后呼吸道问题减少，佐证维生素D的作用。
仅个人经历：我曾有多次呼吸道问题——扁桃体炎、流感、感冒，一年至少3次。我一直以为这是自然的，因为这些疾病有季节性，尤其在冬天。但一次常规血液检查后，医生给我开了维生素D，因为我的水平远低于推荐值。从2017年开始补充维生素D后，三年里我只得过一次轻度流感。所以对我来说，那篇文章并不意外，当然这只是个人经验层面。
rmelhem查看英文原文
just a personal note, I had many many respiratory tract problems - tonsillitis, flu, cold, at least 3 times a year. I always thought it was something natural, given the seasonality of these diseases, especially in winter. but after a routine blood test, my doctor prescribed vitamin D because mine was way below recommended. since 2017, when i started taking vitamin D supplementation, only a mild flu is what I had in 3 years, so to me that article is no surprise, of course in a personal experience level.
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