Background. Studies in developing countries have shown that children with measles have low serum retinol concentrations and that lower retinol levels are associated with measles-related mortality. Vitamin A therapy has been shown to reduce mortality among African children with acute measles.Objectives. To determine whether serum retinol concentration is low among children with measles in the United States and to determine whether retinol concentration is associated with illness severity.Setting. Pediatric referral hospital and clinic in Milwaukee, WI, during the measles outbreak of 1989-1990.Patients. One hundred fourteen patients ≤5 years of age evaluated for serologically confirmed measles with serum obtained within 5 days following rash onset.Methods. Serum retinol concentration was determined by high-performance liquid chromatography. Clinical data were collected by hospital record review. A modified Pediatric Risk of Mortality (PRISM) score was used to assess physiologic instability as a measure of illness severity.Results. Retinol concentrations ranged from 0.25 to 1.18 μmol/L (median 0.58 μmol/L); 82 (72%) patients had low retinol concentration (≤0.70 μmol/L). Median retinol concentrations were lower among hospitalized patients (0.56 vs 0.70, P = .006) and patients with pneumonia (0.52 vs 0.64, P = .02) but higher among children with otitis media (0.63 vs 0.54, P = .01). Higher modified PRISM scores, reflecting greater physiologic instability, were associated with lower retinol concentration (β coefficient -.0147, P = .025). In multivariate analysis, higher modified PRISM scores were associated with lower retinol concentration (β coefficient -.0144, P = .025) even after controlling for hospitalization, presence of complications, race, age, receipt of Aid to Families With Dependent Children, gender, and interval from rash onset until serum was collected.Conclusions. Among these children with measles in an urban United States community, retinol concentrations were depressed, and the degree of depression was associated with illness severity. Vitamin A therapy should be considered for children with measles in the United States who require hospitalization.
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机译：背景。发展中国家的研究表明，麻疹患儿的血清视黄醇浓度较低，视黄醇水平较低与麻疹相关的死亡率有关。研究表明，维生素A治疗可以降低非洲患有急性麻疹儿童的死亡率。为了确定在美国麻疹患儿中血清视黄醇浓度是否较低，并确定视黄醇浓度是否与疾病严重程度相关。 1989-1990年麻疹爆发期间，威斯康星州密尔沃基市的儿科转诊医院和诊所。对114例≤5岁的患者进行皮疹发病后5天内血清学确认的麻疹评估。通过高效液相色谱法测定血清视黄醇浓度。通过医院记录审查收集临床数据。修改后的小儿死亡风险（PRISM）评分用于评估生理不稳定性，以衡量疾病的严重程度。视黄醇浓度范围为0.25至1.18μmol/ L（中位数为0.58μmol/ L）; 82（72％）患者的视黄醇浓度低（≤0.70μmol/ L）。住院患者和肺炎患者的视黄醇浓度中位数较低（0.56 vs 0.70，P = .006）和肺炎患者（0.52 vs 0.64，P = .02），而中耳炎患儿则较高（0.63 vs 0.54，P = .01）。改良的PRISM评分越高，反映出更大的生理不稳定性，与较低的视黄醇浓度相关（β系数-0147，P = .025）。在多变量分析中，即使在控制了住院，并发症，种族，年龄，对有抚养子女的家庭的援助，性别等因素之后，较高的PRISM修正值与较低的视黄醇浓度也相关（β系数-.0144，P = .025）。 ，以及从皮疹发作到收集血清的时间间隔。在美国城市社区的这些麻疹患儿中，视黄醇浓度降低，且抑郁程度与疾病的严重程度有关。在美国，需要住院的麻疹儿童应考虑使用维生素A治疗。
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