5岁以下儿童补充维生素A对预防死亡、疾病及失明的系统回顾和荟萃分析  

Vitamin A supplements for preventing mortality, illness, and blindness in children aged under 5： systematic review and meta-analysis

出　　处：《英国医学杂志中文版》2011年第6期360-360,共1页The BMJ Chinese Edition

摘　　要：目的研究补充维生素A与6个月至5岁儿童死亡率和发病率的减少是否相关。方法系统回顾和荟萃分析，由2名研究者独立筛选文献，数据经双方提取，不同点通过讨论解决，主要进行死亡、疾病、视力及副作用的荟萃分析。数据来源于Cochrane中心注册的对照研究，包括Cochrane图书馆、Medline、Embase、GlobalHealth、Latin American和Caribbean HealthSciences，metaRegister of Controlled Trials和African Index Medicus。数据检索至2010年4月前已发表或待发表的各种语言的文献。入选标准为对口服合成维生素A的6个月至5岁儿童的随机对照研究，研究儿童患有疾病（包括腹泻、麻疹及HIV），排除住院以及食物强化或B胡萝卜素儿童。结果包括215633名儿童的43项研究人选。其中17项研究（194483名儿童）显示全因死亡率减少了24％，其比值比为0．76，95％可信区间（95％CI）0．69～0．83。7项研究报道与腹泻相关的死亡率减少了28％，其比值比为0．72（95％C10．57—0．91）。维生素A的补充与腹泻减少的比值比为0．85（95％C10．82—0．87）、与麻疹、视力问题包括夜盲和眼球干燥症减少的比值比分别为0．50（95％C10．37—0．67）、0．32（95％C10．21～0．50）和0．31（95％C10．22—0．45）。3项研究报道在补充维生素A的48小时内呕吐增加的风险为2．75（95％CI1．81～4．19）。结论补充维生素A在一定范围内与儿童的死亡率、发病率及视力问题的大幅减少有关，且这一结论不能由偏倚来解释。在6个月至59个月的儿童中已无需进行补充维生素A的安慰剂对照研究，但是有必要进一步比较不同剂量和不同给药方式（如强化）的区别。就目前得到的数据而言，所有可能缺乏维生素A的儿童均应得到补充，尤其是中低收入的国家。To determine if vitamin A supplementation is associated with reductions in mortality and morbidity in children aged 6 months to 5 years. Design Systematic review and meta-analysis. Two reviewers independently assessed studies for inclusion. Data were double extracted; discrepancies were resolved by discussion. Meta-analyses were performed for mortality, illness, vision, and side effects. Data sources Cochrane Central Register of Controlled Trials （CENTRAL） in the Cochrane Library, Medline, Embase, Global Health, Latin American and Caribbean Health Sciences, metaRegister of Controlled Trials, and African Index Medicus. Databases were searched to April 2010 without restriction by language or publication status. Eligibility criteria for selecting studies Randomised trials of synthetic oral vitamin A supplements in children aged 6 months to 5 years. Studies of children with current illness （such as diarrhoea, measles, and HIV）, studies of children in hospital, and studies of food fortification or 13 carotene were excluded. Results 43 trials with about 215 633 children were included. Seventeen trials including 194 483 participants reported a 24% reduction in all cause mortality （rate ratio = 0.76, 95% confidence interval 0.69 to 0.83 ）. Seven trials reported a 28% reduction in mortality associated with diarrhoea （0.72, 0.57 to 0.91 ）. Vitamin A supplementation was associated with a reduced incidence of diarrhoea （0.85, 0.82 to 0.87） and measles （0.50, 0.37 to 0.67 ）and a reduced prevalence of vision problems, including night blindness （0.32, 0.21 to 0.50） and xerophthalmia （0.31, 0.22 to 0.45）. Three trials reported an increased risk of vomiting within the first 48 hours of supplementation （2.75, 1.81 to 4.19）. Conclusions Vitamin A supplementation is associated with large reductions in mortality, morbidity, and vision problems in a range of settings, and these results cannot be explained by bias. Further placebo controlled trials of vitamin A supplementation in children betwee

关 键 词：缺乏维生素A 儿童死亡率 荟萃分析 系统回顾 疾病 Cochrane图书馆 COCHRANE中心 MEDLINE 

分 类 号：R772.2[医药卫生—眼科]