不同补硒方式防治大骨节病的系统评价  

A systematic review regarding the effects of different kinds of selenium supplementations on Kaschin-Beck disease

作　　者：时春虎[1] 田宏亮[1] 田金徽[1] 曾嵘[1] 杨克虎[1] 吴泰相[2] 廖永健[3] 

机构地区：[1]兰州大学基础医学院循证医学中心,730000 [2]四川大学华西医院中国循证医学中心中国临床试验注册中心/Chinese Cochrane Centre,INCLEN(华西)资源与培训中心 [3]甘肃省疾病预防控制中心

出　　处：《中华流行病学杂志》2013年第5期507-514,共8页Chinese Journal of Epidemiology

基　　金：甘肃省科技支撑计划（1104FKCA165）

摘　　要：目的系统评价大骨节病病区不同补硒方式对患病儿童的防治效果。方法计算机系统检索各中外文数据库及搜索引擎。全面收集有关各种补硒方法防治大骨节病的对照研究，检索时间截至2012年12月。对纳入研究进行质量评价，采用RevMan5．1软件进行Meta分析。结果最终纳入14个随机对照试验，12个非随机对照试验，方法学质量均较低。Meta分析结果显示，与安慰剂或空白对照相比，单独补硒治疗能提高大骨节病患儿的X线有效率（RR=3．28，95％CI：2．06～5．22）及发硒水平（SMD=2．05，95％CI：1．00～3．11），且能降低新发病例（OR=0．18，95％CI：0．09—0．36）；单独补硒与单独补充维生素C的X线干骺端好转率的差异无统计学意义（RR=1．01，95％CI：0．84—1．22）；补硒联合维生素E治疗的X线有效率及发硒水平高于安慰剂组；与单独补硒相比，补硒联合维生素C在X线疗效和发硒水平上无明显差异；富硒酵母组的有效率（70．83％）高于亚硒酸钠（48．84％）（P〈0．05）；施硒肥组的X线有效率高于空白组（RR=3．98，95％CI：2．25～7．05），综合干预及晒粮等方法亦有一定效果。结论单独补硒可提高大骨节病患者X线有效率和发硒水平；维生素联合补硒效果优于单独补硒；富硒酵母的疗效优于单独补硒和对照组。Objective To systematically assess the efficacy of different programs regarding the selenium supplementation formulae used for prevention and treatment of Kaschin-Beck disease （KBD） in children. Methods PubMed, EMBASE, Coehrane Library, SCI expanded, CNKI （Chinese National Knowledge Infrastructure）, VIP （Chinese Science and Technique Journals Database）, CBM （The Chinese Biomedical Database）, Wanfang Database, CSCD （Chinese Science Citation Database） had been electronically searched. All the searching processes were up-dated to Dec 2012 to identify randomized trials （RCTs） and non-RCTs to compare the selenium supplementation formulae with placebo or with no intervention. Two reviewers assessed the methodological quality of the study design, including RCTs or non-RCTs according to Cochrane Handbook for Systematic Reviews of Interventions 5.1 or a checklist described by Deeks JJ, et al, respectively. Data was extracted independently. Results There were 14 RCTs and 12 non-RCTs papers included, but showing low methodological quality. Data from Meta analysis showed that selenium supplementation had caused the following progresses： radiologic improvement （RR=3.28, 95%CI：2.06-5.22）, higher hair selenium （SMD=2.05, 95%CI： 1.00-3.11） lower new radiologic lesions （OR=0.18, 95%CI： 0.09- 0.36） than in the placebo or with no treatment groups. Both selenium and vitamin C supplementation did not show differences in radiologic improvement of metaphysis （RR=I.01,95%CI： 0.84-1.22）.Combination of selenium and vitamin E supplementation showed higher radiologic improvement than the placebo group. Combination of selenium and vitamin C supplementation had no influence on the difference in radiologic improvement or hair selenium than selenium supplementation. Selenium-enriched yeast showed higher radiologic improvement than sodium selenite （70.83% vs. 48.84%, P〈0.05）. Selenium fertilization showed higher radiologic improvement than the non- treatment group （RR=3.98, 95% CI： 2.25

关 键 词：大骨节病 硒 系统评价 

分 类 号：R684.1[医药卫生—骨科学]