维生素D和钙剂治疗营养性佝偻病疗效的Meta分析  

Meta-analysis of the efficacy of combined therapy vitamin D with calcium in nutritional rickets

作　　者：于静[1] 李卫国[1] 李宇宁[1] 姜莉[1] 陶仲宾[1] 李湘津[1] 赵福林[1] 谢婧[1] 

机构地区：[1]兰州大学第一医院儿内科,730000

出　　处：《国际儿科学杂志》2014年第5期548-554,共7页International Journal of Pediatrics

摘　　要：目的：采用Meta分析对联合补充钙剂、维生素D与单用维生素D或钙剂治疗佝偻病疗效进行定量评价。方法检索CochranceLibrary、Pubmed、Webofscience、Scirus、中国期刊全文数据库、中国生物医学文献数据库和万方数据库，检索时间均从建库至2013年3月。获得维生素D和钙剂治疗营养性佝偻病相关的RCT文献。选取血清25-（OH）维生素-D3、磷、ALP作为主要测量指标，选取钙、甲状旁腺素、白蛋白、影像评分作为次要测量指标。采用ReviewManage5．0．2对纳入的RCT文献进行Meta分析。结果共检索到437篇文献，对符合纳入标准的3篇文献（n=218）进入Meta分析。Meta分析结果显示：（1）血清25-（OH）维生素D3上升程度：联合治疗组与维生素D组MD=-7．88（95%CI：-12．24--3．52）；联合治疗组与钙剂组MD=-18．32（95%CI：-22．61--14．04）；（2）血清磷上升程度：联合治疗组与维生素D组MD=-0．64（95%CI：-0．86--0．42）；联合治疗组与钙剂组MD=-0．16（95%CI：-0．84-0．51）；（3）血清ALP下降程度：联合治疗组与维生素D组MD=109．99（95%CI：20．40-199．58）；联合治疗组与钙剂组MD=59．89（95%CI：10．09-109．59）。（4）血清钙上升程度：联合治疗组与维生素D组MD=-0．71（95%CI：-0．91--0．52）；影像学评分下降程度：联合治疗组与维生素D组MD=0．68（95%CI：0．42-0．95）。以上指标除联合治疗组与钙剂组对血清磷的上升程度差异无统计学意义外，其余差异均具有统计学意义。结论维生素D联合钙剂长期联合治疗佝偻病的疗效要优于单用维生素D或钙剂。Objective To assess the efficacy of combined vitamin D with calcium and vitamin D or cal-cium alone in rickets of vitamin D deficiency by meta-analysis method. Methods Searches were made in Cochrance Library , Pubmed, Web of science, Scirus, CNKI, Chinese Biological Medical Literature Database, （CBM）,Wangfang from the establishment of the data base till March 2013. All randomized controlled trials about combined with vitamin D and calcium in rickets of vitamin D deficiency were eligible. Serum 25-（ OH） ritamin D,phosphate ,ALP,calcium,PTH,phosphate,albumin ,radiographic score were chosen as evaluation in-dex to evaluate the weighted mean diffreence （ WMD） and 95% confidence interval （ CI） for continuous data. RevMan 5. 0. 2 software was used to make meta-analysis. Results 437 literatures were reviewed. Three eligible trials were used for meta-analysis. Meta-analysis showed that：（1）the increase of Serum 25-（OH）vitamin D：Combined therapy group and vitamin D group （MD= -7. 88,95%CI：-12. 24- -3. 52）;Combined therapy group and calcium group （MD= -18. 32,95%CI：-22. 61- -14. 04）. （2）the increase of serum phosphate：Combined therapy group and vitamin D group （ MD= -0. 64 （ 95%CI：-0. 86 - -0. 42 ）;Combined therapy group and calcium group MD= -0. 16 （ 95%CI：-0. 84 -0. 51 ） . （ 3 ） the decrease of Serum ALP：Combined therapy group and vitamin D group （MD= 109. 99,95%CI：20. 40 -199. 58）;Combined therapy group and calcium group （MD=59. 89,95%CI：10. 09-109. 59 ）. （4）the increase of serum calcium ：Combined therapy group and vitamin D group （MD= -0. 71,95%CI：-0. 91,-0. 52）;the decrease of Radiographic score：Com-bined therapy group and vitamin D group（ MD=0. 68,95%CI：0. 42- 0. 95）. Except that the increase of serum phosphate between combined therapy group and calcium group had no significant difference,the rest had signifi-cant difference. Conclusion The long term efficacy in combined therapy group is much effective than vitamin D grou

关 键 词：维生素D 钙 佝偻病 META分析 

分 类 号：R723.2[医药卫生—儿科]