维生素D作为多发性硬化添加治疗的系统评价  

Systematic review of vitamin D as add-on therapy in multiple sclerosis

作　　者：谢沁芳 李晓玲[1] 孙静洁[1] 原铂尧 王满侠[1] 

机构地区：[1]兰州大学第二医院神经内科,兰州730030

出　　处：《中国免疫学杂志》2017年第2期259-263,共5页Chinese Journal of Immunology

摘　　要：目的:评价维生素D作为添加治疗多发性硬化的有效性与安全性。方法:通过检索Pubmed、EMbase、Cochrane图书馆以及中国知网、万方等电子数据库获取文献,时间为2016年2月截止。使用检索关键词"多发性硬化"、"multiple sclerosis"、"MS"以及药名"维生素D"、"vitamin D""Cholecalciferol"。两名作者独立检索以及提取数据。使用RevM an5.3软件对提取资料进行统计分析。结果:共4个试验247名患者纳入研究。①有效性方面,在12个月时,维生素D在EDSS评分[MD=-0.33,95%Confidence interval(CI)=(-0.68,0.01),P=0.05]、复发率[MD=-0.08,95%CI=(-0.37,0.21),P=0.60]以及钆增强病变的数量[MD=-0.16,95%CI=(-0.57,0.25),P=0.45]与安慰剂无明显差异。但24个月时,维生素D在EDSS评分[MD=-0.48,95%CI=(-0.87,-0.09),P=0.02]和复发率[MD=-0.27,95%CI=(-0.52,-0.02),P=0.03]均优于单一治疗。②安全性方面,各研究均无高钙血症的发生,常见的不良反应有腹泻、发热、便秘、消化不良、头疼等,但均属轻度,停药后可缓解。结论:维生素D作为添加治疗多发性硬化时其临床疾病指标表明与安慰剂无差异,但随着治疗时间的延迟,维生素D优于安慰剂。受纳入研究数量和质量所限,上述结论尚需更大样本量和更长期的研究予以验证。Objective： To evaluate a Meta-analysis of randomized controlled trials（ RCTs） in multiple sclerosis（ MS） patients to evaluate the efficacy of vitamin D as add-on therapy. Methods： Searched Pubmed,EMbase,the Cochrane Library,CNKI,Wanfang Data base and so on up to february 2016 using the keywords： ＂ multiple sclerosis＂ or ＂ MS＂ and the drug names： ＂ vitamin D＂ or ＂ Cholecalciferol＂. Two authors independently selected the articles and extracted the data. We performed meta-analysis using Review Manager（ RevM an） version 5. 3 software. Results： Four RCTs with a total of 247 patients were selected. ①Compared to the placebo,the EDSS score[MD =- 0. 33,95% Confidence interval（ CI） =（ 0. 68,0. 01）,P = 0. 05 ],the annual relapse rate[MD =- 0. 08,95%CI =（-0. 37,0. 21）,P = 0. 60]and the number of gadolinium-enhancing lesions[MD =-0. 16,95%CI =（-0. 57,0. 25）,P = 0. 45]showed no significant difference at 12 months,meanwhile the EDSS score[MD =- 0. 48,95% CI =（ 0. 87,- 0. 09）,P = 0. 02] and the annual relapse rate[MD =-0. 27,95%CI =（-0. 52,-0. 02）,P = 0. 03] were significantly less in the vitamin D group at 24 months. ②Safety evaluation： There was no hypercalcaemia in vitamin D treated patients in each studies,main adverse events reported were diarrhoea,fever,constipation,dyspepsia,headache and so on. These symptoms were mild,after stopping drug can relieve the general. Conclusion： Vitamin D as an added in the treatment of MS showed as same as the placebo in some clinical indicators. However,after a longer treatment,the clinical indicators were significantly lower in the vitamin D group. Due to limited quantity and quality of the included studies,further larger and more prolonged studies are merited to verify the above conclusion.

关 键 词：多发性硬化 维生素D META分析 有效性 安全性 

分 类 号：R741[医药卫生—神经病学与精神病学]