补锌对婴幼儿智力及运动发育影响的Meta分析

Effect of zinc supplementation on mental development and motor development in infants:a meta-analysis

目的评价补锌对婴幼儿运动和智力发育改善的作用。方法检索PubMed、EMBASE、Cochrane图书馆、中国期刊全文数据库、维普中文科技期刊数据库和万方数据库等,获得补锌对婴幼儿运动和智力发育影响的RCT文献。根据随机分配方法,分配隐藏,对研究对象、治疗方案和研究结果测量者采用盲法,结果数据的完整性,选择性报告研究结果,其他偏倚来源进行文献偏倚评估。以生后6～36个月智力发育指数(MDI)、运动发育指数(PDI)和发育商(DQ)为疗效判定指标。采用RevMan5.0软件进行Meta分析,检验异质性,根据异质性结果进行原因分析,并选择相应的效应模型分析。计量资料以SMD或WMD及其95%CI表示。结果①共检索到文献84篇,共10篇RCT满足纳入条件进入Meta分析。7篇文献采用了正确的随机方法,8篇文献采用了分配隐藏,9篇文献对受试者采用了盲法,8篇文献对研究者和结局测量者采用了盲法,9篇文献提及报道数据的完整性,9篇文献未选择性报告研究结果,仅1篇文献报道了其他偏倚来源。漏斗图检验未见显著发表偏倚。②Meta分析结果显示,补锌组与对照组MDI的差异无统计学意义,WMD=-0.08(95%CI:-1.55～1.40);补锌组与对照组PDI的差异无统计学意义,SMD=0.15(95%CI:-0.12～0.42)。但研究间均具显著统计学异质性,根据补锌的剂量、是否与其他营养物质合用、纳入对象的营养状况行亚组分析,进一步探讨异质性产生的原因。亚组分析显示不能完全消除文献间的异质性,异质性可能还与其他因素有关。③补锌组与对照组DQ评分的差异无统计学意义,WMD=-0.72(95%CI:-7.97～6.53)。补锌组与对照组干预前后Alberta运动指数的差异无统计学意义,WMD=0.30(95%CI:-2.09～2.69)。结论早期补锌并未提高MDI、PDI及DQ评分,对婴幼儿运动和智力发育未显示有改善作用。鉴于研究间存在显著的统计学异质性,结论仍需谨慎看待。

Objective To assess the efficacy of zinc supplementation for improving psychomotor developmental and mental developmental outcomes in infants younger than 3 years.Methods According to the requirements of Cochrane systematic review,a literature search was performed among PubMed,EMBASE,Cochrane library,CNKI,VIP and Wanfang data from the establishment of the database till October 2010. Mental developmental index （MDI）,psychomotor developmental index （PDI） and development quotient （DQ） of 6-36 months after birth were measured as therapeutic efficacy index.RevMan 5.0 software was used for meta-analysis. The Cochrane handbook 5.0.2 was used to evaluate the methodological quality. Data extraction,quality assessment,and meta-analysis for the results of homogeneous studies were performed by two reviewers. Heterogeneity of the included articles was tested to select proper effective model. Measurement data were expressed as SMD,WMD and its 95%CI.Results Eighty-four articles were searched according to the inclusion and exclusion criteria,21 reviews,37 studies without zinc supplementation,5 studies for pregnant mothers,5 studies for children older than 3 years,1 study in which zinc supplementation was not the only different intervention compared with control group and 5 studies without the outcomes were excluded. Ten RCTs meeting the inclusion criteria were enrolled. The assessment of literature quality showed 7 literatures described the method of random allocation in detail,8 literatures described allocation concealment,8 literatures used double blind method,9 literatures reported complete data addressed and 9 literatures were free of selectively reporting. Only 1 literature described the sources of other bias.There was clinical heterogeneity in the 10 included studies. Nine RCTs （n=2 250） reported PDI with the Bayley Scales of Infant Development or Griffiths Mental Development Scales. There was no significant difference in the PDI between two groups,SMD=0.15（95%CI：-0.12 to 0.42）. Eight RCTs （n=2 136） reported MDI with the Bayley Scales of Infant Development. There was no significant difference in the MDI between two groups,WMD=-0.08（95%CI：-1.55 to 1.40）. Subgroup analyses were carried out for dosage,formulation （zinc alone or zinc combined with other nutrients） and nutrition status （varying measles case fatality rates）. None of these subgroup analyses showed significant difference in the MDI or PDI between groups. One RCT （n=114） reported DQ using the Griffiths Mental Development Scales. The WMD of DQ was-0.72 （95%CI：-7.97 to 6.53）. Another RCT （n=70） reported the change in Alberta Infant Motor Scale and did not show significant difference between groups,WMD=0.30（95%CI：-2.09 to 2.69）.Conclusions Supplementation of zinc shows no effect on psychomotor development and mental development in infants. Further studies are needed to determine whether the findings are reproducible.