口服钙剂和维生素D预防甲状腺癌根治术后低钙血症的Meta分析

Oral Calcium and Vitamin D Supplements Can Prevent Hypocalcemia in Patients with Total Thyroidectomy:A Meta-Analysis

目的评价甲状腺癌根治术后口服钙剂和维生素D预防低钙血症的有效性。方法检索国内外有关甲状腺癌根治术后使用钙剂和维生素D预防低钙血症的所有随机对照试验,由两名评价者分别按Cochrane系统评价方法对文献进行质量评价和提取资料,采用RevMan 5.2统计软件进行Meta分析。结果共纳入4个随机对照试验,459例患者。结果显示术后服用钙剂联合维生素D组与单纯服用钙剂组、非干预组相比在术后早期即可明显提高血清钙水平,降低患者低钙血症的发生率。术后服用钙剂联合维生素D组、单纯钙剂组、非干预组三组患者在甲状旁腺激素水平上差异无统计学意义。术后口服钙剂联合维生素D组与非干预组相比,联合治疗组可以降低患者出现低钙血症临床症状的几率[相对危险度0.23,95%可信区间(0.09,0.56),P=0.001]。与非干预组相比,术后早期服用钙剂联合维生素D[相对危险度0.15,95%可信区间(0.03,0.80),P=0.03]和单纯服用钙剂[相对危险度0.24,95%可信区间(0.06,0.91),P=0.04]都可以降低患者需要静脉补钙剂的几率。结论与单纯服用钙剂和非干预组相比,甲状腺癌根治术后早期服用钙剂和维生素D能很好地预防患者低钙血症的发生和临床症状的出现,降低患者需要静脉补钙剂的几率,由于纳入的文献较少,需要更多大样本的随机对照试验进一步证实。

Objective To evaluate the efficacy of oral Calcium and Vitamin D supplements in prevention of hypocalcemia after total thyroidectomy through a meta analysis. Methods All randomized controlled trials （RCTs） of oral Calcium and Vitamin D for the prevention of hypocalcemia after total thyroidectomy were collected. The quality of included RCTs was assessed and relevant data were selected according to the standard of Cochrane systematic review by two reviewers. Statistical software RevMan 5.2 was used for meta analysis. Results Four randomized controlled trials with 459 cases were included. The results showed that early and combined administration of both oral Calcium and Vitamin D can improve the serum Calcium levels higher than those of patients who received only oral Calcium or no supplements. The incidence of hypocalcemia was significantly lower after combined oral Calcium and Vitamin D than no supplements [RR=0.32,95%CI（0.17,0.59）,P=0.000 3]. There was no significant difference in PTH levels among the three groups. Compared with no supplements after total thyroidectomy , combined with oral Calcium and Vitamin D can prevent symptomatic hypocalcemia [RR=0.23, 95%CI （0.09,0.56）, P=0.001]. The patients who need intravenous Calcium after combined oral Calcium and Vitamin D [RR=0.15, 95%CI（0.03,0.80）, P=0.03] or only oral Calcium [RR=0.24,95%CI（0.06,0.91）, P=0.04] were significantly fewer than those with no supplements total thyroidectomy. Conclusion Current evidence indicates that early and combined administration of both oral Calcium and Vitamin D can improve the serum Calcium and prevent symptomatic hypocalcemia more effectively than merely oral Calcium or no supplements. Because of limited studies, more high quality randomized controlled trials with larger samples are required to get further confirmation.