补充维生素D对肥胖或糖代谢异常患者胰岛素抵抗及血糖改善效果的meta分析

Effect of vitamin D supplementation on insulin resistance and blood glucose in people who are obese or peoplewith abnormal glucose metabolism： A meta-analysis

目的系统评价补充维生素D对肥胖或糖代谢异常患者胰岛素抵抗及血糖的改善效果。方法检索PUBMED、Elsevier、Web of Science和万方等数据库中比较维生素D及其类似物与安慰剂的随机对照试验。从中提取包括稳态模型评估的胰岛素抵抗指数（HOMA-IR）、空腹血糖、HbA1c等关于胰岛素抵抗及血糖的数据。而后采用RevMan5．0软件进行meta分析。结果共纳入9项随机对照试验，包括867名受试者。分析显示（1）对于肥胖合并糖代谢异常的患者，补充维生素D有轻微的改善胰岛素抵抗指数（SMD-0．34，95％CI-0．61to-0．06，P〈0．05）和降低空腹血糖（SMD-0．41mmo/L，95％CI-0．68to-0．15，P〈0．05）的效果，而在血糖正常的肥胖患者中则没有观察到类似效果。（2）没有发生与补充维生素D相关的严重不良事件。结论补充维生素D对改善肥胖合并糖代谢异常患者的胰岛素抵抗、空腹血糖有轻度获益，但对血糖正常的肥胖患者无明显效果。

Objective To systematically review the evidence for the effect of vitamin D supplementation on insulin resistance and blood glucose in people who are obese or people with abnormal glucose metabolism. Methods We searched databases including Pubmed, Elsevier, Web of Science, and WANFANG Database etc. for randomized controlled trials comparing vitamin D or analogues with placebo. We extracted data on insulin resistance and blood glucose, including homeostasis model assessment of insulin resistance （HOMA-IR） , fasting blood glucose, HbAlc （ % ）. All data were analyzed using Review Manager 5.0. Results Nine studies involving 867 participants were included. The results of meta-analysis showed that： （ 1 ） For people who are obese and with abnormal glucose metabolism, recta-analysis showed a small improvement in HOMA-IR （SMD -0.34,95% CI-0.61 to -0.06, P〈 O. 05 ） and a small effect on fasting glucose （ SMD -0.41 retool/L, 95% CI-0.68 to -0.15, P〈0.05 ） ,while such effects were not seen in people who are obese but with normal blood glucose. （ 2 ） No serious adverse events were associated with the administration of vitamin D. Conclusion vitamin D supplementation may be benefit for improving insulin resistance and fasting blood glucose in people who are obese and with abnormal glucose metabolism, but has no effect on obese people with normal blood glucose.