不同口服铁剂治疗儿童缺铁性贫血安全性的网络Meta分析

Safety of oral iron supplements for iron deficiency anemia in children: a network meta-analysis

目的 应用网络Meta分析评价8种口服铁剂治疗儿童缺铁性贫血安全性.方法 检索收集2015年7月之前国内外发表有关口服铁剂与儿童缺铁性贫血文献.采用Microsoft Excel 2013软件加载NetMetaXL宏命令调用WinBUGS 1.4.3软件选择随机效应模型进行统计分析,系统评价8种口服铁剂之间的OR值及优劣顺序.结果 纳入文献31篇,3 417例缺铁性贫血儿童.与右旋糖酐铁相比,硫酸亚铁、铁叶绿素钠、琥珀酸亚铁、葡萄糖酸亚铁、多维铁复合物、多糖铁复合物、富马酸亚铁的OR值及95％ CI分别为0.00（0.00 ～0.03）、0.03（0.00～0.39）、0.02（0.00～0.23）、0.01（0.00 ～0.07）、0.01 （0.00 ～0.11）、0.02（0.00 ～0.19）、0.01（0.00～0.12）.右旋糖酐铁发生不良反应风险最小（SUCRA =0.999 4）,而硫酸亚铁的风险最高（SUCRA=0.034 1）.结论 硫酸亚铁发生不良反应的风险较高,临床医生和患者在选择硫酸亚铁治疗儿童IDA时需慎重.

Objective To compare and evaluate the safety of eight kinds of oral iron supplements that treat children with iron deficiency anemia（IDA） by using Network Meta-analysis. Methods We searched and collected domestic and foreign literatures on oral iron supplement for iron deficiency anemia children in CNKI, PubMed, Cochrane Library and Science Direct Database from the inception to July 2015. Statistical analysis was performed by Microsoft Excel 2013 soft- ware, we used the NetMetaXL macros in it to load the WinBUGS 1.4.3 software to conduct the calculate by random effects Bayesian models. The odds ratios （ORs） and mean ranking and the probability among eight kinds of oral irons were estimated. Results We identified 31 eligible studies which involved 3 417 children with IDA. In network analyses, there was higher risk that ferrous sulfate （ OR = 0. 00, 95% CI：0. 004）. 03）, sodium iron chlorophyll （ OR = 0. 03, 95% CI：0. 00- 0. 39 ） , ferrous succinate （OR = 0. 02, 95% CI：0. 004）. 23 ） , ferrous gluconate（ OR = 0.01 , 95% CI： 0. 004）. 07 ） , mul- tidimensional iron compounds （ OR = 0. 01 95 % CI： 0. 004）. 11 ） , iron polymaltose complex （ OR = 0.02, 95 % CI： 0. 00- 0. 19） and ferrous fumarate （OR =0. 01, 95% CI：0. 00-0. 12） prevented side-effects when compared to iron dextran. Although iron dextran was ranked the regiment with the least favorable adverse event profile among eight kinds of oral irons （SUCRA = 0. 999 4）, ferrous sulfate was the highest risk （SUCRA = 0. 034 1 ）. Conclusions Our results suggest that consumers and clinicians might be more cautious when using ferrous sulfate to treat children with IDA, because of its highest risk among other oral iron supplements.