补充维生素D对膝关节骨关节炎的治疗效果Meta分析

Effect of vitamin D supplementation on osteoarthritis of the knee : a meta-analysis

目的提供关于补充维生素D对膝关节骨关节炎影响的证据。方法计算机检索The Cochrane Library、PubMed、中国知网、中国生物医学数据库与万方数据库,搜集补充维生素D治疗膝关节骨关节炎的临床随机对照试验,检索时间为建库至2017年10月。采用Rev Man 5.3软件进行系统评价和Meta分析。结果最终纳入文献4篇,共1130例膝关节骨关节炎患者。Meta分析结果显示:补充维生素D对缓解膝关节疼痛具有统计学意义[SMD=-0.32,95%CI:(-0.63,-0.02)],在亚组分析中,无论低25(OH)D水平[SMD=-0.57,95%CI:(-1.41,0.27)]研究对象或高25(OH)D水平[SMD=-0.12,95%CI:(-0.28,0.04)]研究对象中补充维生素D对膝关节疼痛都没有显著影响。补充维生素D对胫骨软骨体积无影响[SMD=0.12,95%CI:(-0.05,0.29)]。在关节间隙结构改善方面差异无统计学意义[SMD=0.07,95%CI:(-0.08,0.23)]。结论目前缺乏强有力的证据来支持补充维生素D在膝关节骨关节炎患者中能对病情起到根本性作用。还需要进行更精心化设计的、更高质量的、样本量更大的、更长随访时间的临床随机对照试验来进一步明确补充维生素D对膝关节骨关节炎患者病情的影响。

Objective To provide evidence of the effects of vitamin D supplementation on osteoarthritis of the knee. Methods Computer retrieval the Cochrane Library,PubMed,CNKI,China biomedical database and Wan Fang database to collect data of randomized controlled clinical trials on the effects of vitamin D supplementation in the treatment of knee osteoarthritis. The retrieval time was from database establishment to October 2017. System evaluation and meta-analysis were performed by Revman 5. 3.Results Four references were included,including a total of 1130 cases of patients with knee osteoarthritis. Vitamin D had significant effect for the relief of knee pain [SMD =-0. 32,95% CI：（-0. 63,-0. 02） ]. In subgroup analysis,vitamin D supplementation did not significantly affect knee pain in subjects with a low 25（ OH） D level [SMD =-0. 57,95% CI：（-1. 41,0. 27） ]or high 25（ OH） D level [SMD =-0. 12,95% CI：（-0. 28,0. 04） ]. Vitamin D supplementation had no effect on tibial cartilage volume [SMD = 0. 12,95% CI：（-0. 05,0. 29） ]. There were no statistically significant differences in the joint space structure improvement [SMD = 0. 07,95% CI：（-0. 08, 0. 23） ]. Conclusion There is a lack of strong evidence to support that vitamin D supplementation can play a fundamental role in osteoarthritis of the knee. More high quality randomized clinical trials are needed to further clarify the effect of vitamin D supplementation on knee osteoarthritis.