维生素D补充与儿童哮喘的系统评价及meta分析

System Assessment and meta-analysis of Vitamin D Supplementation and Pediatric Asthma

目的探讨维生素D补充与儿童哮喘的相关性。方法纳入对象为基于社区、学校和医疗机构的儿童,暴露因素为维生素D补充,观察哮喘相关结局的随机病例对照研究。计算机检索PubMed、Embase、Cochrane Library数据库,检索截止日期为2018年12月30日。对纳入的文献行筛选、资料提取及方法学质量评价,采用Cochrane风险偏倚评估工具,应用Revman5.3软件进行meta分析。结果共有11项符合纳入标准的随机对照试验,最终纳入9项研究,其中干预组共361例,对照组共341例。meta分析结果显示:2组血清25(OH)D水平比较差异无统计学意义(P=0.13);以是否联合特异性免疫治疗进行亚组分析,合并效应均数差(MD)分别为9.44nmol/L和15.23nmol/L;干预组哮喘发作次数显著低于对照组,差异有统计学意义(P<0.0001);2组肺功能和哮喘症状评分比较,差异无统计学意义(P>0.05)。结论补充维生素D可以减少哮喘发作,对血清25(OH)D水平、肺功能和哮喘症状评分的作用有限;由于有其他潜在的混杂因素,未来需要进行大规模、长时间、精心设计的随机对照试验来了解维生素D对儿童哮喘的治疗作用。

ObjectiveTo explore the association of vitamin D supplementation with childhood asthma.MethodsSubjects were included in community-based,school-and medical-based settings,with exposure factors being vitamin D supplementation and randomized case-control studies to observe asthma-related outcomes.The PubMed,Embase,and Cochrane Library databases were searched by computer and the search deadline was December 30,2018.The selected literature was screened,extracted,and evaluated by methodological quality.Meta-analysis was performed using the Cochrane Risk Bias Evaluation Tool and Revman 5.3 software.ResultsA total of 11 randomized controlled trials that met the inclusion criteria were included in 9 studies,including 361 in the intervention group and 341 in the control group.The meta analysis results showed:there was no significant difference in serum 25(OH)D levels between the two groups(P=0.13).Subgroup analysis was performed with combined immunotherapy.The combined effect MD was 9.44 nmol/L and 15.23 nmol/L,respectively.The number of asthma attacks in the intervention group was significantly lower than that of the control group(P<0.000 1).There was no significant difference in the scores of pulmonary function and asthma symptoms between the two groups(P>0.05).ConclusionVitamin D supplementation can reduce asthma attacks and has limited effects on serum 25(OH)D levels,lung function,and asthma symptom scores.Due to other potential confounders,large-scale,long-term,well-designed randomized controlled trials are needed to understand the therapeutic effects of vitamin D on childhood asthma.