低维生素D水平与Graves病发生风险关系的Meta分析

Meta-analysis of the relationship between low vitamin D levels and risk of Graves' disease

目的系统评价低维生素D水平与Graves病发生风险之间的关系。方法使用计算机检索PubMed、EMbase、中国学术期刊网(CNKI)、万方全文数据库(Wanfang Data)和中国生物医学文献数据库(CBM)等数据库,收集最早收录时间至2019年9月,包含维生素D、Graves病和自身免疫性甲状腺疾病等相关的中英文文献,应用统计软件Stata 12.0对数据进行Meta分析。将符合纳入标准的文献进行异质性检验,根据结果选用随机效应模型进行综合定量分析,计算标准化平均差﹙SMD﹚及其95%置信区间(CI),利用Egger检验评价发表偏倚,并进行敏感性分析。结果共纳入文献29篇,涉及Graves病患者2281例、对照人群4200例。Meta分析结果显示,纳入的研究存在异质性,采用随机效应模型合并数据后,Graves病患者的维生素D水平显著低于对照人群(SMD=-0.90,95%CI:-1.14,-0.66,P<0.01)。异质性分析和Meta回归分析显示,国家发展程度、地理位置、指标测定方法和Graves病是否初发4个因素均不是异质性的主要来源,但在发展中国家或亚洲国家,Graves病患者的维生素D水平显著低于对照人群(P均<0.01);而在发达国家或欧洲国家,差异无统计学意义(P均>0.05)。发表偏倚分析和敏感性分析结果表明,本研究结果具有一定的稳定性和可靠性。结论低维生素D水平可能会增加Graves病的发生风险。

Objective To investigate the relationship between low vitamin D levels and the risk of Graves'disease.Methods Computer was used to search PubMed,EMbase,China National Knowledge Infrastructure(CNKI),Wanfang Database(Wanfang Data)and China Biomedical Database(CBM).Relevant Chinese and English literatures were collected,including literatures of vitamin D,Graves'disease and autoimmune thyroid disease from the earliest publication time of the literature in the database to September 2019.Statistical software Stata 12.0 was used for Meta-analysis of the data.Heterogeneity test was conducted on the literature that met the inclusion criteria.According to the results,a random-effect model fixed-effect model was selected for comprehensive quantitative analysis.Standardized mean difference(SMD)and 95%confidence interval(CI)were calculated,and Egger's test was used to evaluate publication bias and sensitivity analysis.Results A total of 29 literatures were included in the study,covering 2281 patients with Graves'disease and 4200 control population.Meta-analysis results showed:after the data were combined using a random-effects model,vitamin D levels in patients with Graves'disease were significantly lower than that in the control population(SMD=-0.90,95%CI:-1.14,-0.66,P<0.01﹚;heterogeneity analysis and Meta-regression analysis showed that the four factors of national development degree,geographical location,indicator measurement method and whether Graves'disease was primary were not the main source of heterogeneity.However,in developing countries or Asian,the vitamin D levels of patients with Graves'disease were significantly lower than that of the control population(P<0.01).In developed countries or Europe,the difference was not statistically significant(P>0.05).Sensitivity analysis and publication bias analysis showed that the results of this study had certain stability and reliability.Conclusion Low vitamin D levels may increase the risk of Graves'disease.