维生素D预防老年人跌倒的系统评价再评价

Re-evaluation of the systematic review of vitamin D in prevention of falls in the elderly

目的对维生素D预防老年人跌倒的系统评价的方法学质量和证据质量进行再评价。方法计算机检索Cochrane Library、PubMed、Web of Science、Embase、CNKI、万方数据库、中国生物医学文献数据库和维普网,搜集维生素D预防老年人跌倒的系统评价/Meta分析,并手工检索纳入文献的参考文献,时限为建库至2020年3月。2名研究者独立筛选、提取资料,使用AMSTAR 2量表和GRADE系统分别对纳入研究的方法学及证据质量等级进行评价。结果共纳入13篇系统评价/Meta分析,AMSTAR 2评价结果显示11篇研究方法学质量为极低,2篇为高;GRADE评价结果显示纳入评价的21个结局指标中,8个为极低级质量,7个为低级质量,6个为中级质量,无证据质量为高级。结论目前的研究显示,维生素D预防老年人跌倒具有一定效果,但大多数研究的方法学质量较低,证据质量可靠程度一般;补充维生素D的不良反应也存在较大异质性。未来研究仍需开展大样本、高质量的研究以明确维生素D的作用及不良反应。

Objective To re-evaluate the methodological quality and quality of evidence of the systematic review of vitamin D in prevention of falls in the elderly.Methods Cochrane Library,PubMed,Web of Science,Embase,CNKI,WanFang Database,China Biology Medicine Disc and VIP databases were searched by computer to collect systematic reviews or Meta-analysis on vitamin D in prevention of falls in the elderly,and the references included in the literature were searched manually.The time limit was from the construction of the database to March 2020.Two researchers independently screened and extracted data,and they used AMSTAR 2 Scale and Grading of Recommendations Assessment,Development,and Evaluation(GRADE)system to evaluate the methodology and evidence quality of the included studies.Results A total of 13 systematic reviews or Meta-analysis were included.AMSTAR 2 evaluation results showed that the methodological quality of 11 studies was extremely low,and that of 2 studies was high.Grade evaluation results showed that among the 21 outcome indicators included in the evaluation,8 were extremely low quality,7 were low quality,6 were medium quality,and no evidence was of high quality.Conclusions Current studies have shown that vitamin D has a certain effect in preventing falls in the elderly,but the methodological quality of most studies is relatively low and the quality of evidence is generally reliable.The adverse reactions of vitamin D supplementation are also quite heterogeneous.Future research still needs to carry out large-scale and high-quality research to clarify the role and adverse effects of vitamin D.