儿童25羟维生素D水平与急性下呼吸道感染相关性的Meta分析

Meta-Analysis of Correlation between 25 Hydroxy Vitamin D Level and Acute Lower Respiratory Tract Infection in Children

目的:探讨维生素D水平与儿童急性下呼吸道感染(ALRI)的关系。方法:在线检索PubMed、EMBase、the Cochrane Library、中国知网、万方及维普数据库,系统收集1990年1月1日至2019年5月31日公开发表的关于维生素D与儿童ALRI的病例对照研究,根据严格的纳入排除标准筛选,对纳入的文献进行质量评价及异质性检验,并对结果进行敏感性分析及亚组分析,采用RevMan 5.3对数据进行整理分析。结果:最终纳入10篇文献,获得样本1749例,其中病例组1070例,对照组679例。Meta分析结果显示:(1)ALRI患儿25羟维生素D[25(OH)D]缺乏发生率高于健康儿童(OR=4.3,95%CI 2.5~7.4,Z=5.26,P<0.00001);(2)ALRI患儿25(OH)D水平较健康儿童降低(WMD=-8.44,95%CI-9.33~-7.55,Z=18.64,P<0.00001)。亚组分析结果显示,根据研究地区分组,亚非地区ALRI组与对照组25(OH)D水平比较差异有统计学意义;根据病例组维生素D水平是否充足分组,维生素D不足及缺乏(<30 ng/mL)ALRI组与对照组25(OH)D水平比较差异有统计学意义。结论:ALRI儿童就诊时血清25(OH)D较健康儿童降低,25(OH)D缺乏或不足可能是ALRI发病的危险因素。受纳入研究数量的限制,上述结论需待更多高质量研究予以验证。

Objective:To probe into the correlation between vitamin D level and acute lower respiratory infection(ALRI)in children.Methods:PubMed,EMBase,the Cochrane library,CNKI,Wanfang and VIP database were retrieved to collect the case-control studies of vitamin D and ALRI in children published from Jan.1st,1990 to May 31st,2019.The included articles were screened according to strict inclusion and exclusion criteria,and quality evaluation and heterogeneity tests were performed.Sensitivity analysis and subgroup analysis were carried out for the results.Data were collated and analyzed by RevMan 5.3.Results:A total of 10 articles were collected,including 1,749 samples,with 1,070 cases in the case group and 679 cases in the control group.Meta-analysis results showed:(1)The incidence of 25 hydroxy vitamin D(25(OH)D)deficiency in children with ALRI was higher than that in healthy children(OR=4.3,95%CI from 2.5 to 7.4,Z=526,P<0.000,01).(2)The 25(OH)D level of children with ALRI was lower than that of healthy children(WMD=-8.44,95%CI from-9.33 to-7.55,Z=18.63,P<0.000,001).The results of subgroup analysis showed that according to the area,the difference in 25(OH)D level between the ALRI group and the control group in Asia and Africa was statistically significant.According to the vitamin D level in the case group,there was statistically significant difference in level of 25(OH)D between the ALRI group with vitamin D insufficiency and deficiency(<30 ng/mL)and the control group.Conclusion:Serum 25(OH)D in children with ALRI is lower than that in healthy children,and 25(OH)D insufficiency and deficiency may be a risk factor for ALRI.Due to the limitation of the number of included literature,the above findings need to be validated by more high-quality literature.