孕期维生素D水平与儿童喘息相关性的系统评价及Meta分析

Maternal status of vitamin D and risk of childhood wheeze: a systematic review and meta-analysis

目的 目前,关于孕期维生素D水平与子代喘息相关性的研究越来越多,结果却不尽相同.利用Meta分析方法系统评价孕妇维生素D水平与儿童喘息的关系,为儿童喘息防治提供依据.方法 检索Pubmed和EMbase等英文文献库,检索词为“wheeze”、“Vitamin D”和“pregnancy”.按照预先设定的标准检索、筛选、纳入和分析文献.累计共纳入14 136对母子,分布于亚洲、欧洲、大洋洲及北美洲.采用Stata 12软件进行Meta分析,根据异质性结果选择相应的效应模型分析,采用逆方差加权分析统计量,记录95％可信区间.结果 共有11篇文献纳入分析,总样本量为14 136例.孕期维生素D水平与儿童喘息之间存在关联性,OR值为0.85(95％CI:0.78 ～0.92);孕期VD摄入水平和脐带血VD水平可以降低子代喘息的发生率,合并效应值分别为0.51(0.37 ～0.64)、0.94(0.90～0.98),而孕期血清VD水平无明显统计学意义,OR值为0.99(95％ CI:0.97～1.01).孕期VD水平可以降低子代早发型喘息发生的风险,合并效应值分别为0.78(0.68 ～0.88).结论 孕期维生素D水平与子代喘息发生率存在负相关,孕期补充维生素D对子代喘息的发生有一定的保护作用.

Objective To assess the association between vitamin D levels during pregnancy and the risk of offspring's wheeze.Methods We searched electronic databases of PubMed and EMbasefrom published studies until July 2017.A random-effects meta-analysis was conducted among 11 birth cohort studies.Results Eleven studies on the association between maternal vitamin D status and childhood wheeze met our inclusion criteria.Maternal vitamin D status during pregnancy was associated with childhood wheeze(OR =0.97,95％ CI:0.96 ～ 0.99).Maternal intake of vitamin D(pooled OR =0.51,95 ％ CI:0.37 ～ 0.64),cord blood 25 (OH)D levels at birth (pooled OR =0.94,95％ CI:0.9 ～ 0.98) were associated with childhood wheeze.Furthermore,maternal vitamin D stasus were only associated with childhood early wheeze(OR =0.92,95％ CI:0.89 ～0.96),but not with late-onset or persistent wheeze.Conclusion High levels of vitamin D during pregnancy are inversely associated with the risk of wheeze during childhood.