Impact of vitamin D supplementation on the outcome of tuberculosis treatment: a systematic review and meta-analysis of randomized controlled trials
Impact of vitamin D supplementation on the outcome of tuberculosis treatment: a systematic review and meta-analysis of randomized controlled trials
复制标题
补充维生素 D 对结核病治疗结果的影响：随机对照试验的系统评价和荟萃分析
DOI：
10.3760/cma.j.issn.0366-6999.20140702
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发表时间：
2014-09-05
影响因子：
6.1
通讯作者：
Xu Feng
中科院分区：
文献类型：
--
作者：
Xia Jingyan;Shi Liyun;Xu Feng
背景维生素D补充剂被认为对结核病(TB)患者的治疗是有益的，然而，临床试验的结果尚不确定。方法我们对截至2013年12月发表的MEDLINE、EMBASE、Cochrane中央对照试验登记、Springer、EBSCO、Pro Quest、High Wire Press和Web of Science进行了系统的文献检索。我们单独检查引文，并独立提取数据。我们使用随机效应模型估计了合并风险比(RR)和95%可信区间(CI)。我们还使用Jadad量表评估了偏倚的风险，并使用等级评估了证据的质量。我们纳入了所有随机对照试验，比较维生素D与标准结核病治疗或安慰剂治疗前后的差异。结果在我们的Meta分析中共分析了5项研究，涵盖了841例新诊断的结核病病例。接受维生素D补充的患者在抗结核治疗6周后，痰涂片或培养阳性的风险比对照组降低39%，尽管这不具有统计学意义(合并RR为0.61，95%CI为0.24至1.56，P=0.30)。补充维生素D组治疗8周后，除血清维生素D水平升高外，未发现其他与维生素D相关的不良反应。结论Meta分析结果表明，补充维生素D对结核病的治疗似乎没有任何益处。未来需要进行严格的随机对照试验，以探索补充维生素D是否可以缩短治疗时间，并确认维生素D受体的多态性是否具有任何潜在的有益影响。
Background Vitamin D supplementation is believed to be beneficial in the treatment of patients with tuberculosis (TB), however, results from clinical trials have been inconclusive.Methods We performed a systematic literature search across MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, Springer, EBSCO, Pro Quest, High Wire Press, and Web of Science, published as of December 2013. We individually inspected citations and extracted data independently. We estimated pooled risk ratios (RR) and 95% confidence intervals (CI) using random-effect models. We also assessed risk of bias using the Jadad scale and the quality of the evidence using GRADE. We included all randomized controlled trials comparing vitamin D with or without standard TB therapy or placebo.Results A total of five studies were analyzed in our meta analysis covering 841 newly-diagnosed TB cases. Patients receiving vitamin D supplementation had a 39% reduced risk of sputum smear or culture positive after six weeks of anti-TB treatment than those in the control group, although this is not statistically significant (pooled RR 0.61, 95% CI 0.24 to 1.56, P=0.30). Apart from an increased serum vitamin D level in the supplement group after eight weeks of treatment there was no evidence of any additional adverse effects related to vitamin D.Conclusions The meta analysis results indicate that vitamin D supplementation does not seem to have any beneficial effect in the treatment of TB. Future rigorous randomized controlled trials are needed to explore whether the supplementation of vitamin D could shorten treatment duration and to confirm whether the polymorphisms of vitamin D receptor have any potentially beneficial effect.