Vitamin D supplementation to prevent acute respiratory tract infections: systematic review and meta-analysis of individual participant data.
Vitamin D supplementation to prevent acute respiratory tract infections: systematic review and meta-analysis of individual participant data.
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DOI：
10.1136/bmj.i6583
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发表时间：
2017-02-15
期刊：
影响因子：
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通讯作者：
Camargo CA Jr
中科院分区：
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作者：
Martineau AR;Jolliffe DA;Hooper RL;Greenberg L;Aloia JF;Bergman P;Dubnov-Raz G;Esposito S;Ganmaa D;Ginde AA;Goodall EC;Grant CC;Griffiths CJ;Janssens W;Laaksi I;Manaseki-Holland S;Mauger D;Murdoch DR;Neale R;Rees JR;Simpson S Jr;Stelmach I;Kumar GT;Urashima M;Camargo CA Jr
目的评估补充维生素D对急性呼吸道感染风险的总体影响，并确定影响这种影响的因素。设计：对随机对照试验的个体参与者数据（IPD）进行系统回顾和荟萃分析。数据来源Medline、Embase、对照试验科克伦中心登记处、Web of Science、ClinicalTrials.gov和国际标准随机对照试验编号登记处（从成立到2015年12月）。研究选择的合格标准补充维生素D3或维生素D2的随机、双盲、安慰剂对照试验，如果已获得研究伦理委员会的批准，并且前瞻性收集了急性呼吸道感染发生率的数据，并预先指定为疗效结局，则有资格入选。结果共纳入25个随机对照试验，共11321例受试者，年龄0 ~ 95岁。10933例（96.6%）参与者获得了IPD。补充维生素D可降低所有参与者的急性呼吸道感染风险（调整后的比值比为0.88，95%置信区间为0.81至0.96;异质性P <0.001）。在亚组分析中，在每日或每周接受维生素D而没有额外推注剂量的患者中观察到保护作用（校正比值比0.81，0.72至0.91），但在接受一次或多次推注剂量的患者中没有观察到保护作用（校正比值比0.97，0.86至1.10;相互作用P =0.05）。在每天或每周接受维生素D的患者中，基线25-羟基维生素D水平<25 nmol/L的患者（校正比值比0.30，0.17至0.53）的保护作用强于基线25-羟基维生素D水平≥25 nmol/L的患者（校正比值比0.75，0.60至0.95;相互作用P =0.006）。维生素D不影响至少发生一次严重不良事件的参与者比例（调整后的比值比为0.98，0.80至1.20，P=0.83）。有助于这些分析的大量证据被评估为高质量。结论补充维生素D对急性呼吸道感染的预防是安全的。非常缺乏维生素D的患者和那些没有接受大剂量的患者受益最大。系统综述注册PROSPERO CRD 42014013953。
Objectives To assess the overall effect of vitamin D supplementation on risk of acute respiratory tract infection, and to identify factors modifying this effect. Design Systematic review and meta-analysis of individual participant data (IPD) from randomised controlled trials. Data sources Medline, Embase, the Cochrane Central Register of Controlled Trials, Web of Science, ClinicalTrials.gov, and the International Standard Randomised Controlled Trials Number registry from inception to December 2015. Eligibility criteria for study selection Randomised, double blind, placebo controlled trials of supplementation with vitamin D3 or vitamin D2 of any duration were eligible for inclusion if they had been approved by a research ethics committee and if data on incidence of acute respiratory tract infection were collected prospectively and prespecified as an efficacy outcome. Results 25 eligible randomised controlled trials (total 11 321 participants, aged 0 to 95 years) were identified. IPD were obtained for 10 933 (96.6%) participants. Vitamin D supplementation reduced the risk of acute respiratory tract infection among all participants (adjusted odds ratio 0.88, 95% confidence interval 0.81 to 0.96; P for heterogeneity <0.001). In subgroup analysis, protective effects were seen in those receiving daily or weekly vitamin D without additional bolus doses (adjusted odds ratio 0.81, 0.72 to 0.91) but not in those receiving one or more bolus doses (adjusted odds ratio 0.97, 0.86 to 1.10; P for interaction=0.05). Among those receiving daily or weekly vitamin D, protective effects were stronger in those with baseline 25-hydroxyvitamin D levels <25 nmol/L (adjusted odds ratio 0.30, 0.17 to 0.53) than in those with baseline 25-hydroxyvitamin D levels ≥25 nmol/L (adjusted odds ratio 0.75, 0.60 to 0.95; P for interaction=0.006). Vitamin D did not influence the proportion of participants experiencing at least one serious adverse event (adjusted odds ratio 0.98, 0.80 to 1.20, P=0.83). The body of evidence contributing to these analyses was assessed as being of high quality. Conclusions Vitamin D supplementation was safe and it protected against acute respiratory tract infection overall. Patients who were very vitamin D deficient and those not receiving bolus doses experienced the most benefit. Systematic review registration PROSPERO CRD42014013953.