CAJ | 학술논문

目的：评价甲状腺癌根治术后口服钙剂和维生素D预防低钙血症的有效性。方法检索国内外有关甲状腺癌根治术后使用钙剂和维生素D预防低钙血症的所有随机对照试验，由两名评价者分别按Cochrane 系统评价方法对文献进行质量评价和提取资料，采用RevMan 5．2统计软件进行Meta 分析。结果共纳入4个随机对照试验，459例患者。结果显示术后服用钙剂联合维生素D组与单纯服用钙剂组、非干预组相比在术后早期即可明显提高血清钙水平，降低患者低钙血症的发生率。术后服用钙剂联合维生素D 组、单纯钙剂组、非干预组三组患者在甲状旁腺激素水平上差异无统计学意义。术后口服钙剂联合维生素D 组与非干预组相比，联合治疗组可以降低患者出现低钙血症临床症状的几率[相对危险度0．23，95％可信区间（0．09，0．56），P＝0．001]。与非干预组相比，术后早期服用钙剂联合维生素D [相对危险度0．15，95％可信区间（0．03，0．80），P＝0．03]和单纯服用钙剂[相对危险度0．24，95％可信区间（0．06，0．91），P＝0．04]都可以降低患者需要静脉补钙剂的几率。结论与单纯服用钙剂和非干预组相比，甲状腺癌根治术后早期服用钙剂和维生素 D 能很好地预防患者低钙血症的发生和临床症状的出现，降低患者需要静脉补钙剂的几率，由于纳入的文献较少，需要更多大样本的随机对照试验进一步证实。
목적：평개갑상선암근치술후구복개제화유생소D예방저개혈증적유효성。방법검색국내외유관갑상선암근치술후사용개제화유생소D예방저개혈증적소유수궤대조시험，유량명평개자분별안Cochrane 계통평개방법대문헌진행질량평개화제취자료，채용RevMan 5．2통계연건진행Meta 분석。결과공납입4개수궤대조시험，459례환자。결과현시술후복용개제연합유생소D조여단순복용개제조、비간예조상비재술후조기즉가명현제고혈청개수평，강저환자저개혈증적발생솔。술후복용개제연합유생소D 조、단순개제조、비간예조삼조환자재갑상방선격소수평상차이무통계학의의。술후구복개제연합유생소D 조여비간예조상비，연합치료조가이강저환자출현저개혈증림상증상적궤솔[상대위험도0．23，95％가신구간（0．09，0．56），P＝0．001]。여비간예조상비，술후조기복용개제연합유생소D [상대위험도0．15，95％가신구간（0．03，0．80），P＝0．03]화단순복용개제[상대위험도0．24，95％가신구간（0．06，0．91），P＝0．04]도가이강저환자수요정맥보개제적궤솔。결론여단순복용개제화비간예조상비，갑상선암근치술후조기복용개제화유생소 D 능흔호지예방환자저개혈증적발생화림상증상적출현，강저환자수요정맥보개제적궤솔，유우납입적문헌교소，수요경다대양본적수궤대조시험진일보증실。
Objective To evaluate the efficacy of oral Calcium and Vitamin D supplements in prevention of hypocalcemia after total thyroidectomy through a meta analysis. Methods All randomized controlled trials (RCTs) of oral Calcium and Vitamin D for the prevention of hypocalcemia after total thyroidectomy were collected. The quality of included RCTs was assessed and relevant data were selected according to the standard of Cochrane systematic review by two reviewers. Statistical software RevMan 5.2 was used for meta analysis. Results Four randomized controlled trials with 459 cases were included. The results showed that early and combined administration of both oral Calcium and Vitamin D can improve the serum Calcium levels higher than those of patients who received only oral Calcium or no supplements. The incidence of hypocalcemia was significantly lower after combined oral Calcium and Vitamin D than no supplements [RR=0.32,95%CI(0.17,0.59),P=0.000 3]. There was no significant difference in PTH levels among the three groups. Compared with no supplements after total thyroidectomy , combined with oral Calcium and Vitamin D can prevent symptomatic hypocalcemia [RR=0.23, 95%CI (0.09,0.56), P=0.001]. The patients who need intravenous Calcium after combined oral Calcium and Vitamin D [RR=0.15, 95%CI(0.03,0.80), P=0.03] or only oral Calcium [RR=0.24,95%CI(0.06,0.91), P=0.04] were significantly fewer than those with no supplements total thyroidectomy. Conclusion Current evidence indicates that early and combined administration of both oral Calcium and Vitamin D can improve the serum Calcium and prevent symptomatic hypocalcemia more effectively than merely oral Calcium or no supplements. Because of limited studies, more high quality randomized controlled trials with larger samples are required to get further confirmation.