CAJ | 학술논문

目的：采用Meta分析对联合补充钙剂、维生素D与单用维生素D或钙剂治疗佝偻病疗效进行定量评价。方法检索Cochrance Library、Pubmed、Web of science、Scirus、中国期刊全文数据库、中国生物医学文献数据库和万方数据库，检索时间均从建库至2013年3月。获得维生素D和钙剂治疗营养性佝偻病相关的RCT文献。选取血清25-( OH)维生素-D3、磷、ALP作为主要测量指标，选取钙、甲状旁腺素、白蛋白、影像评分作为次要测量指标。采用Review Manage 5．0．2对纳入的RCT文献进行Meta分析。结果共检索到437篇文献，对符合纳入标准的3篇文献(n=218)进入Meta分析。 Meta分析结果显示：(1)血清25-(OH)维生素 D3上升程度：联合治疗组与维生素 D 组 MD =-7．88(95%CI：-12．24~-3．52)；联合治疗组与钙剂组MD=-18．32(95%CI：-22．61~-14．04)；(2)血清磷上升程度：联合治疗组与维生素D组MD=-0．64(95%CI：-0．86~-0．42)；联合治疗组与钙剂组MD=-0．16(95%CI：-0．84~0．51)；(3)血清 ALP 下降程度：联合治疗组与维生素 D 组 MD =109．99(95%CI：20．40~199．58)；联合治疗组与钙剂组MD=59．89(95%CI：10．09~109．59)。(4)血清钙上升程度：联合治疗组与维生素D组MD=-0．71(95%CI：-0．91~-0．52)；影像学评分下降程度：联合治疗组与维生素D组MD=0．68(95%CI：0．42~0．95)。以上指标除联合治疗组与钙剂组对血清磷的上升程度差异无统计学意义外，其余差异均具有统计学意义。结论维生素D联合钙剂长期联合治疗佝偻病的疗效要优于单用维生素D或钙剂。
목적：채용Meta분석대연합보충개제、유생소D여단용유생소D혹개제치료구루병료효진행정량평개。방법검색Cochrance Library、Pubmed、Web of science、Scirus、중국기간전문수거고、중국생물의학문헌수거고화만방수거고，검색시간균종건고지2013년3월。획득유생소D화개제치료영양성구루병상관적RCT문헌。선취혈청25-( OH)유생소-D3、린、ALP작위주요측량지표，선취개、갑상방선소、백단백、영상평분작위차요측량지표。채용Review Manage 5．0．2대납입적RCT문헌진행Meta분석。결과공검색도437편문헌，대부합납입표준적3편문헌(n=218)진입Meta분석。 Meta분석결과현시：(1)혈청25-(OH)유생소 D3상승정도：연합치료조여유생소 D 조 MD =-7．88(95%CI：-12．24~-3．52)；연합치료조여개제조MD=-18．32(95%CI：-22．61~-14．04)；(2)혈청린상승정도：연합치료조여유생소D조MD=-0．64(95%CI：-0．86~-0．42)；연합치료조여개제조MD=-0．16(95%CI：-0．84~0．51)；(3)혈청 ALP 하강정도：연합치료조여유생소 D 조 MD =109．99(95%CI：20．40~199．58)；연합치료조여개제조MD=59．89(95%CI：10．09~109．59)。(4)혈청개상승정도：연합치료조여유생소D조MD=-0．71(95%CI：-0．91~-0．52)；영상학평분하강정도：연합치료조여유생소D조MD=0．68(95%CI：0．42~0．95)。이상지표제연합치료조여개제조대혈청린적상승정도차이무통계학의의외，기여차이균구유통계학의의。결론유생소D연합개제장기연합치료구루병적료효요우우단용유생소D혹개제。
Objective To assess the efficacy of combined vitamin D with calcium and vitamin D or cal-cium alone in rickets of vitamin D deficiency by meta-analysis method. Methods Searches were made in Cochrance Library , Pubmed, Web of science, Scirus, CNKI, Chinese Biological Medical Literature Database, (CBM),Wangfang from the establishment of the data base till March 2013. All randomized controlled trials about combined with vitamin D and calcium in rickets of vitamin D deficiency were eligible. Serum 25-( OH) ritamin D,phosphate ,ALP,calcium,PTH,phosphate,albumin ,radiographic score were chosen as evaluation in-dex to evaluate the weighted mean diffreence ( WMD) and 95% confidence interval ( CI) for continuous data. RevMan 5. 0. 2 software was used to make meta-analysis. Results 437 literatures were reviewed. Three eligible trials were used for meta-analysis. Meta-analysis showed that:(1)the increase of Serum 25-(OH)vitamin D:Combined therapy group and vitamin D group (MD= -7. 88,95%CI:-12. 24~ -3. 52);Combined therapy group and calcium group (MD= -18. 32,95%CI:-22. 61~ -14. 04). (2)the increase of serum phosphate:Combined therapy group and vitamin D group ( MD= -0. 64 ( 95%CI:-0. 86 ~ -0. 42 );Combined therapy group and calcium group MD= -0. 16 ( 95%CI:-0. 84 ~0. 51 ) . ( 3 ) the decrease of Serum ALP:Combined therapy group and vitamin D group (MD= 109. 99,95%CI:20. 40 ~199. 58);Combined therapy group and calcium group (MD=59. 89,95%CI:10. 09~109. 59 ). (4)the increase of serum calcium :Combined therapy group and vitamin D group (MD= -0. 71,95%CI:-0. 91,-0. 52);the decrease of Radiographic score:Com-bined therapy group and vitamin D group( MD=0. 68,95%CI:0. 42~ 0. 95). Except that the increase of serum phosphate between combined therapy group and calcium group had no significant difference,the rest had signifi-cant difference. Conclusion The long term efficacy in combined therapy group is much effective than vitamin D group or calcium group.