CAJ | 학술논문

目的系统评价大骨节病病区不同补硒方式对患病儿童的防治效果.方法计算机系统检索各中外文数据库及搜索引擎.全面收集有关各种补硒方法防治大骨节病的对照研究,检索时间截至2012年12月.对纳入研究进行质量评价,采用RevMan 5.1软件进行Meta分析.结果最终纳入14个随机对照试验,12个非随机对照试验,方法学质量均较低.Meta分析结果显示,与安慰剂或空白对照相比,单独补硒治疗能提高大骨节病患儿的X线有效率(RR=3.28,95％CI:2.06～5.22)及发硒水平(SMD=2.05,95％CI:1.00～ 3.11),且能降低新发病例(OR=0.18,95％CI:0.09～ 0.36)；单独补硒与单独补充维生素C的X线干骺端好转率的差异无统计学意义(RR=1.01,95％CI:0.84～1.22)；补硒联合维生素E治疗的X线有效率及发硒水平高于安慰剂组；与单独补硒相比,补硒联合维生素C在X线疗效和发硒水平上无明显差异；富硒酵母组的有效率(70.83％)高于亚硒酸钠(48.84％)(P＜0.05)；施硒肥组的X线有效率高于空白组(RR=3.98,95％CI:2.25～7.05),综合干预及晒粮等方法亦有一定效果.结论单独补硒可提高大骨节病患者X线有效率和发硒水平；维生素联合补硒效果优于单独补硒；富硒酵母的疗效优于单独补硒和对照组.
목적 계통평개대골절병병구불동보서방식대환병인동적방치효과.방법 계산궤계통검색각중외문수거고급수색인경.전면수집유관각충보서방법방치대골절병적대조연구,검색시간절지2012년12월.대납입연구진행질량평개,채용RevMan 5.1연건진행Meta분석.결과 최종납입14개수궤대조시험,12개비수궤대조시험,방법학질량균교저.Meta분석결과현시,여안위제혹공백대조상비,단독보서치료능제고대골절병환인적X선유효솔(RR=3.28,95％CI:2.06～5.22)급발서수평(SMD=2.05,95％CI:1.00～ 3.11),차능강저신발병례(OR=0.18,95％CI:0.09～ 0.36)；단독보서여단독보충유생소C적X선간후단호전솔적차이무통계학의의(RR=1.01,95％CI:0.84～1.22)；보서연합유생소E치료적X선유효솔급발서수평고우안위제조；여단독보서상비,보서연합유생소C재X선료효화발서수평상무명현차이；부서효모조적유효솔(70.83％)고우아서산납(48.84％)(P＜0.05)；시서비조적X선유효솔고우공백조(RR=3.98,95％CI:2.25～7.05),종합간예급쇄량등방법역유일정효과.결론 단독보서가제고대골절병환자X선유효솔화발서수평；유생소연합보서효과우우단독보서；부서효모적료효우우단독보서화대조조.
Objective To systematically assess the efficacy of different programs regarding the selenium supplementation formulae used for prevention and treatment of Kaschin-Beck disease (KBD) in children.Methods PubMed,EMBASE,Cochrane Library,SCI expanded,CNKI (Chinese National Knowledge Infrastructure),VIP (Chinese Science and Technique Journals Database),CBM (The Chinese Biomedical Database),Wanfang Database,CSCD (Chinese Science Citation Database)had been electronically searched.All the searching processes were up-dated to Dec 2012 to identify randomized trials (RCTs) and non-RCTs to compare the selenium supplementation formulae with placebo or with no intervention.Two reviewers assessed the methodological quality of the study design,including RCTs or non-RCTs according to Cochrane Handbook for Systematic Reviews of Interventions 5.1 or a checklist described by Deeks J J,et al,respectively.Data was extracted independently.Results There were 14 RCTs and 12 non-RCTs papers included,but showing low methodological quality.Data from Meta analysis showed that selenium supplementation had caused the following progresses:radiologic improvement (RR=3.28,95％CI:2.06-5.22),higher hair selenium (SMD=2.05,95％ CI:1.00-3.11) lower new radiologic lesions (OR=0.18,95％ CI:0.09-0.36) than in the placebo or with no treatment groups.Both selenium and vitamin C supplementation did not show differences in radiologic improvement of metaphysis (RR=1.01,95％CI:0.84-1.22).Combination of selenium and vitamin E supplementation showed higher radiologic improvement than the placebo group.Combination of selenium and vitamin C supplementation had no influence on the difference in radiologic improvement or hair selenium than selenium supplementation.Selenium-enriched yeast showed higher radiologic improvement than sodium selenite (70.83％ vs.48.84％,P＜0.05).Selenium fertilization showed higher radiologic improvement than the nontreatment group (RR=3.98,95％ CI:2.25-7.05).Comprehensive intervention program and ‘grain drying approach' also showed certain effects.Conclusion Selenium supplementation could lead to better radiologic improvement and hair selenium,with lower new radiologic lesions.Current evidence supported its benefits on prevention and treatment of KBD.Large sample sized and well-designed trials together with the reporting on adverse outcome remained necessary.