CAJ | 학술논문

目的通过荟萃分析评价联合应用叶酸、维生素B6和维生素B12降低同型半胱氨酸水平是否会影响心血管疾病的发生风险.方法通过检索Embase、Pubmed、Ovid、Biosis、中国知网期刊数据库(CNKI)、万方、维普中文科技期刊数据库(VIP)、中国生物医学文献数据库(CBM),获得1994年2月至2014年2月发表的有关叶酸、维生素B6和维生素B12联合应用影响心血管疾病发生风险的随机对照试验(分为维生素组与安慰剂组).由2位研究者按照纳入和排除标准独立选择文献、提取资料和评价质量,采用Review Manager 5.2软件进行荟萃分析.采用漏斗图及Egger检验评价发表偏倚.结果共纳入12篇文献和34 481例研究对象.纳入研究的发表偏倚较小(漏斗图示研究处于漏斗图顶部,分布均匀,左右对称;Egger检验P＞0.10),异质性较低(卡方检验,I2＜50％).各项研究维生素组与安慰剂组的基础同型半胱氨酸水平差异均无统计学意义(P均＞0.05),随访期间维生素组同型半胱氨酸水平均低于安慰剂组(P均＜0.05).荟萃分析显示,维生素组与安慰剂组之间的心血管事件、冠心病、心肌梗死和心因性死亡发生率差异均无统计学意义,其RR(95％ CI)分别为0.98(0.93 ～ 1.03)、0.97(0.87 ～1.07)、1.00(0.92 ～ 1.08)和0.92(0.82 ～ 1.03).结论叶酸、维生素B6和维生素B12联合应用可以降低心血管病或高危患者的同型半胱氨酸水平,但是不能降低心血管疾病的发生风险,不推荐联合使用叶酸、维生素B6和维生素B12作为心血管疾病的二级预防措施.
목적 통과회췌분석평개연합응용협산、유생소B6화유생소B12강저동형반광안산수평시부회영향심혈관질병적발생풍험.방법 통과검색Embase、Pubmed、Ovid、Biosis、중국지망기간수거고(CNKI)、만방、유보중문과기기간수거고(VIP)、중국생물의학문헌수거고(CBM),획득1994년2월지2014년2월발표적유관협산、유생소B6화유생소B12연합응용영향심혈관질병발생풍험적수궤대조시험(분위유생소조여안위제조).유2위연구자안조납입화배제표준독립선택문헌、제취자료화평개질량,채용Review Manager 5.2연건진행회췌분석.채용루두도급Egger검험평개발표편의.결과 공납입12편문헌화34 481례연구대상.납입연구적발표편의교소(루두도시연구처우루두도정부,분포균균,좌우대칭;Egger검험P＞0.10),이질성교저(잡방검험,I2＜50％).각항연구유생소조여안위제조적기출동형반광안산수평차이균무통계학의의(P균＞0.05),수방기간유생소조동형반광안산수평균저우안위제조(P균＜0.05).회췌분석현시,유생소조여안위제조지간적심혈관사건、관심병、심기경사화심인성사망발생솔차이균무통계학의의,기RR(95％ CI)분별위0.98(0.93 ～ 1.03)、0.97(0.87 ～1.07)、1.00(0.92 ～ 1.08)화0.92(0.82 ～ 1.03).결론 협산、유생소B6화유생소B12연합응용가이강저심혈관병혹고위환자적동형반광안산수평,단시불능강저심혈관질병적발생풍험,불추천연합사용협산、유생소B6화유생소B12작위심혈관질병적이급예방조시.
Objective To evaluate the effects of folic acid,vitamin B6 and B12 supplementation on plasma homocysteine level and risk of cardiovascular disease.Methods The databases,including Embase,Pubmed,Ovid,Biosis,China National Knowledge Infra-structure(CNKI),Wanfang Data,VIP Database for Chinese Technical Periodical (VIP),Chinese Biomedical Literature Database (CMB),were searched to identify random control trials between February 1994 to February 2014 on the effect of folic acid,vitamin B6 and B12 supplementation on plasma homocysteine level and risk of cardiovascular disease.The screening,data extraction and quality assessment were conducted in accordance with the inclusion and exclusion criteria by two reviewers independently.The software Review Manager 5.2 was used.Funnel plots and Egger's regression test were applied to evaluate the publication bias.Results Data from 12 studies including 34 481 patients were analyzed using a fixed-effects model.Funnel plot and Egger's test(P ＞ 0.10) confirmed the absence of publication bias.No statistically significant heterogeneity was detected on testing after excluding the sources of heterogeneity (chi-square test,I2 ＜ 50％).Baseline homocysteine levels were similar between the placebo and folic acid,vitamin B6 and B12 groups (all P ＞ 0.05).Mean homocysteine levels were significantly lower with folic acid,vitamin B6 and B12 therapy compared with placebo during follow-up (all P ＜ 0.05).The pooled relative risks with 95％ confidence intervals of outcomes for patients treated with folic acid,vitamin B6 and B12 supplementation compared with placebo were 0.98 (0.93-1.03) for cardiovascular event,0.97 (0.87-1.07) for coronary artery disease,1.00 (0.92-1.08) for myocardial infarction and 0.92(0.82-1.03) for cardiovascular death.Conclusions Folic aicd combined with vitamin B6 and B12 treatment significantly reduced plasma homocysteine level,but did not affect the risk of cardiovascular disease.Thus,folic acid combined with vitamin B6 and B12 should not be recommended as secondary prevention of cardiovascular diseases.