足月儿营养性佝偻病的预防干预措施。
Interventions for the prevention of nutritional rickets in term born children.
作者信息
Lerch C, Meissner T
机构信息
Universitaetsklinikum Duesseldorf, Heinrich-Heine University, Department of General Practice, Metabolic and Endocrine Disorders Group, Moorenstr. 5, Duesseldorf, Germany, 40225.
出版信息
Cochrane Database Syst Rev. 2007 Oct 17;2007(4):CD006164. doi: 10.1002/14651858.CD006164.pub2.
BACKGROUND
Nutritional rickets is a disease of growing children leading to bone deformities, bone pain, convulsions or delayed motor development. Today, high-incidence of nutritional rickets is mainly found in low-income countries.
OBJECTIVES
To assess the effects of various interventions on the prevention of nutritional rickets in term born children.
SEARCH STRATEGY
Studies were obtained from computerised searches of The Cochrane Library, MEDLINE, EMBASE, LILACS and reference lists of relevant articles. We contacted authors of studies or reviews to obtain further studies.
SELECTION CRITERIA
Studies were included if they were randomised controlled clinical trials, controlled clinical trials or prospective cohort studies comparing any intervention for the prevention of nutritional rickets in term born children with placebo or no intervention. Minimum duration of the intervention was three months for children under 12 months or six months for children over 12 months.
DATA COLLECTION AND ANALYSIS
Two authors independently extracted data and assessed study quality. Authors of studies were contacted to obtain missing information.
MAIN RESULTS
Four studies enrolled approximately 1700 participants. Trials lasted between nine months to two years. Three studies were randomised controlled trials, two of which showed a cluster randomised design; one trial probably was a controlled trial with researcher controlled group assignment. In children up to three years of age in Turkey, Vitamin D compared to no intervention showed a relative risk of 0.04 (95% confidence interval (CI) 0 to 0.71). Despite a marked non-compliance, a Chinese trial in children up to three years of age comparing a combined intervention of supplementation of vitamin D, calcium and nutritional counseling showed a relative risk of 0.76 (95% CI 0.61 to 0.95) compared to no intervention. In two studies conducted in older children in China and in France no rickets occurred in both the intervention and control group.
AUTHORS' CONCLUSIONS: There a only few studies on the prevention of nutritional rickets in term born children. Until new data become available, it appears sound to offer preventive measures (vitamin D or calcium) to groups of high risk, like infants and toddlers; children living in Africa, Asia or the Middle East or migrated children from these regions into areas where rickets is not frequent. Due to a marked clinical heterogeneity and the scarcity of data, the main and adverse effects of preventive measures against nutritional rickets should be investigated in different countries, different age groups and in children of different ethnic origin.
背景
营养性佝偻病是一种发生于成长中儿童的疾病，可导致骨骼畸形、骨痛、惊厥或运动发育迟缓。如今，营养性佝偻病的高发病率主要见于低收入国家。
目的
评估各种干预措施对足月儿预防营养性佝偻病的效果。
检索策略
通过计算机检索Cochrane图书馆、MEDLINE、EMBASE、LILACS以及相关文章的参考文献列表获取研究。我们联系了研究或综述的作者以获取更多研究。
入选标准
纳入的研究需为随机对照临床试验、对照临床试验或前瞻性队列研究，比较任何用于预防足月儿营养性佝偻病的干预措施与安慰剂或不干预的效果。12个月以下儿童的干预最短持续时间为3个月，12个月以上儿童为6个月。
数据收集与分析
两位作者独立提取数据并评估研究质量。联系研究的作者以获取缺失信息。
主要结果
四项研究纳入了约1700名参与者。试验持续时间为9个月至2年。三项研究为随机对照试验，其中两项采用整群随机设计；一项试验可能是研究者分配对照组的对照试验。在土耳其3岁以下儿童中，维生素D组与不干预组相比，相对危险度为0.04（95%置信区间（CI）0至0.71）。尽管存在明显的不依从情况，但在中国一项针对3岁以下儿童的试验中，比较补充维生素D、钙及营养咨询的联合干预措施与不干预措施，相对危险度为0.76（95%CI 0.61至0.95）。在中国和法国针对较大儿童开展的两项研究中，干预组和对照组均未发生佝偻病。
作者结论
关于足月儿预防营养性佝偻病的研究很少。在有新数据可用之前，向高危人群（如婴幼儿；生活在非洲、亚洲或中东地区的儿童或从这些地区迁移至佝偻病不常见地区的儿童）提供预防措施（维生素D或钙）似乎是合理的。由于明显的临床异质性和数据稀缺，应在不同国家、不同年龄组以及不同种族儿童中研究预防营养性佝偻病措施的主要和不良影响。
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