Shi Chun-hu, Tian Hong-liang, Tian Jin-hui, Zeng Rong, Yang Ke-hu, Wu Tai-xiang, Liao Yong-jian
School of Basic Medical Sciences, Lanzhou University, Lanzhou, China.
Zhonghua Liu Xing Bing Xue Za Zhi. 2013 May;34(5):507-14.
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.
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 JJ, et al, respectively. Data was extracted independently.
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 non-treatment group (RR = 3.98, 95%CI: 2.25 - 7.05). Comprehensive intervention program and 'grain drying approach' also showed certain effects.
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.
系统评价不同补硒方案用于防治儿童大骨节病（KBD）的疗效。
电子检索PubMed、EMBASE、Cochrane图书馆、SCI扩展版、中国知网（CNKI）、维普中文科技期刊数据库（VIP）、中国生物医学文献数据库（CBM）、万方数据库、中国科学引文数据库（CSCD）。所有检索过程更新至2012年12月，以识别随机对照试验（RCT）和非随机对照试验，比较补硒方案与安慰剂或无干预措施。两名评价员分别根据《Cochrane系统评价干预措施手册》5.1版或Deeks JJ等人描述的清单评估研究设计的方法学质量。数据独立提取。
纳入14篇RCT和12篇非RCT论文，但方法学质量较低。Meta分析数据显示，补硒取得了以下进展：与安慰剂组或未治疗组相比，放射学改善（RR = 3.28，95%CI：2.06 - 5.22）、头发硒含量升高（SMD = 2.05，95%CI：1.00 - 3.11）、新的放射学病变减少（OR = 0.18，95%CI：0.09 - 0.36）。补硒和补充维生素C在干骺端放射学改善方面无差异（RR = 1.01，95%CI：0.84 - 1.22）。硒与维生素E联合补充显示出比安慰剂组更高的放射学改善。硒与维生素C联合补充在放射学改善或头发硒含量差异方面与单独补硒相比无影响。富硒酵母的放射学改善高于亚硒酸钠（70.83%对48.84%，P < 0.05）。施硒的放射学改善高于未治疗组（RR = 3.98，95%CI：2.25 - 7.05）。综合干预方案和“粮食干燥法”也显示出一定效果。
补硒可带来更好的放射学改善和头发硒含量，新的放射学病变减少。现有证据支持其在防治大骨节病方面的益处。仍有必要进行大样本、设计良好的试验并报告不良结局。
