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维生素D补充剂治疗慢性心力衰竭:随机对照试验的荟萃分析

Vitamin D Supplementation in the Treatment of Chronic Heart Failure: A Meta-analysis of Randomized Controlled Trials.

作者信息

Jiang Wei-Long, Gu Hai-Bo, Zhang Yu-Feng, Xia Qing-Qing, Qi Jia, Chen Jian-Chang

机构信息

Department of Respiration, Jiangyin Hospital of Traditional Chinese Medicine Affiliated to Nanjing University of Chinese Medicine, Jiangyin, China.

Department of Cardiology, The Second Affiliated Hospital of Soochow University, Suzhou, China.

出版信息

Clin Cardiol. 2016 Jan;39(1):56-61. doi: 10.1002/clc.22473. Epub 2015 Sep 28.

Abstract

BACKGROUND

In recent years, there has been growing evidence that vitamin D deficiency is associated with the development and progression of chronic heart failure (CHF).

HYPOTHESIS

Additional supplementation of vitamin D may have protective effects in patients with CHF.

METHODS

We searched PubMed, Embase, and Cochrane databases through June 2015 and included 7 randomized controlled trials that investigated the effects of vitamin D on cardiovascular outcomes in patients with CHF. Then, we performed a meta-analysis of clinical trials to confirm whether vitamin D supplementation is beneficial in CHF patients. The weighted mean difference (WMD) and 95% confidence interval (CI) were calculated using fixed- or random-effects models.

RESULTS

Our pooled results indicated that additional supplementation of vitamin D was not superior to conventional treatment in terms of left ventricular ejection fraction, N-terminal pro-B-type natriuretic peptide, and 6-minute walk distance. Moreover, vitamin D supplementation was associated with significant decreases in the levels of tumor necrosis factor-α (WMD: -2.42 pg/mL, 95% CI: -4.26 to -0.57, P < 0.05), C-reactive protein (WMD: -0.72 mg/L, 95% CI: -1.42 to -0.02, P < 0.05), and parathyroid hormone (WMD: -13.44 pg/mL, 95% CI: -21.22 to -5.67, P < 0.05).

CONCLUSIONS

Vitamin D supplementation may decrease serum levels of parathyroid hormone and inflammatory mediators in CHF patients, whereas it has no beneficial effects on improvement of left ventricular function and exercise tolerance.

摘要

背景

近年来,越来越多的证据表明维生素D缺乏与慢性心力衰竭(CHF)的发生和发展有关。

假设

额外补充维生素D可能对CHF患者具有保护作用。

方法

我们检索了截至2015年6月的PubMed、Embase和Cochrane数据库,纳入了7项研究维生素D对CHF患者心血管结局影响的随机对照试验。然后,我们对这些临床试验进行荟萃分析,以确定补充维生素D对CHF患者是否有益。使用固定效应或随机效应模型计算加权平均差(WMD)和95%置信区间(CI)。

结果

我们的汇总结果表明,在左心室射血分数、N末端B型利钠肽原和6分钟步行距离方面,额外补充维生素D并不优于传统治疗。此外,补充维生素D与肿瘤坏死因子-α水平显著降低(WMD:-2.42 pg/mL,95%CI:-4.26至-0.57,P<0.05)、C反应蛋白水平显著降低(WMD:-0.72 mg/L,95%CI:-1.42至-0.02,P<0.05)以及甲状旁腺激素水平显著降低(WMD:-13.44 pg/mL,95%CI:-21.22至-5.67,P<0.05)相关。

结论

补充维生素D可能降低CHF患者的甲状旁腺激素和炎症介质血清水平,而对改善左心室功能和运动耐量没有有益影响。

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