Xie Dongmei, Liao Yulin, Yue Jirong, Zhang Chao, Wang Yanyan, Deng Chuanyao, Chen Ling
National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University.
Department of Geriatrics, West China Hospital, Sichuan University, Chengdu, China.
BMJ Open. 2018 Mar 6;8(3):e017883. doi: 10.1136/bmjopen-2017-017883.
To compare the effectiveness of five kinds of selenium supplementation for the treatment of patients with Kashin-Beck disease, and rank these selenium supplementations based on their performance.
We searched for all publications between 1 January 1966 and 31 March 2017 using seven electronic databases. GRADE system to network meta-analyses (NMAs) was applied to rate the quality of the evidence. We conducted a random effects model NMA in STATA 12.1 to determine comparative effectiveness of each intervention. Rankings were obtained by using the surface under the cumulative ranking curve (SUCRA) values and mean ranks.
A total of 15 randomised controlled trials involving 2931 patients were included. After assessment of the overall quality of the evidence, we downgraded our primary outcomes from high to low or very low quality. NMAs showed that all five kinds of selenium supplementation had higher metaphysis X-ray improvement which were superior to placebo. Ranking on efficacy indicated that selenium salt was ranked the highest, followed by sodium selenite + vitamin E, selenium enriched yeast, sodium selenite and then sodium selenite + vitamin C.
Based on the results of NMA, all five types of selenium supplements are more effective than placebo and so that selenium supplementation is of help in repairing metaphyseal lesions. Since the overall quality of the evidence was low or very low, the SUCRA values may be misleading and should be considered jointly with the The Grading of Recommendations Assessment, Development and Evaluation (GRADE) confidence in the estimates for each comparison. The quality of the evidence is insufficient to draw a conclusion about what method of selenium supplementation is most effective.
CRD42016051874.
比较五种补硒方式治疗大骨节病患者的有效性，并根据其表现对这些补硒方式进行排序。
我们使用七个电子数据库检索了1966年1月1日至2017年3月31日期间的所有出版物。采用GRADE系统进行网状Meta分析（NMA）以评估证据质量。我们在STATA 12.1中进行随机效应模型NMA以确定每种干预措施的比较有效性。通过累积排序曲线下面积（SUCRA）值和平均秩次获得排序结果。
共纳入15项随机对照试验，涉及2931例患者。在评估证据的整体质量后，我们将主要结局从高质量降为低质量或极低质量。NMA显示，所有五种补硒方式在干骺端X线改善方面均高于安慰剂组，效果更佳。疗效排序表明，硒盐排名最高，其次是亚硒酸钠+维生素E、富硒酵母、亚硒酸钠，然后是亚硒酸钠+维生素C。
基于NMA结果，所有五种类型的硒补充剂均比安慰剂更有效，因此补硒有助于修复干骺端病变。由于证据的整体质量较低或极低，SUCRA值可能会产生误导，应与推荐分级评估、制定和评价（GRADE）对各比较估计值的置信度一起综合考虑。证据质量不足以得出哪种补硒方法最有效的结论。
PROSPERO注册号：CRD42016051874。
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