维生素 D 补充对心血管疾病患者血糖控制、血脂谱和 C 反应蛋白的影响：一项随机对照试验的系统评价和荟萃分析。

The Effects of Vitamin D Supplementation on Glycemic Control, Lipid Profiles and C-Reactive Protein Among Patients with Cardiovascular Disease: a Systematic Review and Meta-Analysis of Randomized Controlled Trials.

机构信息

Research Center for Biochemistry and Nutrition in Metabolic Diseases, Kashan University of Medical Sciences, Kashan, Iran.

Students' Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran.

出版信息

Curr Pharm Des. 2019;25(2):201-210. doi: 10.2174/1381612825666190308152943.

DOI:10.2174/1381612825666190308152943

PMID:30854952

Abstract

BACKGROUND

Insulin resistance, dyslipidemia and chronic inflammation are important risk factors for cardiovascular diseases (CVD). Hence, vitamin D supplementation might be an appropriate approach to decrease the complications of CVD. This systematic review and meta-analysis aimed to determine the effects of vitamin D supplementation on glycemic control, lipid profiles, and C-reactive protein among patients with coronary artery disease.

METHODS

Two independent authors systematically searched online databases including EMBASE, Scopus, Pub- Med, Cochrane Library, and Web of Science until 20th September 2018. Cochrane Collaboration risk of bias tool was applied to assess the methodological quality of included trials. The heterogeneity among the included studies was assessed using Cochran's Q test and I-square (I2) statistic. Data were pooled using a random-effects model and weighted mean difference (WMD) was considered as the overall effect size.

RESULTS

A total of eight trials (305 participants in the intervention group and 325 in placebo group) were included in the current meta-analysis. Pooling effect sizes from studies revealed a significant reduction in fasting glucose (WMD): -15.67; 95% CI: -29.32, -2.03), insulin concentrations (WMD: -3.53; 95% CI: -4.59, -2.46) and homeostatic model assessment of insulin resistance (WMD: -1.07; 95% CI: -1.49, -0.66), and significant increase in the quantitative insulin-sensitivity check index (WMD: 0.02; 95% CI: 0.01, 0.03) following the administration of vitamin D. In addition, pooled analysis revealed a significant increase in serum HDL-cholesterol concentrations following vitamin D therapy (WMD: 3.08; 95% CI: 1.42, 4.73). Additionally, vitamin D supplementation significantly reduced C-reactive protein (CRP) levels (WMD: -0.75; 95% CI: -1.28, -0.23).

CONCLUSION

This meta-analysis demonstrated the beneficial effects of vitamin D supplementation on improving glycemic control, HDL-cholesterol and CRP levels among patients with CVD, though it did not affect triglycerides, total- and LDL-cholesterol levels.

摘要

背景

胰岛素抵抗、血脂异常和慢性炎症是心血管疾病（CVD）的重要危险因素。因此，维生素 D 补充可能是降低 CVD 并发症的一种合适方法。本系统评价和荟萃分析旨在确定维生素 D 补充对冠心病患者血糖控制、血脂谱和 C 反应蛋白的影响。

方法

两名独立作者系统地检索了在线数据库，包括 EMBASE、Scopus、PubMed、Cochrane 图书馆和 Web of Science，检索时间截至 2018 年 9 月 20 日。采用 Cochrane 协作偏倚风险工具评估纳入试验的方法学质量。使用 Cochran's Q 检验和 I 平方（I2）统计量评估纳入研究的异质性。使用随机效应模型汇总数据，并考虑加权均数差（WMD）作为总体效应量。

结果

共有八项试验（干预组 305 例，安慰剂组 325 例）纳入本次荟萃分析。对研究结果进行合并效应量分析显示，空腹血糖（WMD：-15.67；95%CI：-29.32，-2.03）、胰岛素浓度（WMD：-3.53；95%CI：-4.59，-2.46）和稳态模型评估的胰岛素抵抗（WMD：-1.07；95%CI：-1.49，-0.66）显著降低，定量胰岛素敏感性检查指数（WMD：0.02；95%CI：0.01，0.03）显著升高。此外，荟萃分析显示，维生素 D 治疗后血清高密度脂蛋白胆固醇浓度显著升高（WMD：3.08；95%CI：1.42，4.73）。此外，维生素 D 补充显著降低 C 反应蛋白（CRP）水平（WMD：-0.75；95%CI：-1.28，-0.23）。