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维生素 D 补充治疗慢性心力衰竭的荟萃分析。

Meta-analysis of vitamin D supplementation in the treatment of chronic heart failure.

机构信息

a Department of Gerontology , Shaanxi Provincial People's Hospital , Xi'an , China.

b Department of Intensive Care Unit , Shaanxi Provincial People's Hospital , Xi'an , China.

出版信息

Scand Cardiovasc J. 2019 Jun;53(3):110-116. doi: 10.1080/14017431.2019.1612084. Epub 2019 May 15.

Abstract

. We performed a meta-analysis to determine whether vitamin D supplementation is beneficial in patients with chronic heart failure (CHF). . Meta-analysis of randomised controlled trials. . Vitamin D supplementation in patients with CHF improved health-related quality of life and C-reactive protein levels [weighted mean difference (WMD): 6.75, 95% confidence interval (CI): 2.87 to 10.64,  < .001; standardised mean difference (SMD): -0.41, 95% CI: -0.71 to -0.11,  = .007]. However, this supplementation was not superior to conventional treatment in terms of mortality, changes in left ventricular ejection fraction (ΔLVEF), N-terminal pro-B-type natriuretic peptide or B-type natriuretic peptide levels, and 6-minute walk distance (risk ratio: 1.11, 95% CI: 0.79 to 1.57,  = .53; WMD: 2.56, 95% CI: -2.18 to 7.31,  = .29; SMD: -0.18, 95% CI: -0.42 to 0.06,  = .15; WMD: -23.30, 95% CI: -58.31 to 11.72,  = .19). In contrast, ΔLVEF significantly improved (WMD: 6.75, 95% CI: 4.16 to 9.34,  < .001) in the subgroup without calcium supplementation. Additionally, some randomised controlled trials showed that adverse events were more frequent in people with high vitamin D levels. . Vitamin D supplementation decreases serum levels of inflammatory markers and improves quality of life in CHF patients. Pooled analysis of vitamin D supplementation did not show reduced mortality or improved left ventricular function perhaps because of excessive increase in plasma 25-hydroxyvitamin D and calcium levels. Future studies should pay attention to vitamin D and calcium levels achieved.

摘要

. 我们进行了一项荟萃分析,以确定维生素 D 补充剂是否对慢性心力衰竭(CHF)患者有益。. 随机对照试验的荟萃分析。. 补充维生素 D 可改善 CHF 患者的健康相关生活质量和 C 反应蛋白水平[加权均数差(WMD):6.75,95%置信区间(CI):2.87 至 10.64, < 0.001;标准化均数差(SMD):-0.41,95%CI:-0.71 至 -0.11, = 0.007]。然而,在死亡率、左心室射血分数(ΔLVEF)变化、N 末端 pro-B 型利钠肽或 B 型利钠肽水平以及 6 分钟步行距离方面,这种补充并不优于常规治疗(风险比:1.11,95%CI:0.79 至 1.57, = 0.53;WMD:2.56,95%CI:-2.18 至 7.31, = 0.29;SMD:-0.18,95%CI:-0.42 至 0.06, = 0.15;WMD:-23.30,95%CI:-58.31 至 11.72, = 0.19)。相反,在没有钙补充的亚组中,ΔLVEF 显著改善(WMD:6.75,95%CI:4.16 至 9.34, < 0.001)。此外,一些随机对照试验表明,维生素 D 水平较高的人发生不良事件的频率更高。. 维生素 D 补充剂可降低 CHF 患者的血清炎症标志物水平并改善生活质量。荟萃分析显示,维生素 D 补充剂并未降低死亡率或改善左心室功能,这可能是由于血浆 25-羟维生素 D 和钙水平过度升高所致。未来的研究应注意达到的维生素 D 和钙水平。

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