维生素 D 治疗对慢性肾脏病患者血糖控制、血脂谱和 C 反应蛋白的影响：系统评价和随机对照试验的荟萃分析。
The effects of vitamin D treatment on glycemic control, serum lipid profiles, and C-reactive protein in patients with chronic kidney disease: a systematic review and meta-analysis of randomized controlled trials.
机构信息
Students' Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran.
Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran.
出版信息
Int Urol Nephrol. 2019 Sep;51(9):1567-1580. doi: 10.1007/s11255-019-02236-9. Epub 2019 Jul 23.
PURPOSE
Insulin resistance, dyslipidemia and increased systemic inflammation are important risk factors for chronic kidney disease (CKD). Hence, vitamin D administration might be an appropriate approach to decrease the complications of CKD. Randomized controlled trials assessing the effects of vitamin D supplementation or treatment on glycemic control, lipid profiles, and C-reactive protein (CRP) among patients with CKD were included.
METHODS
Two independent authors systematically searched online databases including EMBASE, Scopus, PubMed, Cochrane Library, and Web of Science in November 2018 with no time restriction. Cochrane Collaboration risk of bias tool was applied to assess the methodological quality of included trials. Between-study heterogeneity was estimated using the Cochran's Q test and I-square (I) statistic. Data were pooled using a random-effects model and weighted mean difference (WMD) was considered as the overall effect size.
RESULTS
Of the 1358 citations identified from searches, 17 full-text articles were reviewed. Pooling findings from five studies revealed a significant reduction in fasting glucose (WMD: - 18.87; 95% CI: - 23.16, - 14.58) and in homeostatic model assessment of insulin resistance (HOMA-IR) through three studies (WMD: - 2.30; 95% CI: - 2.88, - 1.72) following the administration of vitamin D. In addition, pooled analysis revealed a significant reduction in triglycerides (WMD: - 32.52; 95% CI: - 57.57, - 7.47) through six studies and in cholesterol concentrations (WMD: - 7.93; 95% CI: - 13.03, - 2.83) through five studies, following vitamin D supplementation or treatment, while there was no effect on insulin, HbA1c, LDL and HDL cholesterol, and CRP levels.
CONCLUSIONS
This meta-analysis demonstrated the beneficial effects of vitamin D supplementation or treatment on improving fasting glucose, HOMA-IR, triglycerides and cholesterol levels among patients with CKD, though it did not influence insulin, HbA1c, LDL and HDL cholesterol, and CRP levels.
目的
胰岛素抵抗、血脂异常和全身炎症增加是慢性肾脏病（CKD）的重要危险因素。因此，维生素 D 治疗可能是降低 CKD 并发症的一种合适方法。纳入了评估维生素 D 补充或治疗对 CKD 患者血糖控制、血脂谱和 C 反应蛋白（CRP）影响的随机对照试验。
方法
两位独立作者于 2018 年 11 月在 EMBASE、Scopus、PubMed、Cochrane 图书馆和 Web of Science 等在线数据库中进行了系统搜索，没有时间限制。应用 Cochrane 协作偏倚风险工具评估纳入试验的方法学质量。采用 Cochran's Q 检验和 I 平方（I）统计量估计研究间异质性。使用随机效应模型对数据进行合并，并认为加权均数差（WMD）为总体效应大小。
结果
从检索中得到的 1358 条引文，有 17 篇全文文章进行了综述。对五项研究的综合结果表明，维生素 D 治疗后空腹血糖（WMD：-18.87；95%CI：-23.16，-14.58）和稳态模型评估的胰岛素抵抗（HOMA-IR）（WMD：-2.30；95%CI：-2.88，-1.72）显著降低。此外，通过六项研究的汇总分析发现，维生素 D 补充或治疗后三酰甘油（WMD：-32.52；95%CI：-57.57，-7.47）显著降低，五项研究中胆固醇浓度（WMD：-7.93；95%CI：-13.03，-2.83）显著降低，而胰岛素、HbA1c、LDL 和 HDL 胆固醇及 CRP 水平没有影响。
结论
这项荟萃分析表明，维生素 D 补充或治疗对改善 CKD 患者的空腹血糖、HOMA-IR、三酰甘油和胆固醇水平有有益作用，尽管它对胰岛素、HbA1c、LDL 和 HDL 胆固醇及 CRP 水平没有影响。
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