Tang X Z, Huang T, Ma Y, Fu X Y, Qian K, Yi Y L, Wu G H
Chengdu Municipal Public Health Clinical Medical Center, Chengdu 610000, China.
Zhonghua Yi Xue Za Zhi. 2020 Aug 25;100(32):2525-2531. doi: 10.3760/cma.j.cn112137-20200121-00146.
To systematically evaluate the efficacy and safety of vitamin D supplementation in the treatment of pulmonary tuberculosis. Biomedical Database was searched to collect randomized controlled trials (RCT) related to vitamin D supplementation in tuberculosis patients, and the retrieval time was from establishment to November 2019. Two evaluators independently screened the literature and extracted the data. The negative conversion rate of acid-fast-bacilli of sputum smear, the negative conversion rate of mycobacterium tuberculosis culture and the change of serum vitamin D level were the main outcome indicators, and the body mass index was the secondary outcome indicator. The incidence of hypercalcemia and abnormal urinary calcium were used as adverse event indicators and the RevMan 5.2 software was used for meta-analysis. A total of 8 RCT(S) met the inclusion criteria, including 850 patients with tuberculosis. Meta-analysis showed that compared with the control group, negative conversion rate of acid-fast-bacilli of sputum smear and serum vitamin D level increased after 8 weeks of vitamin D supplementation [ (95) and mean deviation () (95) were 1.06 (1.00, 1.13) and 8.81 (1.81, 15.81), respectively; negative conversion rate of acid-fast-bacilli of sputum smear was not increased at week 4 and 12 [ (95) were 1.08 (0.97, 1.20) and 1.01 (0.91, 1.12), respectively]; negative conversion rate of mycobacterium tuberculosis culture in sputum was not increased after 4 and 8 weeks [ (95) were 1.06 (0.91, 1.22) and 1.02 (0.96, 1.08), respectively]; there was no change in body mass index [ (95):-0.02 (-0.53, 0.50)]; there was increased risk of abnormal urinary calcium [ (95): 2.45 (1.75, 3.41)], while no increase in risk of hypercalcemia [RR (95): 1.99 (0.96, 4.13)]. Vitamin D supplementation is safe but not effective in the treatment of pulmonary tuberculosis.
系统评价补充维生素D治疗肺结核的疗效和安全性。检索生物医学数据库，收集与肺结核患者补充维生素D相关的随机对照试验（RCT），检索时间为建库至2019年11月。两名评价者独立筛选文献并提取数据。痰涂片抗酸杆菌阴转率、结核分枝杆菌培养阴转率和血清维生素D水平变化为主要结局指标，体重指数为次要结局指标。以高钙血症发生率和尿钙异常作为不良事件指标，采用RevMan 5.2软件进行Meta分析。共纳入8项符合纳入标准的RCT，包括850例肺结核患者。Meta分析结果显示，与对照组相比，补充维生素D 8周后痰涂片抗酸杆菌阴转率和血清维生素D水平升高[比值比（95%置信区间）分别为1.06（1.00，1.13）和8.81（1.81，15.81）]；4周和12周时痰涂片抗酸杆菌阴转率未升高[比值比（95%置信区间）分别为1.08（0.97，1.20）和1.01（0.91，1.12）]；4周和8周后痰结核分枝杆菌培养阴转率未升高[比值比（95%置信区间）分别为1.06（0.91，1.22）和1.02（0.96，1.08）]；体重指数无变化[平均差（95%置信区间）：-0.02（-0.53，0.50）]；尿钙异常风险增加[比值比（95%置信区间）：2.45（1.75，3.41）]，而高钙血症风险未增加[相对危险度（95%置信区间）：1.99（0.96，4.13）]。补充维生素D治疗肺结核安全但无效。
