铁补充剂治疗神经发育障碍的管理：系统评价、荟萃分析和定性综合。

Iron Supplementation in Management of Neurodevelopmental Disorders: Systematic Review, Meta-Analysis, and Qualitative Synthesis.

作者信息

Elliott Stephen D, Vickers Mark L, McKeon Gemma, Eriksson Lars, Malacova Eva, Scott James G

机构信息

Metro North Mental Health Service, Herston, Australia (Elliott, Vickers); Faculty of Medicine, University of Glasgow, Glasgow, United Kingdom (Elliott); Faculty of Medicine (Vickers), Child Health Research Center (McKeon, Scott), and Herston Health Sciences Library (Eriksson), University of Queensland, Brisbane, Australia; Faculty of Health, Queensland University of Technology, Brisbane, Australia (Vickers); West Moreton Health Psychology, Park Center for Mental Health, Brisbane, Australia (McKeon); Child and Youth Mental Health Group, Queensland Center for Mental Health Research, Brisbane, Australia (McKeon, Scott); Queensland Institute of Medical Research Berghofer Medical Research Institute, Brisbane, Australia (Malacova, Scott); Child and Youth Mental Health Service, Children's Health Queensland Hospital and Health Service, Brisbane, Australia (Scott).

出版信息

J Neuropsychiatry Clin Neurosci. 2024 Summer;36(3):178-186. doi: 10.1176/appi.neuropsych.20230081. Epub 2024 Feb 12.

DOI:10.1176/appi.neuropsych.20230081

PMID:38343311

Abstract

OBJECTIVE

The authors sought to explore the role of iron supplementation in the management of neurodevelopmental disorders among children and youths.

METHODS

A systematic review in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was undertaken. A subset of results was suitable for meta-analysis. The quality of the evidence and strength of the clinical recommendations were assessed by using the Grading of Recommendations, Assessment, Development, and Evaluation method, and critical appraisal was conducted with the Joanna Briggs Institute critical appraisal tools.

RESULTS

Nine articles met inclusion criteria. These articles included studies of attention-deficit hyperactivity disorder (ADHD) (N=7), autism spectrum disorder (N=1), and Tourette's syndrome (N=1). Three randomized controlled trials evaluating iron supplementation for ADHD hyperactivity symptom severity (124 participants: placebo, N=56; supplement, N=68) met inclusion criteria for a meta-analysis. Effect sizes for the placebo and supplement groups were moderate (Cohen's d=0.76) and large (Cohen's d=1.70), respectively, although these differences were not significant. The impact of iron supplementation on inattentive ADHD symptom severity was examined in two trials (75 participants: placebo, N=31; supplement, N=44). Large, nonsignificant effect sizes were demonstrated for the placebo (Cohen's d=1.66) and supplementation (Cohen's d=3.19) groups. The quality of the evidence and strength of the clinical recommendations were considered very low.

CONCLUSIONS

Further research is needed to examine the role of iron supplementation in the management of ADHD and neurodevelopmental disorders more generally. Additionally, iron supplementation comes with risks, including death in the case of overdose.

摘要

目的

作者旨在探讨铁补充剂在儿童和青少年神经发育障碍管理中的作用。

方法

根据系统评价和荟萃分析的首选报告项目进行了系统评价。一部分结果适合进行荟萃分析。使用推荐分级评估、制定与评价（Grading of Recommendations, Assessment, Development, and Evaluation）方法评估证据质量和临床推荐强度，并使用 Joanna Briggs 研究所的批判性评估工具进行批判性评估。

结果

符合纳入标准的文章有 9 篇。这些文章包括注意力缺陷多动障碍（ADHD）的研究（N=7）、自闭症谱系障碍（N=1）和妥瑞氏症（Tourette's syndrome）的研究（N=1）。有 3 项随机对照试验评估了铁补充剂对 ADHD 多动症状严重程度的影响（124 名参与者：安慰剂组，N=56；补充剂组，N=68），符合荟萃分析的纳入标准。安慰剂组和补充剂组的效应大小分别为中度（Cohen's d=0.76）和较大（Cohen's d=1.70），尽管这些差异无统计学意义。有 2 项试验（75 名参与者：安慰剂组，N=31；补充剂组，N=44）检验了铁补充剂对注意缺陷型 ADHD 症状严重程度的影响。安慰剂组（Cohen's d=1.66）和补充剂组（Cohen's d=3.19）的效应大小均较大，但无统计学意义。证据质量和临床推荐强度被认为非常低。