Meng Jiahao, Li Xi, Xiong Yilin, Wu Yumei, Liu Pan, Gao Shuguang
Department of Orthopaedics, Xiangya Hospital Central South University, #87 Xiangya Road, Changsha, 410008, Hunan, China.
Hunan Key Laboratory of Joint Degeneration and Injury, Changsha, Hunan, China.
Infection. 2024 Nov 29. doi: 10.1007/s15010-024-02446-z.
To explore the role of supplementing vitamin D in the prevention and treatment of tuberculosis infection through a meta-analysis of randomized controlled trials.
The databases of PubMed, Cochrane Library, Embase, and Web of Science were systematically searched from inception to April 21, 2024, to identify studies comparing vitamin D supplementation with non-vitamin D supplementation for tuberculosis infection prevention or treatment. The inclusion criteria were randomized controlled trials involving participants diagnosed with either no tuberculosis or tuberculosis, with the intervention group receiving vitamin D supplementation and the control group receiving a placebo or standard treatment, and reporting outcomes related to tuberculosis prevention or treatment effects. The exclusion criteria were studies without full text and those not meeting the specific participant or treatment criteria. The analysis was performed using the Inverse Variance method with a random-effects model. Subgroup analyses were conducted to explore the impact of different administration routes. The stability of the pooled results was assessed using the leave-one-out method. Publication bias was evaluated with Egger's and Begg's tests.
We identified a total of 26 eligible trials, involving 19,586 participants. Four trials compared the preventive effects of vitamin D supplementation on tuberculosis infection, and the results (RR 0·75; 95% CI 0·56 to 1·01) were inconclusive. Regarding the role of vitamin D supplementation in anti-tuberculosis treatment, there were no significant statistical differences between the vitamin D and non-vitamin D groups in sputum smear conversion, sputum culture conversion, or time to sputum culture conversion. However, patients in the vitamin D group showed significantly lower Tuberculosis scores at 8 weeks (MD - 0·39; 95% CI -0·57 to -0 22) and 12 weeks (MD - 0·53; 95% CI - 0·84 to - 0·22). There were similar safety profiles between the two groups. Subgroup analysis based on the frequency of vitamin D intake revealed that patients who received daily vitamin D supplementation had higher rates of sputum smear conversion at 6 weeks and 8 weeks. They also had lower TB scores at 8 weeks.
Supplementing with vitamin D during anti-tuberculosis treatment does not accelerate the clearance of tuberculosis bacteria, but it can improve patient symptoms.
通过对随机对照试验的荟萃分析，探讨补充维生素D在预防和治疗结核感染中的作用。
系统检索PubMed、Cochrane图书馆、Embase和Web of Science数据库，检索时间从建库至2024年4月21日，以识别比较补充维生素D与不补充维生素D预防或治疗结核感染的研究。纳入标准为随机对照试验，参与者诊断为无结核病或患有结核病，干预组接受维生素D补充，对照组接受安慰剂或标准治疗，并报告与结核预防或治疗效果相关的结果。排除标准为无全文的研究以及不符合特定参与者或治疗标准的研究。采用随机效应模型的逆方差法进行分析。进行亚组分析以探讨不同给药途径的影响。使用留一法评估合并结果的稳定性。用Egger检验和Begg检验评估发表偏倚。
共纳入26项符合条件的试验，涉及19586名参与者。4项试验比较了补充维生素D对结核感染的预防效果，结果（风险比0.75；95%置信区间0.56至1.01）尚无定论。关于补充维生素D在抗结核治疗中的作用，维生素D组和非维生素D组在痰涂片转阴、痰培养转阴或痰培养转阴时间方面无显著统计学差异。然而，维生素D组患者在8周时（平均差-0.39；95%置信区间-0.57至-0.22）和12周时（平均差-0.53；95%置信区间-0.84至-0.22）的结核病评分显著更低。两组的安全性概况相似。基于维生素D摄入频率的亚组分析显示，每日补充维生素D的患者在6周和8周时痰涂片转阴率更高。他们在8周时的结核病评分也更低。
抗结核治疗期间补充维生素D不会加速结核杆菌清除，但可改善患者症状。
