危重症患者补充维生素D：一项荟萃分析。
Vitamin D supplementation in critically ill patients: a meta-analysis.
作者信息
Zheng Wen-He, Shi Jia-Heng, Yu Da-Xing, Huang Hui-Bin
机构信息
Department of Critical Care Medicine, The Second People's Hospital Affiliated to Fujian University of Traditional Chinese Medicine, Fuzhou, China.
Department of Critical Care Medicine, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China.
出版信息
Front Nutr. 2025 Apr 30;12:1505616. doi: 10.3389/fnut.2025.1505616. eCollection 2025.
BACKGROUND
Vitamin D is commonly used in clinical practice, while its clinical significance in critically ill patients remains controversial. Therefore, we aimed to perform a systemic review and meta-analysis to investigate the effect of vitamin D on this patient population.
METHODS
We searched for randomized controlled trials (RCTs) in PubMed, Embase, and the Cochrane Library databases from inception until August 15, 2024. Studies evaluating critically ill adult patients who received vitamin D compared to controls were included. The primary outcome was short-term mortality. We used the Cochrane risk of bias tool and GRADE system to evaluate the study quality and evidence. Secondary outcomes were changes in serum 25-hydroxyvitamin D levels, mechanical ventilation (MV) duration, and length of stay (LOS) in the ICU or hospital. We also conducted meta-regression, subgroup analyses, and trial sequential analysis (TSA) to explore the potential heterogeneity among the included trials.
RESULTS
Nineteen RCTs with 2,754 patients were eligible. Overall, vitamin D significantly increased serum 25-hydroxyvitamin D levels and significantly reduced the short-term mortality (risk ratio [RR] = 0.83; 95%CI, 0.70-0.98; = 0.03, = 13%), duration of MV (MD = -2.96 days; 95% CI, -5.39 to -0.52; = 77%; = 0.02) and ICU LOS (MD = -2.66 days; 95% CI, -4.04 to -1.29, = 70%; = 0.0001) but not hospital LOS (MD = -0.48 days; 95% CI, -2.37 to 1.40; = 31%; = 0.61). The meta-regression analysis revealed that the proportion of MV (MV%) accounted for the source of heterogeneity, and the subgroup analyses based on MV% suggested that the MV group was more likely to benefit from vitamin D applications than the partly MV group in all the predefined outcomes (all values<0.05). TSA for short-term mortality suggested that more data is required to confirm our main conclusion.
CONCLUSION
Vitamin D supplementation increased serum 25-hydroxyvitamin D levels and significantly benefited critically ill patients, especially those with MV.
SYSTEMATIC REVIEW REGISTRATION
https://inplasy.com/inplasy-2022-10-0074/, INPLASY2022100074.
背景
维生素D在临床实践中常用，但其在重症患者中的临床意义仍存在争议。因此，我们旨在进行一项系统评价和荟萃分析，以研究维生素D对该患者群体的影响。
方法
我们在PubMed、Embase和Cochrane图书馆数据库中检索了从数据库建立至2024年8月15日的随机对照试验（RCT）。纳入评估接受维生素D治疗的成年重症患者与对照组的研究。主要结局是短期死亡率。我们使用Cochrane偏倚风险工具和GRADE系统来评估研究质量和证据。次要结局包括血清25-羟基维生素D水平的变化、机械通气（MV）持续时间以及在重症监护病房（ICU）或医院的住院时间（LOS）。我们还进行了meta回归、亚组分析和试验序贯分析（TSA），以探讨纳入试验之间潜在的异质性。
结果
19项RCT共2754例患者符合纳入标准。总体而言，维生素D显著提高了血清25-羟基维生素D水平，并显著降低了短期死亡率（风险比[RR]=0.83；95%CI，0.70-0.98；P=0.03，I²=13%）、MV持续时间（MD=-2.96天；95%CI，-5.39至-0.52；I²=77%；P=0.02）和ICU住院时间（MD=-2.66天；95%CI，-4.04至-1.29，I²=70%；P=0.0001），但未降低医院住院时间（MD=-0.48天；95%CI，-2.37至1.40；I²=31%；P=0.61）。meta回归分析显示，MV比例（MV%）是异质性的来源，基于MV%的亚组分析表明，在所有预定义结局中，MV组比部分MV组更可能从维生素D应用中获益（所有P值<0.05）。短期死亡率的TSA表明，需要更多数据来证实我们的主要结论。
结论
补充维生素D可提高血清25-羟基维生素D水平，并使重症患者显著获益，尤其是MV患者。
系统评价注册
https://inplasy.com/inplasy-2022-10-0074/，INPLASY2022100074。
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