低出生体质量儿补铁时间的Meta分析

摘要

目的 目前关于早产儿和低出生体质量儿(LBW)预防性肠内补铁的最佳时机尚不十分清楚,本研究旨在比较LBW早期和晚期补铁的疗效.方法 计算机检索PubMed、Cochrane Library、中国知网、万方数据知识服务平台等数据库,检索时间为建库至2015-12-31.收集关于LBW早期补铁疗效(出生后2周开始补铁)和晚期补铁疗效(出生后4周开始补铁)的前瞻性随机对照试验对纳入文献进行质量评价和数据提取,采用RevMan 5.3软件对血清铁蛋白、血红蛋白(Hb)、输血率、新生儿坏死性小肠结肠炎(NEC)发生率进行分析.结果 共纳入4篇文献,418例患儿,其中早期补铁组209例,晚期补铁组209例.所纳入文献的质量较高.Meta分析结果显示,早期补铁组血清铁蛋白水平下降的幅度低于晚期补铁组,差异有统计学意义[均数差(MD)=14.08,95％CI (9.08,19.08),P ＜0.001].早期补铁组血红蛋白水平下降的幅度低于晚期补铁组,差异有统计学意义[MD=0.87,95％ CI (0.71,1.02),P＜0.001].早期补铁组输血率低于晚期补铁组,差异有统计学意义[OR =0.44,95％ CI (0.27,0.71),P＜0.001].早期补铁组和晚期补铁组NEC发生率比较,差异无统计学意义[OR =0.73,95％CI (0.33,1.60),P=0.43].经leave one-out法进行敏感性分析,将每篇文献依次剔除,研究结果没有产生较大影响,具有良好可靠性.结论 早期补铁可减少血清铁蛋白和血红蛋白水平下降的幅度.然而,LBW补铁应谨慎对待,以免导致铁过量和可能对神经发育的长期负面影响.%Objective At present,the best time of preventive enteral iron supplementation for preterm and low-birth -weight (LBW) infants is not very clear.This study aims to compare the efficacies between early and late enteral iron supplementation in LBW infants.Methods The databases of PubMed,Cochrane Library,CNKI and Wanfang Data were searched by using computer up to December 31st,2015.Randomized controlled trials about assessing the efficacy of early iron supplementation (at 2 weeks after birth) and late iron supplementation (at 4 weeks after birth) in LBW infants were collected.We evaluated the quality and extracted the data of the included literature.The data about the levels of serum ferritin,hemoglobin (Hb),blood transfusion rate,neonatal necrotizing enterocolitis (NEC) in the included literature were analyzed by RevMan 5.3 software.Results A total of 4 high-quality literature was included,which involved in 418 LBW infants consisting of 209 with early enteral iron supplementation and 209 with late enteral iron supplementation.The results of meta-analysis showed that the extent of decline in serum ferritin level was less in early enteral iron supplementation group than in late enteral iron supplementation group [MD =14.08,95％ CI (9.08,19.08),P ＜ 0.001].The level of Hb decreased less in early enteral iron supplementation group than it did in late enteral iron supplementation group [MD =0.87,95％ CI (0.71,1.02),P ＜0.001].Compared with late enteral iron supplementation group,early enteral iron supplementation group had lower blood transfusion rate [OR =0.44,95％ CI (0.27,0.71),P ＜0.001].No difference in the incidence of NEC was found between early and late enteral iron supplementation groups [OR =0.73,95％ CI (0.33,1.60),P =0.43].After the susceptibility analysis by leave one-out method,the results were not influenced by excluding the literature successively,showing high reliability of our research.Conclusion Early enteral iron supplementation can reduce the decline extent for both serum ferritin and hemoglobin levels in LBW infants.However,caution should be taken to avoid excessive iron intake and the possibly resulted long-term negative effects on neural development.