补充维生素D对膝关节骨关节炎的治疗效果Meta分析

摘要

目的 提供关于补充维生素D对膝关节骨关节炎影响的证据.方法 计算机检索The Cochrane Library、PubMed、中国知网、中国生物医学数据库与万方数据库,搜集补充维生素D治疗膝关节骨关节炎的临床随机对照试验,检索时间为建库至2017年10月.采用RevMan 5.3软件进行系统评价和Meta分析.结果 最终纳入文献4篇,共1130例膝关节骨关节炎患者.Meta分析结果显示:补充维生素D对缓解膝关节疼痛具有统计学意义[SMD＝-0.32,95% CI:(－0.63,－0.02)],在亚组分析中,无论低25(OH)D水平[SMD＝-0.57,95% CI:(－1.41,0.27)]研究对象或高25(OH)D水平[SMD＝-0.12,95% CI:(－0.28,0.04)]研究对象中补充维生素D对膝关节疼痛都没有显著影响.补充维生素D对胫骨软骨体积无影响[SMD＝0.12,95% CI:(－0.05,0.29)].在关节间隙结构改善方面差异无统计学意义[SMD ＝0.07,95% CI:(－0.08,0.23)].结论 目前缺乏强有力的证据来支持补充维生素D在膝关节骨关节炎患者中能对病情起到根本性作用.还需要进行更精心化设计的、更高质量的、样本量更大的、更长随访时间的临床随机对照试验来进一步明确补充维生素D对膝关节骨关节炎患者病情的影响.%Objective To provide evidence of the effects of vitamin D supplementation on osteoarthritis of the knee.Methods Computer retrieval the Cochrane Library,PubMed,CNKI,China biomedical database and Wan Fang database to collect data of randomized controlled clinical trials on the effects of vitamin D supplementation in the treatment of knee osteoarthritis.The retrieval time was from database establishment to October 2017.System evaluation and meta-analysis were performed by Revman 5.3.Results Four references were included,including a total of 1130 cases of patients with knee osteoarthritis.Vitamin D had significant effect for the relief of knee pain [SMD＝-0.32,95% CI:(－0.63,－0.02)].In subgroup analysis,vitamin D supplementation did not significantly affect knee pain in subjects with a low 25(OH)D level [SMD＝-0.57,95% CI:(－1.41,0.27)] or high 25(OH)D level [SMD＝-0.12,95% CI:(－0.28,0.04)].Vitamin D supplementation had no effect on tibial cartilage volume [SMD＝0.12,95% CI:(－0.05,0.29)].There were no statistically significant differences in the joint space structure improvement [SMD＝0.07,95% CI:(－0.08,0.23)].Conclusion There is a lack of strong evidence to support that vitamin D supplementation can play a fundamental role in osteoarthritis of the knee.More high quality randomized clinical trials are needed to further clarify the effect of vitamin D supplementation on knee osteoarthritis.