目的:评价补充不同维生素对预防早产儿支气管肺发育不良(BPD)的疗效.方法:检索中国知网(CNKI)、万方(Wan fang)、维普网(cqvip)、PubMed、Cochrane Library、Web of Science数据库,纳入关于补充维生素预防早产儿BPD的随机对照试验(RCTs),筛选符合纳入标准的RCTs,运用Cochrane偏倚风险评估工具进行文献质量评价,通过贝叶斯网状meta分析,分析比较不同维生素预防BPD的疗效.结果:共纳入21篇RCTs,(3188例早产儿).与安慰剂组相比,中等剂量补充维生素D(400～800IU/d,OR=0.41,95％Cl[0.18,0.90])、小剂量补充维生素A(＜1333IU/kg/d,OR=0.50,95％Cl[0.25,0.95])与BPD发生率降低相关.小剂量补充维生素D(＜400IU/d,OR=12.36,95％Cl[1.00,600.21])可能与早产儿死亡率增加相关.小剂量补充维生素E(OR=0.59,95％Cl[0.23,1.36]),大剂量补充维生素E(OR=0.74,95％Cl[0.14,3.64])置信区间较宽,2项与预防早产儿BPD关系不大.结论:补充中等剂量维生素D、小剂量维生素A可有效预防早产儿BPD发生.小剂量补充维生素D可能增加早产儿死亡率,提示早产儿补充维生素D时应予足量补充.目前尚未充分证实维生素E在预防BPD方面的有效性.
A meta-analysis of vitamin A,D,and E supplementation for preventing the bronchopulmonary dysplasia of preterm in-fants
Objective:To evaluate the efficacy of the different vitamins supplementation for preventing the bronchopul-monary dysplasia(BPD)of preterm infants.Methods:The randomized controlled trials(RCTs)on vitamin supple-mentation for preventing BPD of preterm infants were searched in the databases,such as PubMed,EMbase,Cochrane Library,Web of Science,CNKI and Wan fang.The RCTs that met the inclusion criteria were screened,and the quali-ties of the RCTs were evaluated by Cochrane Risk of Bias Assessment Tool.The efficacy of the different vitamins sup-plementation for preventing BPD of the preterm infants was analyzed and compared by Bayesian net meta-analysis.Re-sults:A total of 21 RCTs,including 3188 preterm infants,were included in this meta-analysis.Compared with those of the infants in the placebo group,the medium-dose supplementation with vitamin D(400-800IU/d,OR=0.41,95％Cl 0.18-0.90),and the low-dose supplementation with vitamin A(＜1333IU/kg/d,OR=0.50,95％Cl 0.25-0.95)of the infants were associated with their reduced incidence of BPD.The low-dose vitamin D supplementation(＜400IU/d,OR=12.36,95％,Cl 1.00-600.21)of the infants might be associated with their increased preterm mortality.The con-fidence intervals of the low-dose vitamin E supplementation(OR=0.59,95％Cl 0.23-1.36)and the high-dose vitamin E supplementation(OR=0.74,95％Cl 0.14-3.64)of the infant s were wide,and both of which were not strongly asso-ciated with the prevention of BPD of the infants.Conclusion:In the vitamin supplementation programmes for the preterm infants,the medium-dose supplementation with vitamin D and the low-dose supplementation with vitamin A can effectively prevent their BPD,but the low-dose supplementation of vitamin D may increase the preterm mortality of the preterm infants,thus the vitamin D supplementation for the preterm infants should be given in appropriate doses.The effectiveness of vitamin E supplementation of the preterm infants for preventing their BPD has not been adequately demonstrated.
万方数据
维普
