【作者】 刘莹；

【导师】 王秋月；

【作者基本信息】 中国医科大学 ， 呼吸与危重症医学（专业学位）， 2019， 硕士

【摘要】 背景:维生素D通过调节细胞膜及细胞核上维生素D受体参与到宿主对结核分枝杆菌的免疫反应中,起到杀死细胞内结核分枝杆菌的作用。但是关于补充维生素D剂对结核患者治疗中的痰结核菌转阴时间及转阴率,结核病评分,BMI,血清维生素D浓度,血钙浓度以及肺结核患者严重不良反应事件的影响,不同的试验研究结论存在争议。因此我们通过检索并收集相关临床试验的文献进行meta分析来研究维生素D在肺结核治疗中对痰结核菌的阴转率及平均转阴时间的影响。方法:通过提取关键词并构建检索表达式,我们系统地检索了在2018年8月1日前发表在电子数据库中,包括Pubmed、Medline、Embase、Cochrane Central Register、Web of Science、CBM、CNKI、万方数据等相关文献,依据纳入及排除标准,通过浏览标题、摘要甚至全文筛选出9篇临床实验研究文献符合要求,共纳入肺结核患者2017人,主要研究指标为痰涂片或培养平均转阴时间及转阴率,同时提取补充维生素D患者的基本临床特征数据及不良反应事件等指标。应用Review Manager软件使用随机或者固定效应模型及完成数据的最终合成及分析,应用Cochrane风险偏倚评估工具对偏倚风险进行评价。结果:纳入的9篇文献均为英文文献,且均为随机对照研究,其中干预措施为应用维生素D制剂。共有2017名患者接受抗结核治疗的基础上应用不同疗程及计量的维生素D或安慰剂对照。研究分析得出应用维生素D患者在痰涂片或培养转阴率差异有统计学意义(OR 1.18,95%CI 1.03~1.34,z=2.45,P=0.01),但是针对痰平均阴转时间(MD-2.66,95%CI-8.25~2.93,z=0.93,P=0.35)差异无统计学意义。针对临床指标的分析维生素D组患者的血清维生素D浓度及血清钙离子浓度较对照组升高(MD 110.69,95%CI 85.60~?135.78,P<0.00001,SMD 0.0395%CI 0.01~0.06,P=0.02),但是对比结核评分、BMI及严重不良反应两组数据差异无统计学意义。结论:Meta分析结果表明补充维生素D可以提高肺结核患者痰菌的阴转率,但是在缩短肺结核患者痰涂片或培养转阴时间并无影响。更多还原

【Abstract】 Background: Vitamin D participates in the host’s immune response to Mycobacterium tuberculosis by regulating the vitamin D receptor on the cell membrane and nucleus,and acts to kill Mycobacterium tuberculosis in cells.However,different trials on the effects of vitamin D supplementation on the time of sputum tuberculosis and the negative rate of tuberculosis,tuberculosis score,BMI,serum vitamin D concentration,serum calcium concentration and serious adverse events in tuberculosis patients.The conclusion is controversial.Therefore,we conducted a meta-analysis by searching and collecting the literature of relevant clinical trials to study the effect of vitamin D on the negative conversion rate and mean time of sputum tuberculosis in the treatment of tuberculosis.Methods : By extracting keywords and constructing search expressions,we systematically searched the electronic database published before August 1,2018,including Pubmed,Medline,Embase,Cochrane Central Register,Web of Science,CBM,CNKI,and Wan-fang Data.According to the inclusion and exclusion criteria,9 clinical trial research literatures were selected by browsing the title,abstract and even the full text.A total of 2017 patients with tuberculosis were included.The main research indicators were sputum smear or culture mean conversion time、conversion rate、 basic clinical characteristics of patients with vitamin D supplementation and adverse events and other indicators.The Review Manager software was used to evaluate the risk of bias using a random or fixed-effects model and the final synthesis and analysis of the completed data using the Cochrane Risk Bias Evaluation Tool.Results: Nine of the included literatures are in English and were randomized controlled trials in which the intervention was the use of vitamin D preparations.A total of 2017 patients received anti-tuberculosis treatment then get different courses of treatment and dose vitamin D or placebo control.The study showed that there was a statistically significant difference in the rate of sputum smear or culture conversion between patients with vitamin D(OR 1.18,95% CI 1.03~ 1.34,z=2.45,P = 0.01),but for the mean conversion time was not statistically significant.(MD-2.66,95% CI-8.25~2.93,z=0.93,P=0.35).Analysis of clinical indicators the serum vitamin D concentration and serum calcium ion concentration in the vitamin D group were higher than those in the control group(MD 110.69,95% CI 85.60~ 135.78,P < 0.00001,SMD 0.03 95% CI 0.01~0.06,P=0.02).There were no statistically significant differences between the two groups in the TB scores、BMI,、and serious adverse events.Conclusion: Meta-analysis showed that vitamin D supplementation can increase the conversion rate of sputum in tuberculosis patients,but it has no effect in shortening the conversion time of sputum smear or culture sputum in patients with tuberculosis.更多还原