维生素D预防和治疗肾移植术后骨质疏松的系统评价

目的 评价维生素D预防和治疗肾移植术后骨质疏松的安全性和有效性.方法 使用由国际循证医学Cochrane协作网推荐的方法,采用计算机检索1990年1月至2009年11月期间MEDLINE、EMBase、Cochrane图书馆临床对照试验数据库(CENTRAL)、中国期刊网(CNKI)等数据库,辅以手工检索及追查已纳入文献库的维生素D预防和治疗肾移植术后骨质疏松的临床随机对照试验(RCT).由2位评价者共同评价纳入的RCT质量,对符合标准的研究采用Revman 4.2软件进行Meta分析.结果 共纳入9个RCT,肾移植术后受者658例.研究质量评价结果为:A级4篇、B级2篇和C级3篇.Meta分析结果显示:维生素D治疗1年后,试验组和对照组受者比较,骨质密度值、Z值(被测人的骨密度与同性别、同年龄对照组平均骨密度的差值)或T值(被测人的骨密度与同性别年轻人对照组平均骨密度的差值)的差异均有统计学意义(P＜0.05);血清甲状旁腺激素(PTH)浓度差异有统计学意义(P＜0.01);血清钙、磷离子浓度差异无统计学意义(P＞0.05);高钙血症发生率差异无统计学意义(P＞0.05).结论 维生素D预防和治疗肾移植术后骨质疏松是安全和有效的.

Systematic review on vitamin D preventing and treating bone loss in renal transplant patients

Objective To assess the effectiveness and safety of vitamin D in preventing and treating bone loss in renal transplant patients.Methods Methods recommended by the Cochrane Collaboration were used.MEDLINE,EMBase,Cochrane Library and CNKI were searched from Jan.1990 to Nov.2009 to locate all the randomized controlled trials (RCT) concerning preventing and treating bone loss by vitamin D in renal transplant patients.The qualities of included trials were evaluated by two independent reviewers.Trails consistent with criteria wereanalyzed by Revman 4.2 software.Results Nine RCTs involving 658 post transplant patients were included.The qualities of included trials were graded as grade A in 4,grade B in 2 and grade C in 3.Meta-analysis showed that after being treated with vitamin D for one year,the difference of BMD,Z-score and T-score between the two groups was statistically significant (P＜ 0.05); the difference of PTH concentration was also statistically significant (P＜0.01),but there was no significant difference in concentrations of serum calcium and phosphorus,and the incidence of hypercalcemia (P＞0.05).Conclusion Current available evidence demonstrates that vitamin D is effective and safe in preventing and treating bone loss in renal transplant patients.