中文English
ISSN 1001-5256 (Print)
ISSN 2097-3497 (Online)
CN 22-1108/R

留言板

尊敬的读者、作者、审稿人, 关于本刊的投稿、审稿、编辑和出版的任何问题, 您可以本页添加留言。我们将尽快给您答复。谢谢您的支持!

姓名
邮箱
手机号码
标题
留言内容
验证码

儿童和青少年非酒精性脂肪性肝病与维生素D水平关系的Meta分析

胡庭鹏 唐苏丹 余泽波

引用本文:
Citation:

儿童和青少年非酒精性脂肪性肝病与维生素D水平关系的Meta分析

DOI: 10.3969/j.issn.1001-5256.2021.03.024
利益冲突声明:本研究不存在研究者、伦理委员会成员、受试者监护人以及与公开研究成果有关的利益冲突,特此声明。
作者贡献声明:胡庭鹏负责课题设计,资料分析,撰写论文;唐苏丹参与收集数据,修改论文;余泽波负责拟定写作思路,指导撰写文章并最后定稿。
详细信息
    作者简介:

    胡庭鹏(1993—),男,主要从事感染性疾病和输血的临床研究

    通信作者:

    余泽波,yuzebo2001@163.com

  • 中图分类号: R575.5

Relationship between vitamin D level in children and adolescents with nonalcoholic fatty liver disease: A Meta-analysis

  • 摘要:   目的  系统评价儿童和青少年维生素D水平和非酒精性脂肪性肝病(NAFLD)的相关性。  方法  计算机检索PubMed、Cochrane Library、Embase数据库以及CNKI、中国生物医学文献数据库、万方和维普数据库,收集有关儿童及青少年维生素D水平与NAFLD之间关系的研究,检索时限从建库到2020年8月。按照纽卡斯尔-渥太华量表(NOS)进行文献质量评价,采用RevMan 5.3软件进行数据分析。  结果  Meta分析最终纳入10篇文献,NAFLD组共622例,健康对照组共1608例。10篇纳入研究的NOS评分均≥6分。10篇文献采用随机效应模型合并(I2=97%, P<0.05),NAFLD组血清25(OH)D水平显著低于对照组,差异有统计学意义(SMD=-1.40, 95%CI: -2.07~-0.72)。  结论  儿童和青少年NAFLD患者血清中25(OH)D水平显著降低,其可能与NAFLD的进展和严重程度有关。

     

  • 图  1  文献筛选流程图

    图  2  维生素D水平与儿童和青少年NAFLD的关系的森林图

    图  3  儿童及青少年维生素D水平与NAFLD之间关系的敏感性分析

    图  4  儿童及青少年维生素D水平与NAFLD之间关系的漏斗图

    表  1  纳入研究的基本特征及质量评价

    第一作者 发表年份 国家 研究类型 NAFLD诊断方法 BMI(kg/m2) 年龄(岁) NOS评分
    NAFLD组(n=622) 对照组(n=1608)
    Sezer[12] 2016 土耳其 横断面研究 超声 28.7±4.3 27.3±3.3 12.6±3.1 6
    Chang [14] 2015 韩国 病例对照 UPLC-MS/MS 25.89±4.13 23.70±2.63 8.70±3.87 6
    Yildiz[15] 2014 土耳其 病例对照 超声 30.9±3.9 29.3±4.4 11.0±2.8 8
    Pirgon[16] 2013 土耳其 病例对照 超声 28.7±4.7 28.4±3.6 12.48±1.60 6
    Mohamed[17] 2016 埃及 横断面研究 超声 10.6±3.1 8
    Malespin[18] 2015 美国 横断面研究 升高的ALT 12.9±2.9 6
    Black[19] 2014 澳大利亚 横断面研究 超声 27.0±7.4 22.0±3.0 17 7
    Nobili[20] 2014 意大利 横断面研究 超声 31.3±4.37 12.24±7.23 6
    胡颖[21] 2018 中国 病例对照 超声 17.2±2.5 10.1±3.6 7
    张兰华[22] 2019 中国 病例对照 超声 27.2±3.6 17.2±2.6 11.2±2.5 6
    注:UPLC-MS/MS,超高效液相色谱串联质谱。
    下载: 导出CSV

    表  2  纳入研究的25(OH)D水平

    第一作者 发表年份 NAFLD组(n=622) 对照组(n=1608)
    例数(女/男) 25(OH)D(ng/ml) 例数(女/男) 25(OH)D(ng/ml)
    Sezer[12] 2016 58(26/32) 16.60±6.20 53(38/15) 14.60±7.00
    Chang[14] 2015 62(无分类) 17.90±6.84 32(无分类) 17.70±5.05
    Yildiz[15] 2014 58(22/36) 12.60±6.52 43(24/19) 16.40±9.19
    Pirgon[16] 2013 45(无分类) 29.50±18.40 72(无分类) 43.96±19.97
    Mohamed[17] 2016 47(28/19) 20.89±16.56 23(14/9) 41.98±14.52
    Malespin[18] 2015 25(6/19) 16.50±6.40 382(193/189) 20.80±7.10
    Black[19] 2014 156(96/60) 26.84±8.81 838(381/457) 30.85±9.62
    Nobili[20] 2014 73(无分类) 19.30±6.70 85(32/53) 29.04±5.81
    胡颖[21] 2018 62(25/37) 15.20±2.06 50(11/39) 26.26±2.25
    张兰华[22] 2019 36(15/21) 15.20±2.10 30(12/18) 26.30±2.30
    下载: 导出CSV
  • [1] SERRADILLA MARTÍN M, OLIVER GUILLÉN JR, PALOMARES CANO A, et al. Metabolic syndrome, non-alcoholic fatty liver disease and hepatocarcinoma[J]. Rev Esp Enferm Dig, 2020, 112(2): 133-138.
    [2] XIAO WS, LE YY, ZENG SL, et al. Research advances in the pathogenesis of nonalcoholic fatty liver disease[J]. J Clin Hepatol, 2020, 36(8): 1874-1879. (in Chinese) DOI: 10.3969/j.issn.1001-5256.2020.08.043

    肖伟松, 乐滢玉, 曾胜澜, 等. 非酒精性脂肪性肝病的发病机制研究进展[J]. 临床肝胆病杂志, 2020, 36(8): 1874-1879. DOI: 10.3969/j.issn.1001-5256.2020.08.043
    [3] WU J, SUN M. Diagnosis and treatment of non-alcoholic fatty liver disease in children[J]. J Appl Clin Pediatr, 2019, 34(19): 1441-1444. (in Chinese) https://www.cnki.com.cn/Article/CJFDTOTAL-CRBX201902018.htm

    吴捷, 孙梅. 儿童非酒精性脂肪性肝病的诊治进展[J]. 中华实用儿科临床杂志, 2019, 34(19): 1441-1444. https://www.cnki.com.cn/Article/CJFDTOTAL-CRBX201902018.htm
    [4] TORUN E, GÖNÜLLÜ E, OZGEN IT, et al. Vitamin d deficiency and insufficiency in obese children and adolescents and its relationship with insulin resistance[J]. Int J Endocrinol, 2013, 2013: 631845. http://pubmedcentralcanada.ca/pmcc/articles/PMC3623428/?report=abstract
    [5] MANSON JE, COOK NR, LEE IM, et al. Vitamin D supplements and prevention of cancer and cardiovascular disease[J]. N Engl J Med, 2019, 380(1): 33-44. DOI: 10.1056/NEJMoa1809944
    [6] CHAROENNGAM N, HOLICK MF. Immunologic effects of vitamin D on human health and disease[J]. Nutrients, 2020, 12(7): 2097. DOI: 10.3390/nu12072097
    [7] BOREL P, CAILLAUD D, CANO NJ. Vitamin D bioavailability: State of the art[J]. Crit Rev Food Sci Nutr, 2015, 55(9): 1193-1205. DOI: 10.1080/10408398.2012.688897
    [8] GULSETH HL, GJELSTAD IM, BIRKELAND KI, et al. Vitamin D and the metabolic syndrome[J]. Curr Vasc Pharmacol, 2013, 11(6): 968-984. DOI: 10.2174/15701611113119990169
    [9] LU Z, PAN X, HU Y, et al. Serum vitamin D levels are inversely related with non-alcoholic fatty liver disease independent of visceral obesity in Chinese postmenopausal women[J]. Clin Exp Pharmacol Physiol, 2015, 42(2): 139-145. DOI: 10.1111/1440-1681.12334
    [10] LIU T, XU L, CHEN FH, et al. Association of serum vitamin D level and nonalcoholic fatty liver disease: A meta-analysis[J]. Eur J Gastroenterol Hepatol, 2020, 32(2): 140-147. DOI: 10.1097/MEG.0000000000001486
    [11] GIBSON PS, QUAGLIA A, DHAWAN A, et al. Vitamin D status and associated genetic polymorphisms in a cohort of UK children with non-alcoholic fatty liver disease[J]. Pediatr Obes, 2018, 13(7): 433-441. DOI: 10.1111/ijpo.12293
    [12] SEZER OB, BULUŞ D, HIZLI Ş, et al. Low 25-hydroxyvitamin D level is not an independent risk factor for hepatosteatosis in obese children[J]. J Pediatr Endocrinol Metab, 2016, 29(7): 783-788. DOI: 10.1515/jpem-2015-0426
    [13] STANG A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses[J]. Eur J Epidemiol, 2010, 25(9): 603-605. DOI: 10.1007/s10654-010-9491-z
    [14] CHANG EJ, YI DY, YANG HR. Vitamin D status and bone mineral density in obese children with nonalcoholic fatty liver disease[J]. J Korean Med Sci, 2015, 30(12): 1821-1827. DOI: 10.3346/jkms.2015.30.12.1821
    [15] YILDIZ I, EROL OB, TOPRAK S, et al. Role of vitamin D in children with hepatosteatosis[J]. J Pediatr Gastroenterol Nutr, 2014, 59(1): 106-111. DOI: 10.1097/MPG.0000000000000371
    [16] PIRGON O, CEKMEZ F, BILGIN H, et al. Low 25-hydroxyvitamin D level is associated with insulin sensitivity in obese adolescents with non-alcoholic fatty liver disease[J]. Obes Res Clin Pract, 2013, 7(4): e275-283. DOI: 10.1016/j.orcp.2012.01.004
    [17] MOHAMED AHMED A, ABDEL GHANY M, ABDEL HAKEEM GL, et al. Assessment of vitamin D status in a group of Egyptian children with nonalcoholic fatty liver disease[J]. Nutr Metab (Lond), 2016, 13: 53. DOI: 10.1186/s12986-016-0112-z
    [18] MALESPIN M, SLEESMAN B, LAU A, et al. Prevalence and correlates of suspected nonalcoholic fatty liver disease in Chinese American children[J]. J Clin Gastroenterol, 2015, 49(4): 345-349. DOI: 10.1097/MCG.0000000000000121
    [19] BLACK LJ, JACOBY P, SHE PING-DELFOS WC, et al. Low serum 25-hydroxyvitamin D concentrations associate with non-alcoholic fatty liver disease in adolescents independent of adiposity[J]. J Gastroenterol Hepatol, 2014, 29(6): 1215-1222. DOI: 10.1111/jgh.12541
    [20] NOBILI V, GIORGIO V, LICCARDO D, et al. Vitamin D levels and liver histological alterations in children with nonalcoholic fatty liver disease[J]. Eur J Endocrinol, 2014, 170(4): 547-553. DOI: 10.1530/EJE-13-0609
    [21] HU Y, ZHOU Y, HE JX, et al. Effect of serum level change of 25-(OH) D3 and IL-17 in obesity children with NAFLD[J]. Chin J Health Lab Technol, 2018, 28(3): 323-325. (in Chinese) https://www.cnki.com.cn/Article/CJFDTOTAL-ZWJZ201803021.htm

    胡颖, 周莹, 何继新, 等. 血清25-羟维生素D3和IL-17水平变化在肥胖儿童非酒精性脂肪肝病进展中的作用[J]. 中国卫生检验杂志, 2018, 28(3): 323-325. https://www.cnki.com.cn/Article/CJFDTOTAL-ZWJZ201803021.htm
    [22] ZHANG LH, SHAO Q, XIA ZJ. Changes of serum 25-(OH) D3 and IL-17 levels are associated with progress of nonalcoholic fatty liver disease in obese children[J]. J Prac Hepatol, 2019, 22(4): 522-525. (in Chinese) https://www.cnki.com.cn/Article/CJFDTOTAL-GBSY201904018.htm

    张兰华, 邵琴, 夏振娟. 非酒精性脂肪性肝病儿童血清25-(OH)D3和IL-17水平变化初步研究[J]. 实用肝脏病杂志, 2019, 22(4): 522-525. https://www.cnki.com.cn/Article/CJFDTOTAL-GBSY201904018.htm
    [23] ZHOU XL, FU JF. Expert consensus on the diagnosis and treatment of nonalcoholic fatty liver disease in children[J]. Chin J Pract Pediatr, 2018, 33(7): 487-492. (in Chinese) https://www.cnki.com.cn/Article/CJFDTOTAL-ZSEK201807002.htm

    周雪莲, 傅君芬. 儿童非酒精性脂肪肝病诊断与治疗专家共识[J]. 中国实用儿科杂志, 2018, 33(7): 487-492. https://www.cnki.com.cn/Article/CJFDTOTAL-ZSEK201807002.htm
    [24] CHALASANI N, YOUNOSSI Z, LAVINE JE, et al. The diagnosis and management of non-alcoholic fatty liver disease: Practice Guideline by the American Association for the Study of Liver Diseases, American College of Gastroenterology, and the American Gastroenterological Association[J]. Hepatology, 2012, 55(6): 2005-2023. DOI: 10.1002/hep.25762
    [25] SHAUNAK M, BYRNE CD, DAVIS N, et al. Non-alcoholic fatty liver disease and childhood obesity[J]. Arch Dis Child, 2021, 106(1): 3-8. DOI: 10.1136/archdischild-2019-318063
    [26] AQUINO S, CUNHA A, LIMA JG, et al. Effects of vitamin D supplementation on fasting glucose, dyslipidemia, blood pressure, and abdominal obesity among patients with metabolic syndrome: A protocol for systematic review and meta-analysis of randomized controlled trials[J]. Syst Rev, 2020, 9(1): 176. DOI: 10.1186/s13643-020-01433-3
    [27] GOLDNER WS, STONER JA, THOMPSON J, et al. Prevalence of vitamin D insufficiency and deficiency in morbidly obese patients: A comparison with non-obese controls[J]. Obes Surg, 2008, 18(2): 145-150. DOI: 10.1007/s11695-007-9315-8
    [28] ROSENBLUM JL, CASTRO VM, MOORE CE, et al. Calcium and vitamin D supplementation is associated with decreased abdominal visceral adipose tissue in overweight and obese adults[J]. Am J Clin Nutr, 2012, 95(1): 101-108. DOI: 10.3945/ajcn.111.019489
    [29] QU YL, WANG YC, WAN JX. Association of nonalcoholic fatty liver disease with vitamin D and bone mineral density[J]. J Clin Hepatol, 2019, 35(9): 2021-2025. (in Chinese) DOI: 10.3969/j.issn.1001-5256.2019.09.027

    曲玉蕾, 王迎春, 万金鑫. 非酒精性脂肪性肝病与血清维生素D及骨密度的关系[J]. 临床肝胆病杂志, 2019, 35(9): 2021-2025. DOI: 10.3969/j.issn.1001-5256.2019.09.027
    [30] MAI XM, CHEN Y, CAMARGO CA Jr, et al. Cross-sectional and prospective cohort study of serum 25-hydroxyvitamin D level and obesity in adults: the HUNT study[J]. Am J Epidemiol, 2012, 175(10): 1029-1036. DOI: 10.1093/aje/kwr456
    [31] LUKENDA ZANKO V, DOMISLOVIC V, TRKULJA V, et al. Vitamin D for treatment of non-alcoholic fatty liver disease detected by transient elastography: A randomized, double-blind, placebo-controlled trial[J]. Diabetes Obes Metab, 2020, 22(11): 2097-2106. DOI: 10.1111/dom.14129
  • 加载中
图(4) / 表(2)
计量
  • 文章访问数:  430
  • HTML全文浏览量:  130
  • PDF下载量:  41
  • 被引次数: 0
出版历程
  • 收稿日期:  2020-07-30
  • 录用日期:  2020-08-31
  • 出版日期:  2021-03-20
  • 分享
  • 用微信扫码二维码

    分享至好友和朋友圈

目录

    /

    返回文章
    返回