摘要
目的系统评价大骨节病区与非病区外环境中硒元素水平的差异及大骨节病患者与健康人体内硒元素代谢情况的差异,以探讨硒与大骨节病的相关性。方法计算机检索PubMed、Cochrane Librar(y2013年第8期)、EMbase和ISI Web of Knowledge、CNKI、CBM、VIP、WanFang Data,纳入所有比较大骨节病区与非病区水、土、粮中硒水平及患者与健康人血硒、尿硒和发硒水平的观察性研究,检索时限截至2013年8月16日。采用Cochrane协作网推荐的RevMan 5.2软件进行Meta分析。结果共纳入46个对照研究。Meta分析结果显示:病区饮水中硒水平[SMD=–0.99,95%CI(–1.31,–0.66)]、土壤中硒水平[SMD=–1.20,95%CI(–1.92,–0.49)]、小麦中硒水平[SMD=–1.94,95%CI(–2.63,–1.26)]、玉米中硒水平[SMD=–1.66,95%CI(–2.33,–0.98)]均低于非病区;大骨节病患者的全血硒[SMD=–1.03,95%CI(–1.54,–0.53)]、血清硒[SMD=–0.66,95%CI(–1.01,–0.31)]、红细胞硒[SMD=–2.75,95%CI(–4.13,–1.37)]、尿硒[SMD=–0.99,95%CI(–1.43,–0.55)]、发硒水平[SMD=–1.67,95%CI(–2.14,–1.20)]均低于健康人。亚组分析提示与病区健康人比较,病区大骨节病患者在全血硒、血清硒、尿硒以及发硒方面有统计学差异。与此同时,病区健康人在全血硒[SMD=–6.12,95%CI(–8.58,–3.66)]、血清硒[SMD=–1.02,95%CI(–1.34,–0.69)]、红细胞硒[SMD=–3.37,95%CI(–5.38,–1.35)]、尿硒[SMD=–1.94,95%CI(–2.54,–1.34)]和发硒[SMD=–3.49,95%CI(–5.32,–1.66)]方面均低于非病区健康人。敏感性分析提示:各指标在剔除异质性较大的研究后结果稳定,且受异质性影响的可能性较小。结论大骨节病区外环境中硒水平显著低于非病区;而且病区患者体内硒含量的各个指标均明显低于健康人,病区健康人的体内硒含量水平也低于非病区健康人。由此提示外环境硒缺乏可能与大骨节病发病有关。
Objective To systematically review the differences of selenium levels in environment between endemic and normal regions and in patients with Kaschin-Beck disease and health people.
Methods Such databases as PubMed, The Cochrane Library （Issue 8, 2013）, EMbase, ISI Web of Knowledge, CNKI, CBM, VIP and WanFang Data were electronically searched to August 16th, 2013 for all observational studies about the differences of selenium levels in environment （including soil, water, and cereal） between endemic and normal regions, and in patients with Kaschin-Beck disease and health people （including blood, urine, and hair） were included. Meta-analysisi was performed using RevMan 5.2 software. Results Forty-six controlled studies were included. The results of meta-analysis showed that, selenium levels in water （SMD= –0.99, 95%CI –1.31 to –0.66）, soil （SMD= –1.20, 95%CI –1.92 to –0.49）, cereal （SMD= –1.94, 95%CI –2.63 to –1.26） and corn （SMD= –1.66, 95%CI –2.33 to –0.98） in endemic region were lower than those in normal region. The selenium in blood （SMD= –1.03, 95%CI –1.54 to –0.53）, blood serum （SMD= –0.66, 95%CI –1.01 to –0.31）, red blood cell （SMD= –2.75, 95%CI –4.13 to –1.37）, urine （SMD= –0.99, 95%CI –1.43 to –0.55） and hair （SMD= –1.67, 95%CI –2.14 to –1.20） of Kaschin-Beck disease patients were lower than those in healthy people. The results of subgroup analysis also showed that significant differences were found between patients and healthy people in endemic region. The selenium in blood （SMD= –6.12, 95%CI –8.58 to –3.66）, blood serum （SMD= –1.02, 95%CI –1.34 to –0.69）, red blood cell （SMD= –3.37, 95%CI –5.38 to –1.35）, urine （SMD= –1.94, 95%CI –2.54 to –1.34）, and hair （SMD –3.49, 95%CI –5.32 to –1.66） of healthy people in endemic region were lower than those in normal region. After removing the specific studies on every pooling outcome with high risk of heterogeneity, the results of sensitivity analysis showed that the results were of robustness and the impact due to heterogenicity was fairly low. Conclusion Selenium levels in external environment in endemic region are significantly lower than those in normal region, and patients’ selenium levels in the body are also significantly lower than the healthy in endemic region. The selenium levels of the healthy in endemic region are also significantly lower than those of the healthy in normal region. Current evidence indicated that lack of selenium in external environment might be related to Kaschin-Beck disease.
出处
《中国循证医学杂志》
CSCD
2013年第12期1421-1430,共10页
Chinese Journal of Evidence-based Medicine
基金
甘肃省科技支撑计划项目(编号:1104FKCA165)
关键词
大骨节病
硒
系统评价
META分析
Kaschin-Beck disease
Selenium
Systematic review
Meta-analysis
