摘要
目的评价B族维生素预防再发性脑卒中的效果。方法系统检索荷兰爱思唯尔电子期刊全文数据库ScieneDirect、美国国立医学图书馆PubMed／Medline数据库、中国知网、中国生物医学文献数据库检索系统、万方数据库、维普中文科技期刊数据库，收集自建库至2016年8月所有采用B族维生素预防再发JJ生脑卒中的随机对照临床试验（RCT）。对照组采取安慰剂或未包括B族维生素的基础疗法；试验组采用B族维生素治疗或在常规治疗基础上采用B族维生素治疗。由两位研究人员分别独立采集数据，并应用修订后Jadad量表对纳入文献质量进行评价。采用Stata12．0软件进行Meta分析，绘制漏斗图，并用Egger和Begg回归法来评估文献发表偏倚情况，同时进行敏感性分析。结果共纳入7篇RCT文献、9846例脑卒中患者，对照组4755例、试验组5091例。①B族维生素对再发性脑卒中的预防效应：纳入文献存在异质性（I^2=62．9％，P=0．009），采用随机效应模型进行合并Meta分析显示，试验组再发性脑卒中发生率明显低于对照组[合并相对危险度（RR）=0．64，95％可信区间（95％CI）=0．47～0．87]，提示补充B族维生素对再发性脑卒中有预防效果。累积Meta分析结果显示，从2012年开始，B族维生素即显示出对再发性脑卒中的预防效果；随样本量增加，95％CI趋于稳定，且有较好的变化趋势。文献发表偏倚评估结果显示，目测漏斗图不对称，进一步量化分析，Egger回归P值为0．008，Begg回归P值为0．035，均P〈0．05，提示纳入研究有一定的发表偏倚。将纳入文献进行敏感性分析显示，整体结果具有稳定性，结论可靠。②B族维生素对脑卒中患者血浆同型半胱氨酸（Hcy）水平的影响：纳入文献具有异质性（I^2=96．2％，P=0．000），采用随机效应模型进行合并Meta分析显示，与对照组相比，试验组补充B族维生素后患者血浆Hcy水平明屁降低[合并加权均数差（WMD）=-6．92，95％CI=-9．11～-4．73]，提示补充B族维生素后可显著降低血浆Hcy水平。累积Meta分析显示，随着年代推移及样本量增加，95％CI趋于稳定，变化趋势较好。文献发表偏倚评估结果显示，漏斗图目测对称，进一步量化分析，Egger回归法P值为0．345，Begg回归法P值为0．764，均P〉0．05，提示纳入研究不存在发表偏倚。结论对脑卒中患者补充B族维生素，可能预防脑卒中的再次发生，对于脑卒中的二级预防有重要意义；补充B族维生素可显著降低脑卒中患者血浆Hcy水平。
Objective To evaluate whether Vitamin B supplementation could prevent ischemic stroke recurrence. Methods Randomized controlled trials （RCTs） observing Vitamin B supplementation in patients with stroke was performed in databases including ScieneeDirect, PubMed/Medline, China National Knowledge Infrastructure, Chinese Biomedical Data-Base, Wanfang Database, and VIP Chinese Science and Technology Joumal Database to find related studies in English or Chinese published before August 2016. The patients in control group received a placebo or basic therapy without Vitamin B, and those in experimental group was treated with Vitamin B alone or Vitamin B on the basis of conventional treatment. The data were collected by two researchers independently and the quality of studies was assessed by the modified Jadad Scale. The Mcta-analysis was performed using Stata 12.0, funnel plot was drawn, and Egger and Begg regressions were used to evaluate the publication bias, and sensitivity was also analyzed. Results Seven RCTs studies were enrolled to analyze with a total number of 9 846 stroke patients, 4 755 patients in control group, and 5 091 in experimental group, respectively. （1） Vitamin B supplementation for prevention of recurrent stroke： heterogeneity test results showed a heterogeneity in literatures enrolled （I^2 = 62.9%, P = 0.009）, and a random effect model was used for Meta-analysis. It was shown that the incidence of recurrent stroke in the experimental group was significantly lower than thai in the control group [pooled relative risk （RR） = 0.64, 95% confidence interval （95%CI） = 0.47-0.87], which indicated that the supplementation of Vitamin B could prevent the recurrence of stroke. Cumulative Meta-analysis showed that Vitamin B supplementation exhibited positive effects in the prevention stroke recurrence from 2012. The 95%CI tended to be stable while demonstrating good change trend as sample growing. The publication bias evaluation results showed that the funnel plot was not symmetrical by visual inspection, further quantitative analysis showed that P value from Egger regression was 0.008, while that from Begg regression was 0.035, both P 〈 0.05, suggesting there were some publication bias. The sensitivity analysis showed that the overall results were stable and reliable. （2） The effect of Vitamin B supplementation on plasma homoeysteine （Hcy） levels in stroke patients： heterogeneity test resuhs showed a heterogeneity in literatures enrolled （I^2 = 96.2%, P = 0.000）, and a random effect model was used for Meta-analysis. It was shown that compared with control group, the plasma Hey levels of patients after Vitamin B supplementation in experimental group were significantly decreased [pooled weighted mean difference （WMD） = -6.92, 95%CI = -9.11 to -4.73）, indicating that Vitamin B could significantly reduce plasma Hey levels in stroke patients. Cumulative meta analysis showed that, as time went on, the relevant research samples were increased, 95%CI tended to be stable and the variation tendency was better. The publication bias evaluation results showed that the funnel plot was symmetry by visual inspection, and further quantitative analysis showed that the P value from Egger regression was 0.345, and that from Begg regression was 0.764, both P 〉 0.05, which indicating that there was no evidence of publication bias in the study included. Conclusions Vitamin B supplementation was associated with a lower risk of recurrent stroke in stroke patients and could significantly improve the quality of secondary prevention of stroke. Furthermore, supplementation of Vitamin B could reduce plasma Hey levels in stroke patients which might contribute to its effect in preventing stroke recurrence.
出处
《中华危重病急救医学》
CAS
CSCD
北大核心
2017年第5期419-424,共6页
Chinese Critical Care Medicine
