中国循证医学杂志

中国循证医学杂志

妊娠期钙补充预防先兆子痫的 Meta 分析

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目的 探讨妊娠期钙补充对先兆子痫(preeclampsia,PE)发生及相关母婴结局的影响。 方法 计算机检索 The Cochrane Library、PubMed、EMbase、CBM、WanFang Data、VIP 和 CNKI 数据库,搜集钙补充干预先兆子痫及相关母婴结局的随机对照试验(RCT),检索时限均从建库至 2018 年 7 月。由 2 名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用 RevMan 5.3 软件进行 Meta 分析。 结果 共纳入 33 个 RCT,包括 29 234 例研究对象。Meta 分析结果显示:与对照组相比,钙补充可有效预防先兆子痫[RR=0.48,95%CI(0.38,0.62),P<0.000 01]和妊娠型高血压的发生[RR=0.65,95%CI(0.55,0.77),P<0.000 01]。钙补充组的早产、宫内发育迟缓和严重先兆子痫发生率均低于安慰剂组;钙补充组新生儿体重高于安慰剂组。但两组妊娠周期的差异无统计学意义(P>0.005)。 结论 当前证据显示,钙补充能够预防先兆子痫及相关不良结局,改善母婴健康。受纳入研究数量和质量的限制,上述结论尚待更多高质量研究予以验证。

Objectives To investigate calcium supplement in pregnancy for prevention of preeclampsia and relevant outcomes. Methods The Cochrane Library, PubMed, EMbase, CBM, WanFang Data, VIP and CNKI databases were searched online to collect randomized controlled trials (RCTs) of calcium supplement in pregnancy for prevention of preeclampsia and relevant outcomes from inception to July 2018. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Meta-analysis was then performed by RevMan 5.3 software. Results A total of 33 RCTs involving 29 234 subjects were included. The results of meta-analysis showed that: compared with control group, the calcium supplement group was associated with lower preeclampsia (RR=0.48, 95%CI 0.38 to 0.62, P<0.000 01) and gestational hypertension (RR=0.65, 95%CI 0.55 to 0.77,P<0.000 01) incidence. The incidence of premature delivery, intrauterine growth retardation and severe preeclampsia in calcium supplement group was lower than that in placebo group, and the neonatal weight in calcium was higher than that in placebo group. However, there was no significant difference in the pregnancy cycle between the two groups. Conclusions Current evidence shows that calcium supplement is associated with lower risk of preeclampsia and gestational hypertension. Due to limited quality and quantity of the included studies, more high quality studies are required to verify the above conclusion.

关键词: 先兆子痫; 钙补充; 妊娠高血压; 钙剂量; Meta 分析; 系统评价; 随机对照试验

Key words: Preeclampsia; Calcium supplement; Pregnancy-induced-hypertension; Calcium dose; Meta-analysis; Systematic review; Randomized controlled trial

引用本文: 李慧娟, 姚亮, 闫沛静, 李美萱, 荀杨芹, 卢存存, 杨克虎, 张登霞. 妊娠期钙补充预防先兆子痫的 Meta 分析. 中国循证医学杂志, 2018, 18(10): 1070-1079. doi: 10.7507/1672-2531.201804013 复制

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