Objective To systematically review the impact of vitamin D supplement on blood pressure, so as to provide a basis for clinical treatment. Methods Such databases as The Cochrane Library (Issue 8, 2011), MEDLINE (1996 to August 2011), EMbase (1974 to August 2011), CBM (1989 to 2011), CNKI (1997 to August 2011) and VIP (1989 to 2011) were searched to collect the randomized controlled trials (RCTs) about the impact of vitamin D supplement on blood pressure. Two reviewers independently screened the literature according to the inclusion criteria, extracted the data and assessed the quality. Then the meta-analysis was performed using RevMan 5.0 software. Results A total of 8 studies involving 907 participants were included. The methodological quality based on the improved Jadad scales displayed that, 7 studies scored 4 to 7 and only 1 study scored less than 4. The results of meta-analysis showed that compared with the placebo groups, vitamin D supplement had no significant difference in both systolic and diastolic blood pressure. Conclusion Based on current research evidences, compared with placebo, vitamin D supplement has no marked impact on either systolic or diastolic blood pressure. Due to the lack of studies, this conclusion still needs to be proved by conducting more well designed, large sample, and multicenter RCTs.
ObjectiveTo explore the therapeutic effect of glucosamine hydrochloride combined with calcium and vitamin D on knee osteoarthritis. MethodsA total of 120 female outpatients with knee osteoarthritis from January 2014 to January 2015 were selected. The patients were randomly divided into study group and control group (60 patients in each group) according to their treatment sequence. The patients in the study group were given oral calcium citrate, alfacalcidol and glucosamine hydrochloride while those in the control group were given glucosamine hydrochloride only. Both groups were investigated and scored by Western Ontario and McMaster University Osteoarthritis Index (WOMAC) questionnaire before and three and six months after treatment. ResultsThree and six months after the treatment, WOMAC scores of both groups were lower than those before the treatment with significant differences (P<0.05). Three months after the treatment, WOMAC scores between the two groups didn't differ much (P>0.05), while the difference between the two groups was significant 6 months after the treatment (P<0.05). Three months after the treatment, the difference of total effective rate in the study group (43.3%) and control group (41.7%) was not significant (P>0.05), while the rate in the study group (65.0%) was obviously higher than that in the control group (46.7%) 6 months after the treatment (P<0.05). ConclusionGlucosamine hydrochloride has exact effect on knee osteoarthritis. There are differences in the therapeutic effect on knee osteoarthritis between glucosamine hydrochloride combined with calcium and vitamin D and glucosamine hydrochloride alone after six-month treatment.
ObjectiveTo systematically review the quality of evidence-based guidelines (EBGs) on medication therapy for children with vitamin D deficiency, and to compare differences and similarities of the drugs recommended, in order to provide guidance for clinical practice. MethodsDatabases such as the TRIP, PubMed, EMbase, CNKI, VIP, WanFang Data, CBM, National Guideline Clearinghouse and Guidelines International Network were searched to collect EBGs on medication therapy for children with vitamin D deficiency. The methodological quality of the guideline was evaluated according to the AGREE Ⅱ instrument, and the differences between recommendations were compared. ResultsA total of 9 EBGs were included. Among them, 3 guidelines were developed by America, 1 by Europe, 1 by France, 1 by China, 1 by Poland, 1 by Canadian and 1 guideline was by Australia and New Zealand. Seven guidelines were developed specially for children, while others were for people of different ages. According to the AGREE Ⅱ instrument, only "Scope and purpose" and "clarity and presentation" were scored more than 60%. The recommendations of different guidelines were of large different. ConclusionThe quality of included guidelines concerning children with vitamin D deficiency is vary. Although only the America 2011 guideline is of high quality, the strength of recommendation is not high. Thus, the development of national guidelines is urgently needed.
ObjectiveTo evaluate the association between the Single Nucleotide Polymorphism (SNP) BsmI (rs1544410) in the vitamin D receptor gene and the susceptibility of coronary artery disease. MethodsDatabases including PubMed, Web of Science, CNKI, WanFang Data, VIP and CBM were searched from inception to May, 2016 to collect case-control studies about SNP BsmI (rs1544410) in the vitamin D receptor gene and the susceptibility of coronary artery disease. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of included studies. Then Meta-analysis was performed by using RevMan 5.3. ResultsA total of seven studies were included, which involved 2182 patients and 5925 controls. The results of meta-analyses showed that the B allele and BB genotype in rs1544410 was associated with the risk of coronary artery disease (B vs. b:OR=1.36, 95%CI 1.03 to 1.79, P=0.03; BB vs. bb:OR=1.70, 95%CI 1.06 to 2.72, P=0.03; BB+Bb vs. bb:OR=1.52, 95%CI 1.00 to 2.30, P=0.05). Subgroup analysis by age showed that rs1544410 was associated with the risk of coronary artery disease in the age <65(B vs. b:OR=1.65, 95%CI 1.00 to 2.73, P=0.05; BB vs. Bb+ bb:OR=1.79, 95%CI 1.08 to 2.97, P=0.02; BB vs. bb:OR=2.64, 95%CI 1.12 to 6.25, P=0.03). Subgroup analysis by ethnicity showed that rs1544410 was associated with the risk of coronary artery disease in Caucasians (B vs. b:OR=1.47, 95%CI 1.10 to 1.97, P=0.01; BB+Bb vs. bb:OR=1.71, 95%CI 1.09 to 2.68, P=0.02; BB vs. Bb+bb:OR=1.39, 95%CI 1.01 to 1.92, P=0.05; BB vs. bb:OR=1.80, 95%CI 1.10 to 2.95, P=0.03). Subgroup analysis by genotyping methods showed that rs1544410 was associated with the risk of coronary artery disease in the TaqMan (B vs. b:OR=2.18, 95%CI 1.06 to 4.45, P=0.03; BB+Bb vs. bb:OR=3.32, 95%CI 1.06 to 10.40, P=0.04; BB vs. bb:OR=3.31, 95%CI 1.06 to 10.30, P=0.04). Subgroup analysis by diagnostic criteria for cases showed that rs1544410 was associated with the risk of coronary artery disease in the ECG (B vs. b:OR=1.15, 95%CI 1.02 to 1.29, P=0.02; BB+Bb vs. bb:OR=1.22, 95%CI 1.02 to 1.45, P=0.03; BB vs. bb:OR=1.31, 95%CI 1.03 to1.67, P=0.03). ConclusionBsmI (rs1544410) B allele may have a significant association with the high risk of coronary artery disease especially the Caucasians and the ones with age <65.
ObjectiveTo systematically evaluate the effects of vitamin D supplementation on fasting blood glucose, insulin resistance, β cell function in type 2 diabetes mellitus. MethodsDatabases including PubMed, The Cochrane Library (Issue 12, 2015), Web of Science, ScienceDirect Online, VIP, CNKI, WanFang Data, and CBM were searched to collect randomized controlled trials (RCTs) about vitamin D supplementation for type 2 diabetes mellitus from inception to December 2015. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then meta-analysis was conducted by RevMan 5.3 and Stata12.0 softwares. ResultsA total of 22 RCTs involving 1 756 patients were included. The results of meta-analysis showed that, compared with the control group, the vitamin D supplementation group had a significant improvement in insulin resistance (SMD=–0.68, 95%CI –1.23 to –0.12, P=0.02), but there were no significant differences in levels of FPG, HbA1c and HOMA-β between the two groups (all P value > 0.05). Subgroup analysis showed that, the levels of FPG and HOMA-IR were significantly decreased in the vitamin D supplementation group in Middle Easterners and patients whose follow-up duration was less than three months. ConclusionVitamin D supplementation could improve HOMA-IR but could not improve the levels of FPG, HbA1c and HOMA-β. However, the evidence is weak to recommend vitamin D as a means of improving glycemic control, insulin resistance and β cell function in type 2 diabetes mellitus. Further larger, high quality trials are warranted.
ObjectiveTo investigate the correlation between serum level of 25(OH)D3 and peripheral neuropathy in patients with impaired glucose tolerance. MethodsA total of 108 patients with impaired glucose tolerance treated or examined between January 2012 and July 2014 were recruited in this study. According to whether peripheral neuropathy was combined, the patients were divided into neuropathy group (n=50) and non-neuropathy group (n=58). The level of 25(OH)D3 was measured and compared between the two groups, and the correlation of 25(OH)D3 with the clinical indexes of impaired glucose tolerance was analyzed. ResultsThe level of 25(OH)D3 in the neuropathy group and non-neuropathy group was respectively (16.1±4.2) and (19.6±4.7) ng/mL with a significant difference (P<0.05). The 25(OH)D3 deficiency rate of the above two groups was respectively 80.0% and 41.38%, also with a significant difference (P<0.05). The 25(OH)D3 level had a negative correlation with body mass index (BMI) and glycosylated hemoglobin (P<0.05). Conclusions There is a significant relationship between impaired glucose tolerance and 25(OH)D3 level. The 25(OH)D3 level has a negative correlation with BMI and glycosylated hemoglobin.
Objective To observe the level of vitamin D in patients with steroid resistant (SR) asthma, and investigate the effect of 1,25-(OH)2D3 on JNK/AP-1 and glucocorticoid receptor of T lymphocytes in SR asthmatics. Methods Sixty-two outpatients and inpatients with asthma with acute exacerbation between 2014 and 2015 were recruited in the study, including 26 cases of steroid sensitive (SS) asthmatics and 36 cases of SR asthmatics. Meanwhile 25 healthy volunteers were recruited as control. Clinical data were collected and peripheral venous blood was sampled for measuring the level of 25-(OH)D and separating the T lymphocytes. T lymphocytes were assigned to six groups, ie. a healthy control group (Group A), a SS asthmatics control group (Group B), a SR asthmatics control group (Group C), a SR asthmatics with JNK inhibitor (SP600125)+1,25-(OH)2D3 group (Group D), a SR asthmatics with JNK inhibitor (SP600125) group (Group E), and a SR asthmatics with 1,25-(OH)2D3 group (Group F). T lymphocytes were cultured for 48 hours. By the end of culture, the expression of phospho-JNK (p-JNK) and phospho-glucocorticoid receptor (p-GR) of T lymphocytes were detected by Western blot method, and the expression of c-Jun mRNA was detected by RT-PCR method. Results The level of 25-(OH) D was lower in Group B and Group C than Group A (P<0.05), and lower in Group C than Group B (P<0.05). The level of p-JNK was higher in Group B and Group C than Group A (P<0.05), higher in Group C than Group B (P<0.05), lower in Group E and Group F than Group C (P<0.05), lower in Group D than Group F (P<0.05). The level of p-GR was lower in Group C than Group A and Group B (P<0.05), higher in Group E and Group F than Group C (P<0.05), higher in Group D than Group F (P<0.05). The level of c-Jun mRNA was higher in Group B and Group C than Group A (P<0.05), higher in Group C than Group B (P<0.05), lower in Group E and Group F than Group C (P<0.05), and lower in Group D than Group F (P<0.05). The 25-(OH) D level was negatively correlated with the expression of p-JNK and c-Jun mRNA in Group C (r=–0.69, r=–0.65, P<0.05). However, there was a positive correlation between the 25-(OH) D level and p-GR (r=0.72, P<0.05). Conclusions There is a high prevalence of vitamin D deficiency or lack in SR asthmatics. 1,25-(OH)2D3 can promote the expression of p-GR by inhibiting the JNK/AP-1 signaling pathway of T lymphocytes in SR asthmatics, which may be one of the mechanisms of vitamin D to improve glucocorticoid resistance in SR asthmatics.
ObjectiveTo investigate the clinical value of peripheral blood vitamin D level in predicting the outcome of weaning from mechanical ventilation in critically ill patients.MethodsA total of 130 critically ill patients who undergoing mechanical ventilation for more than 48 hours in our hospital were recruited from June 2014 to June 2017. Serum 25(OH)D3 was detected on admission and before spontaneous breathing test (SBT) meanwhile general clinical data and laboratory examination indexes were recorded. The cases were divided into a successful weaning group and a failure weaning group according to the outcome of weaning from mechanical ventilation. Logistic regression equation was used to analyze the relationship between vitamin D level and failure weaning, and a receiver operating characteristic (ROC) curve was used to analyze the predictive value for failure weaning.ResultsThere were 46 patients with failure weaning among 130 patients (35.38%). Compared with the successful weaning group, the failure weaning group had significantly higher Acute Physiology and Chronic Health EvaluationⅡ score, longer duration in intensive care unit, higher respiratory rate, higher rapid shallow breathing index, higher C-reactive protein, higher N-terminal prohormone of brain natriuretic peptide, higher serum creatinine, and significantly lower albumin (all P<0.05). 25(OH)D3 level classifications on admission and before SBT in the failure weaning group were worse than those in the successful weaning group (P<0.05). 25(OH)D3 levels of the failure weaning group were lower than those of the successful weaning group [on admission: (18.16±4.33) ng/ml vs. (21.60±5.25) ng/ml, P<0.05; before SBT: (13.50±3.52) ng/mlvs. (18.61±4.30) ng/ml, P<0.05]. Multivariate logistic regression analysis showed that 25(OH)D3 levels on admission and before SBT were independent risk factors for failure weaning (OR values were 2.257 and 2.613, respectively, both P<0.05). ROC curve analysis showed that areas under ROC curve were 0.772 and 0.836, respectively, with sensitivities of 80.3% and 85.2%, specificities of 69.0% and 71.0%, respectively.Conclusions25(OH)D3 deficiency or insufficiency is common in critically ill patients. The lower the level of vitamin D, the higher the risk of failure weaning. So it may be an independent predictor of failure weaning.
ObjectiveTo systematically review the efficacy of vitamin D supplementation on patients with polycystic ovary syndrome (PCOS).MethodsPubMed, EMbase, The Cochrane Library, Web of Science, EBSCO, CBM, WanFang Data, CNKI and VIP databases were electronically searched to collect randomized controlled trials (RCTs) on the efficacy of vitamin D supplementation for PCOS from inception to July 2019. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies, then, meta-analysis was performed by using RevMan 5.3 software.ResultsA total of 11 RCTs involving 692 patients were included. The results of meta-analysis showed that compared with placebo, vitamin D could reduce the level of hypersensitive C-reactive protein (hs-CRP) (MD=−0.54, 95%CI −1.00 to −0.08, P=0.02) and total testosterone (MD=−0.17, 95%CI −0.29 to −0.05, P=0.004), and increase endometrial thickness (MD=1.78, 95%CI 0.49 to 3.06, P=0.007). However, there were no significant differences between two groups in the incidence of sex hormone binding globulin (SHBG) level and hypertrichosis’s score (mF-G) (P>0.05).ConclusionsCurrent evidence indicates that vitamin D supplementation can significantly reduce the level of total testosterone and hs-CRP, and increase endometrial thickness of PCOS. Due to the limited quality and quantity of the included studies, more high quality studies are required to verify the above conclusions.
ObjectiveTo systematically review vitamin D nutritional status among children and adolescents in China.MethodsCNKI, CBM, WanFang Data, VIP and PubMed databases were electronically searched to collect cross-sectional studies on vitamin D nutritional status among children and adolescents in China from inception to September, 2020. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies. Meta-analysis was then performed by using Stata 11.0 software.ResultsA total of 23 cross-sectional studies involving 38 047 total sample size were included.The results of meta-analysis showed that the combined vitamin D deficiency rate was 27.9% (95%CI 21.9% to 33.8%), and the inadequate rate was 31.6% (95%CI 25.7% to 37.6%).Subgroup analysis showed that vitamin D deficiency rate of females was higher than that of males (25.3% vs. 22.5%). The vitamin D deficiency rate of children aged 10 to 18 was higher than those aged 6 to 9 (44.9% vs. 32.9%). The vitamin D deficiency rate of children in the north was higher than that in south (36.1% vs. 14.8%). The vitamin D deficiency rate from 2015 to 2018 was higher than that from 2011 to 2014 (34.9% vs. 17.6%). In addition, the vitamin D deficiency rate ofurban children was higher than that of rural children (29.9% vs. 24.9%).ConclusionsThe incidence of vitamin D deficiency among children and adolescents is high in China. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above conclusions.