低出生体质量儿补铁时间的Meta分析

发布时间：2018-11-16 21:42

【摘要】：目的目前关于早产儿和低出生体质量儿(LBW)预防性肠内补铁的最佳时机尚不十分清楚,本研究旨在比较LBW早期和晚期补铁的疗效。方法计算机检索Pub Med、Cochrane Library、中国知网、万方数据知识服务平台等数据库,检索时间为建库至2015-12-31。收集关于LBW早期补铁疗效(出生后2周开始补铁)和晚期补铁疗效(出生后4周开始补铁)的前瞻性随机对照试验。对纳入文献进行质量评价和数据提取,采用Rev Man 5.3软件对血清铁蛋白、血红蛋白(Hb)、输血率、新生儿坏死性小肠结肠炎(NEC)发生率进行分析。结果共纳入4篇文献,418例患儿,其中早期补铁组209例,晚期补铁组209例。所纳入文献的质量较高。Meta分析结果显示,早期补铁组血清铁蛋白水平下降的幅度低于晚期补铁组,差异有统计学意义〔均数差(MD)=14.08,95%CI(9.08,19.08),P0.001〕。早期补铁组血红蛋白水平下降的幅度低于晚期补铁组,差异有统计学意义〔MD=0.87,95%CI(0.71,1.02),P0.001〕。早期补铁组输血率低于晚期补铁组,差异有统计学意义〔OR=0.44,95%CI(0.27,0.71),P0.001〕。早期补铁组和晚期补铁组NEC发生率比较,差异无统计学意义〔OR=0.73,95%CI(0.33,1.60),P=0.43〕。经leave one-out法进行敏感性分析,将每篇文献依次剔除,研究结果没有产生较大影响,具有良好可靠性。结论早期补铁可减少血清铁蛋白和血红蛋白水平下降的幅度。然而,LBW补铁应谨慎对待,以免导致铁过量和可能对神经发育的长期负面影响。
[Abstract]:Objective to compare the effect of early and late iron supplementation on (LBW) in premature infants and low birth weight infants. Methods Pub Med,Cochrane Library, China knowledge Web, Wanfang data knowledge Service platform and other databases were searched by computer. The retrieval time was from 2015 to 12-31. Prospective randomized controlled trials were collected on the effects of early iron supplementation in LBW (iron supplementation at 2 weeks after birth) and late iron supplementation (iron supplementation at 4 weeks after birth). The quality evaluation and data extraction were carried out. Serum ferritin, hemoglobin (Hb), transfusion rate and incidence of neonatal necrotizing enterocolitis (NEC) were analyzed by Rev Man 5.3 software. Results A total of 418 children were included in 4 literatures, 209 in early iron supplementation group and 209 in late iron supplementation group. The results of Meta analysis showed that the decrease of serum ferritin level in early iron supplementation group was lower than that in late iron supplementation group, and the difference was statistically significant (mean difference (MD) = 14.0895 CI (9.0819.08), P 0.001). The decrease of hemoglobin level in the early iron supplementation group was lower than that in the late iron supplementation group (P < 0. 001). The difference was statistically significant (MD=0.87,95%CI (0. 71 卤1. 02), P 0. 001). The blood transfusion rate in early iron supplementation group was lower than that in late iron supplementation group (OR=0.44,95%CI (0.270.71), P 0.001). There was no significant difference in the incidence of NEC between the early iron supplementation group and the late iron supplementation group (OR=0.73,95%CI (0.33 卤1.60), P = 0.43). After sensitivity analysis by leave one-out method, each paper is eliminated in turn. The results of the study have no great influence and are of good reliability. Conclusion early iron supplementation can reduce the decrease of serum ferritin and hemoglobin levels. However, iron supplementation by LBW should be treated with caution in order not to lead to excessive iron and possible long term negative effects on neural development.
【作者单位】：浙江省宁波市妇女儿童医院新生儿科;山东省聊城市东阿县人民医院;
【分类号】：R722.6

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