补锌对婴幼儿智力及运动发育影响的Meta分析[1]

4 ChinJEvidBasedPediatr　January2011,Vol6,No

1

论著

DOI:10.3969/j.issn.167325501.2011.01.002

补锌对婴幼儿智力及运动发育影响的Meta分析

朱帝玲　毛　萌　杨文旭　杨慧明

　　摘要　目的　评价补锌对婴幼儿运动和智力发育改善的作用。方法　PubMed、E图书馆、中国期刊全文数据库、维普中文科技期刊数据库和万方数据库等,文献。根据随机分配方法,分配隐藏,对研究对象、,,,其他偏倚来源进行文献偏倚评估6(I)(PDI)和发育商(DQ)为疗效判定指标。采用5eta,,并选择相应的效应模型分析。计量资料以SCI。结果　①共检索到文献84篇,共10篇RCT满足纳入条件进入Meta分析。7,8篇文献采用了分配隐藏,9篇文献对受试者采用了盲法,8篇文献对研究者和结局测量者采用了盲法,9篇文献提及报道数据的完整性,9篇文献未选择性报告研究结果,仅1篇文献报道了其他偏倚来源。漏斗图检验未见显著发表偏倚。②Meta分析结果显示,补锌组与对照组MDI的差异无统计学意义,WMD=-0.08(95%CI:-1.55～1.40);补锌组与对照组PDI的差异无统计学意义,SMD=0.15(95%CI:-0.12～0.42)。但研究间均具显著统计学

异质性,根据补锌的剂量、是否与其他营养物质合用、纳入对象的营养状况行亚组分析,进一步探讨异质性产生的原因。亚组分析显示不能完全消除文献间的异质性,异质性可能还与其他因素有关。③补锌组与对照组DQ评分的差异无统计学意义,WMD=-0.72(95%CI:-7.97～6.53)。补锌组与对照组干预前后Alberta运动指数的差异无统计学意义,

WMD=0.30(95%CI:-2.09～2.69)。结论　早期补锌并未提高MDI、PDI及DQ评分,对婴幼儿运动和智力发育未显示

有改善作用。鉴于研究间存在显著的统计学异质性,结论仍需谨慎看待。

关键词　锌;　婴幼儿;　智力发育;　神经发育;　Meta分析

Effectofzincsupplementationonmentaldevelopmentandmotordevelopmentininfants:ameta2analysis

ZHUDi2ling,MAOMeng,YANGWen2xu,YANGHui2ming(DepartmentofPediatrics,WestChinaSecondUniversityHospitalofSichuan,Chengdu610041,China)

CorrespondingAuthor:YANGHui2ming,E2mail:yanghuiming03@http://www.77cn.com.cn

Abstract　Objective　Toassesstheefficacyofzincsupplementationforimprovingpsychomotordevelopmentalandmental

developmentaloutcomesininfantsyoungerthan3years.Methods　AccordingtotherequirementsofCochranesystematicreview,aliteraturesearchwasperformedamongPubMed,EMBASE,Cochranelibrary,CNKI,VIPandWanfangdatafromtheestablishmentofthedatabasetillOctober2010.Mentaldevelopmentalindex(MDI),psychomotordevelopmentalindex(PDI)anddevelopmentquotient(DQ)of6-36monthsafterbirthweremeasuredastherapeuticefficacyindex.RevMan5.0softwarewasusedformeta2analysis.TheCochranehandbook5.0.2wasusedtoevaluatethemethodologicalquality.Dataextraction,qualityassessment,andmeta2analysisfortheresultsofhomogeneousstudieswereperformedbytworeviewers.Heterogeneityoftheincludedarticleswastestedtoselectpropereffectivemodel.MeasurementdatawereexpressedasSMD,WMDandits95%CI.Results　Eighty2fourarticlesweresearchedaccordingtotheinclusionandexclusioncriteria,21reviews,37studieswithoutzinc

supplementation,5studiesforpregnantmothers,5studiesforchildrenolderthan3years,1studyinwhichzincsupplementationwasnottheonlydifferentinterventioncomparedwithcontrolgroupand5studieswithouttheoutcomeswereexcluded.TenRCTsmeetingtheinclusioncriteriawereenrolled.Theassessmentofliteraturequalityshowed7literaturesdescribedthemethodofrandomallocationindetail,8literaturesdescribedallocationconcealment,8literaturesuseddoubleblindmethod,9literatures作者单位　四川大学华西第二医院儿科　成都,610041

通讯作者　杨慧明,E2mail:yanghuiming03@http://www.77cn.com.cn

中国循证儿科杂志　2011年1月第6卷第1

期 5

reportedcompletedataaddressedand9literatureswerefreeofselectivelyreporting.Only1literaturedescribedthesourcesofotherbias.Therewasclinicalheterogeneityinthe10includedstudies.NineRCTs(n=2250)reportedPDIwiththeBayleyScalesofInfantDevelopmentorGriffithsMentalDevelopmentScales.TherewasnosignificantdifferenceinthePDIbetweentwogroups,SMD=0.15(95%CI:-0.12to0.42).EightRCTs(n=2136)reportedMDIwiththeBayleyScalesofInfantDevelopment.TherewasnosignificantdifferenceintheMDIbetweentwogroups,WMD=-0.08(95%CI:-1.55to1.40).Subgroupanalyseswerecarriedoutfordosage,formulation(zincaloneorzinccombinedwithothernutrients)andnutritionstatus(varyingmeaslescasefatalityrates).NoneofthesesubgroupanalysesshowedsignificantdifferenceintheMDIorPDIbetweengroups.OneRCT(n=114)reportedDQusingtheGriffithsMentalDevelopmentScales.TheWMDofDQwas-0.72(95%CI:-7.97to6.53).AnotherRCT(n=70)reportedthechangeinAlbertaInfantMotorScaleanddidshowsignificantbetweengroups,WMD=0.30(95%CI:-2.09to2.69).Conclusions　Supplenopdevelopmentandmentaldevelopmentininfants.FurtherstudiesareneededtherepKeywords　Zinc;　Infant;analysis

　　,,在细胞的生长及分化中起重要作用。动物实验发现孕期及生长发育的重要时期限制锌的摄入可导致胎儿大脑神经发育畸形及功能异常,可引起认知功能受损,如注意力/记忆力和学习能力下降等

[1]

development)OR(mentaldevelopment)OR(neuro2

development)OR(cognition)OR(intelligence));限定词:humans,clinicaltrail,randomizedcontrolledtrial。中文检索

词:锌、智力或运动或认知或生长发育或神经发育、婴幼儿。根据具体数据库相应调整检索策略。

1.3.3　原文获取途径　检索电子期刊全文数据库或直接

。有

多项研究探讨了孕期或婴幼儿期补锌对后期运动及智力发育的影响,但单项研究的结果并不一致[1～4]。为明确补锌对远期运动和智力发育的影响,本研究检索相关文献,采用

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