【原】术前维生素D缺乏与术后谵妄和认知功能障碍风险的关联：一项Meta分析

术前维生素D缺乏与术后谵妄和认知功能障碍风险的关联：一项Meta分析

贵州医科大学     麻醉与心脏电生理课题组

翻译：潘志军  编辑：张中伟  审核：曹莹

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摘

要

背景：尽管维生素D缺乏（VDD）与一般人群的认知功能障碍有关，但术前VDD对术后谵妄（POD）和术后认知功能障碍（POCD）的影响仍有待阐明。     

试验设计：队列研究Meta分析。   

范围设置：术后护理。

干预措施：术前VDD作为预后因素。

受试人群：接受手术的成年患者。

方法：数据库包括MEDLINE、EMBASE、Google scholar和Cochrane图书馆数据库，从建立到2021年9月进行搜索。随机效应模型用于汇总术前VDD与POD/POCD之间的相关性结果。主要结果是VDD与POD/POCD风险的相关性，而次要结果包括其他预后因素（如高血压）与POD/POCD风险。计算预测区间（PI），以表明95%的所有人群中未来研究的真实效应大小范围。

结果：对7项涉及2673名患者的观察性研究的Meta分析表明，POD/POCD的合并发病率为29%（95%可信区间（CI）：18%-44%）。我们的研究结果表明，术前VDD增加了POD/POCD的风险[比值比（OR）=1.54，95%CI:1.21-1.97，p<0.01；I2=29.2%，7项研究，2673名患者；95%PI:0.89-2.67]，而维生素D不足与POD/POCD的更高风险无关（OR=0.88，95%CI:0.49-1.57，p=0.66；I2=62.6%，4项研究，1410名患者；95%PI:0.09-8.79）。我们的主要结果（即0.89至2.67）中的PI包含1.0，这表明未来研究中可能会出现不一致的结果。患有POD/POCD的患者比没有POD/POCD的患者年龄更大。高血压、糖尿病、男性或吸烟未被认为是POD/POCD的危险因素。

结论：我们的结果表明，术前维生素D缺乏与术后认知障碍有关。鉴于预测区间的局限性，需要更多的未来研究来阐明VDD和POD/POCD之间的关联。 

原始文献来源：Kuo-Chuan Hung,Li-Kai Wang, Yao-Tsung Lin,et al.Association of preoperative vitamin D deficiency with the risk of postoperative delirium and cognitive dysfunction: A meta-analysis [J]. (J Clin Anesth 2022 08;79).

英文原文

Association of preoperative vitamin D deficiency with the risk of

postoperative delirium and cognitive dysfunction: A meta-analysis      

Abstract

Study objective: Despite vitamin D deficiency (VDD) associated with cognitive dysfunction in the general population, the impacts of preoperative VDD on postoperative delirium (POD) and cognitive dysfunction (POCD) remain to be clarified.

Design: Meta-analysis of cohort studies.

Setting: Postoperative care.

Intervention: Preoperative VDD as the prognostic factor.

Patients: Adult patients undergoing surgery.

Measurements: Databases including MEDLINE, EMBASE, Google scholar, and the Cochrane Library databases were searched from inception to September 2021. Random-effects modeling was applied to the pooling of results on the association between preoperative VDD and POD/POCD. The primary outcome was the association of VDD with the risk of POD/POCD, while the secondary outcomes included other prognostic factors (e.g., hypertension) with the risk of POD/POCD. A prediction interval (PI) was calculated to indicate the range of a true effect size of  a future study in 95% of all populations. 

Main results: Meta-analysis of seven observational studies involving 2673 patients showed that the pooled incidence of POD/POCD was 29% (95% confidence interval (CI): 18% to 44%). Our results demonstrated that preoperative VDD increased the risk of POD/POCD [odds ratio (OR) = 1.54, 95% CI: 1.21–1.97, p < 0.01; I2 =29.2%, seven studies, 2673 patients; 95% PI: 0.89–2.67], while vitamin D insufficiency was not associated with a higher risk of POD/POCD (OR = 0.88, 95% CI: 0.49–1.57, p = 0.66; I2 = 62.6%, four studies, 1410 patients; 95% PI: 0.09–8.79). The PI in our primary outcome (i.e., 0.89 to 2.67) containing 1.0 suggested the possibility of inconsistent results in future studies. Patients with POD/POCD were older compared to those without. Hypertension, diabetes mellitus, male gender, or smoking was not recognized as risk factors for POD/POCD.

 Conclusions: Our results demonstrated that preoperative vitamin D deficiency was associated with postoperative cognitive impairment. Given the prediction interval, more future studies are needed to elucidate associations between VDD and POD/POCD.

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