Ukuxhatshazwa kwe-insulin kudlala indima ebalulekileyo kwi-pathogenesis yesifo sesibindi esinamafutha e-noncoholic (NAFLD) .Izifundo ezininzi ziye zavavanya umbutho weivithamin DUkuxhaswa kunye nokuxhatshazwa kwe-insulin kwizigulane ezine-NAFLD.Iziphumo ezifunyenweyo zisaza neziphumo eziphikisanayo.Injongo yolu phononongo yayikukuvavanya isiphumo sonyango olongezelelweyo lwe-vitamin D ekuphuculeni ukumelana ne-insulin kwizigulane ezine-NAFLD.Uncwadi olufanelekileyo lufunyenwe kwi-PubMed, Google Izazinzulu, iCOCHRANE kunye neSayensi Direct idatabase.Izifundo ezifunyenweyo zahlalutywa kusetyenziswa iziphumo ezisisigxina okanye imodeli yeziphumo ezingalindelekanga.Izifundo ezifanelekileyo ezisixhenxe ezinabathathi-nxaxheba abangama-735 bebonke zibandakanyiwe.Ivithamin Dukuxhaswa kuphuculwe ukunyanzeliswa kwe-insulin kwizigulane ezine-NAFLD, eziphawulwe ngokunciphisa i-Homeostatic Model Assessment ye-Insulin Resistance (HOMA-IR), kunye ne-pooled mean difference of -1.06 (p = 0.0006; 95% CI -1.66 ukuya -0.45). Ukuxhaswa kwe-Vitamin D kwandise amanqanaba e-serum ye-vitamin D kunye nokwahlukana kwe-17.45 (p = 0.0002; 95% CI 8.33 kwi-26.56).Ivithamin DI-supplementation yanciphisa amanqanaba e-ALT kunye nokwahlukana kwe-ALT edibeneyo -4.44 (p = 0.02; 95% CI -8.24 ukuya -0.65) .Akukho mphumo wabonwa kumanqanaba e-AST.Ukuxhaswa kwe-Vitamin D kunemiphumo emihle ekuphuculeni ukumelana ne-insulin kwizigulane ze-NAFLD. ukuxhaswa kunokunciphisa i-HOMA-IR kwizigulane ezinjalo.Inokusetyenziswa njengonyango olunokuthi lube nonyango lwezigulane ze-NAFLD.
Isifo sesibindi esinamafutha e-Nonalcoholic (NAFLD) liqela lezifo zesibindi ezinxulumene namafutha1.Ibonakaliswa ngokuqokelelwa okuphezulu kwe-triglycerides kwi-hepatocytes, ngokuqhelekileyo kunye nomsebenzi we-necroinflammatory kunye ne-fibrosis (steatohepatitis) 2.Inokuqhubela phambili kwi-nonalcoholic steatohepatitis (NASH), i-fibrosis kunye ne-cirrhosis.I-NAFLD ithathwa njengeyona nto ibangela isifo sesibindi esingapheliyo kunye nokuxhaphaka kwayo kuyanda, kuqikelelwa kwi-25% ukuya kwi-30% yabantu abadala kumazwe athuthukileyo3,4.Ukuxhatshazwa kwe-insulin, ukuvuvukala, kunye noxinzelelo lwe-oxidative kucingelwa ukuba yizona zinto zibalulekileyo uphuhliso lwe-NAFLD1.
I-pathogenesis ye-NAFLD ihambelana ngokusondeleyo nokuxhatshazwa kwe-insulin.Ngokusekelwe kwimodeli exhaphakileyo "ye-hypothesis emibini", ukuxhatshazwa kwe-insulin kubandakanyeka kwinkqubo "yokuqala". i-hepatocytes, apho ukuxhatshazwa kwe-insulin kucatshangelwa ukuba yimbangela enkulu ekuphuhliseni i-hepatic steatosis. "I-first hit" ikwandisa ubungozi besibindi kwizinto ezenza "i-second hit".Ingakhokelela ekonakaleni kwesibindi, ukuvuvukala kunye ne-fibrosis.Ukuveliswa kwe-cytokines ye-proinflammatory, ukungasebenzi kwe-mitochondrial, uxinzelelo lwe-oxidative, kunye ne-lipid peroxidation nazo zizinto ezinokuthi zibe negalelo ekuphuhliseni ukulimala kwesibindi, okwenziwe yi-adipokines.
I-Vitamin D yi-vitamin e-fat-soluble elawula i-homeostasis yamathambo.Indima yayo ihlolwe ngokubanzi kwiimeko zempilo ezingabonakaliyo ezifana nesifo se-metabolic syndrome, ukuxhatshazwa kwe-insulin, ukukhuluphala, uhlobo lwe-2 yeswekile kunye nezifo ezinxulumene ne-cardiovascular.Kutshanje, a a ubungqina obukhulu besayensi buhlolisise ubudlelwane phakathi kwe-vitamin D kunye ne-NAFLD.I-Vitamin D iyaziwa ngokulawula ukuxhatshazwa kwe-insulin, ukuvuvukala okungapheliyo kunye ne-fibrosis.Ngoko ke, i-vitamin D inokunceda ukukhusela ukuqhubela phambili kwe-NAFLD6.
Izilingo ezininzi ezilawulwa ngokungahleliwe (RCTs) ziye zavavanya umphumo we-vitamin D yokuxhaswa kwe-insulin ukumelana.Nangona kunjalo, iziphumo ezifunyenweyo zisahluka;nokuba ubonisa umphumo onenzuzo kwi-insulin ukumelana okanye ungabonakali nayiphi na inzuzo7,8,9,10,11,12,13.Nangona iziphumo eziphikisanayo, uhlalutyo lweemeta luyadingeka ukuvavanya umphumo opheleleyo wokuxhaswa kwe-vitamin D.Uhlalutyo oluninzi lwe-meta zenziwe ngaphambili14,15,16.Uhlalutyo lwemeta nguGuo et al.Kubandakanywa nezifundo ezintandathu zokuvavanya umphumo wevithamini D ekuxhathiseni kwe-insulin kunika ubungqina obuninzi bokuthi i-vitamin D ingaba nefuthe elihle kwi-insulin sensitivity14.Nangona kunjalo, enye i-meta- Uhlalutyo luvelise iziphumo ezahlukeneyo.I-Pramono et al15 yafumanisa ukuba unyango olongezelelweyo lwe-vitamin D alunampembelelo kwi-insulin sensitivity.Inani labantu elibandakanyiweyo kwisifundo laliyizifundo okanye ezisengozini yokuxhatshazwa kwe-insulin, kungekhona ezo zijoliswe ngqo kwi-NAFLD.Olunye uphando ngu-Wei et al. ., kubandakanywa nezifundo ezine, zenze iziphumo ezifanayo.Ukuxhaswa kwe-Vitamin D akuzange kunciphise i-HOMA IR16.Ukuqwalasela zonke ii-meta-analysis zangaphambili malunga nokusetyenziswa kwe-vitamin D izongezelelo zokuxhatshazwa kwe-insulin, i-updaI-ted meta-analysis iyadingeka kunye noncwadi olongezelelweyo oluhlaziyiweyo.Injongo yolu phononongo yayikukuvavanya umphumo we-vitamin D yokuxhaswa kwe-insulin.
Ngokusebenzisa isicwangciso esiphezulu sokukhangela, sifumene izifundo ze-207 ezipheleleyo, kwaye emva kokuphindaphinda, safumana amanqaku angama-199. Asibandakanyi amanqaku e-182 ngokuhlola izihloko kunye nezicatshulwa, sishiya izifundo ezichaphazelekayo ze-17. Izifundo ezingakhange zinike lonke ulwazi. efunekayo kule meta-analysis okanye ukuba isicatshulwa esipheleleyo sasingekho ngaphandle.Emva kokuhlolwa kunye nokuhlolwa kwekhwalithi, sifumene amanqaku asixhenxe okuhlaziywa okucwangcisiweyo ngoku kunye nohlalutyo lwemeta.Itshati yokuhamba kwesifundo se-PRISMA iboniswe kuMfanekiso 1 .
Sifake amanqaku apheleleyo eemvavanyo ezisixhenxe ezilawulwa ngokungahleliwe (RCTs) .Iminyaka yokupapashwa kwala manqaku isuka kwi-2012 ukuya kwi-2020, kunye neesampuli ze-423 kwiqela lokungenelela kunye ne-312 kwiqela le-placebo.Iqela lokulinga lifumene ezahlukeneyo. iidosi kunye nobude bezongezelelo ze-vitamin D, ngelixa iqela lokulawula lifumene indawo ye-placebo. Isishwankathelo seziphumo zophando kunye neempawu zokufunda zichazwe kwiThebhile 1.
Umngcipheko we-bias uhlalutywe kusetyenziswa umngcipheko we-Cochrane Collaboration yendlela yokukhetha.Onke amanqaku asixhenxe afakwe kolu phononongo aphumelele ukuvavanywa komgangatho.Iziphumo ezipheleleyo zomngcipheko wokungakhethi kuwo onke amanqaku afakiweyo aboniswe kuMfanekiso 2.
Ukuxhaswa kwe-Vitamin D kuphucula ukunyanzeliswa kwe-insulin kwizigulane ezine-NAFLD, ezibonakaliswe ngokunciphisa i-HOMA-IR.Ngokusekelwe kwimodeli yeziphumo ezingahleliwe (I2 = 67%; χ2 = 18.46; p = 0.005), umahluko odibeneyo phakathi kwe-vitamin D yokuncedisa kwaye akukho vithamini Ukuxhaswa kwe-D kwaba -1.06 (p = 0.0006; 95% CI -1.66 ukuya -0.45) (umfanekiso 3).
Ngokusekelwe kwimodeli ye-random-effects (umzobo we-4), ukuhlukana kwentsingiselo ehlanganisiweyo kwi-serum ye-vitamin D emva kokuxhaswa kwe-vitamin D ngu-17.45 (p = 0.0002; 95% CI 8.33 ukuya kwi-26.56) .Ngokohlalutyo, ukuxhaswa kwe-vitamin D kunokunyusa i-vitamin D. I-serum ye-vitamin D inqanaba nge-17.5 ng / mL. Okwangoku, umphumo we-vitamin D ukuxhaswa kwi-enzymes yesibindi i-ALT kunye ne-AST ibonise iziphumo ezahlukeneyo.Ukuxhaswa kwe-Vitamin D kunciphisa amanqanaba e-ALT kunye nokwahlukana okuxutywayo kwe-4.44 (p = 0.02; 95% CI -8.24 ukuya -0.65) (Umfanekiso 5) .Nangona kunjalo, akukho mphumo yabonwa kumanqanaba e-AST, kunye nokwahlukana kwentsingiselo edibeneyo -5.28 (p = 0.14; 95% CI - 12.34 kwi-1.79) ngokusekelwe kwimodeli yeziphumo ezingahleliwe ( Umzobo 6).
Utshintsho kwi-HOMA-IR emva kokuxhaswa kwe-vitamin D kubonise i-heterogeneity enkulu (I2 = 67%). Uhlalutyo lwe-Meta-regression yendlela yokulawula (ngomlomo okanye kwi-intramuscular), i-intake (imihla ngemihla okanye engeyiyo yonke imihla), okanye ubude be-vitamin D (≤) Iiveki ze-12 kunye neeveki ze-12) zicebisa ukuba ukusetyenziswa rhoqo kunokuchaza ukungafani (Itheyibhile 2) .Zonke kodwa isifundo esisodwa sikaSakpal et al.I-11 isebenzise indlela yomlomo yokulawula.Ukutya imihla ngemihla yezongezelelo ze-vitamin D ezisetyenziswe kwizifundo ezintathu7,8,13.Uhlalutyo olongezelelweyo lwe-sensitivity ngokuhlalutya kwekhefu-enye yeenguqu kwi-HOMA-IR emva kokuxhaswa kwe-vitamin D kubonise ukuba akukho sifundo esinoxanduva i-heterogeneity yeenguqu kwi-HOMA-IR (Umfanekiso 7).
Iziphumo ezidibeneyo zohlalutyo lweemeta zangoku zifumene ukuba unyango olongezelelweyo lwe-vitamin D lunokuphucula ukuxhatshazwa kwe-insulin, uphawu oluncitshisiweyo lwe-HOMA-IR kwizigulane ezine-NAFLD. .Uhlalutyo olongezelelweyo lwesiphumo salo ekuphuculeni ukuxhathisa kwe-insulin ukuqonda utshintsho kwi-serum ALT kunye namanqanaba e-AST.Ukunciphisa amanqanaba e-ALT, kodwa kungekhona amanqanaba e-AST, kwabonwa ngenxa yokongezwa kwe-vitamin D.
Ukwenzeka kwe-NAFLD kuhambelana ngokusondeleyo nokuxhatshazwa kwe-insulin.Ukwanda kwe-fatty acids yamahhala (FFA), ukuvutha kwezicubu ze-adipose, kunye nokunciphisa i-adiponectin inoxanduva lokuphuhliswa kwe-insulin ukumelana kwi-NAFLD17.Serum ye-FFA iphakamileyo kakhulu kwizigulane ze-NAFLD, eziguqulwa emva koko. ukuya kwi-triacylglycerols nge-glycerol-3-phosphate pathway.Enye imveliso yale ndlela yi-ceramide kunye ne-diacylglycerol (DAG) .I-DAG iyaziwa ukuba ibandakanyeka ekusebenzeni kweprotein kinase C (PKC), enokuthi inqanda i-insulin receptor threonine 1160, ehambelana nokunciphisa ukunyanzeliswa kwe-insulin.Ukuvuvukala kwezicubu ze-adipose kunye nokunyuka kwe-proinflammatory cytokines ezifana ne-interleukin-6 (IL-6) kunye ne-tumor necrosis factor alpha (TNF-alpha) nayo inegalelo ekunganyangeki kwe-insulin.Ngokubhekiselele kwi-adiponectin, inokukhuthaza Ukuvinjelwa kwe-fatty acid beta-oxidation (FAO), ukusetyenziswa kwe-glucose kunye ne-fatty acid synthesis.Amanqanaba ayo ayancipha kwizigulane ze-NAFLD, ngaloo ndlela ekhuthazaI-lopment of insulin resistance.Inxulumene ne-vitamin D, i-vitamin D receptor (VDR) ikhona kwiiseli zesibindi kwaye ibandakanyeke ekunciphiseni iinkqubo ezivuthayo kwisifo esingapheliyo sesibindi.Umsebenzi we-VDR wandisa uvakalelo lwe-insulin ngokumodareyitha i-FFA.Ukongezelela, i-vitamin D ineempawu ezichasayo kunye ne-anti-fibrotic kwisibindi19.
Ubungqina bangoku bubonisa ukuba ukungabikho kwe-vitamin D kunokubandakanyeka kwi-pathogenesis yezifo ezininzi.Le ngcamango ibambe inyaniso kwikhonkco phakathi kokungabikho kwe-vitamin D kunye nokuxhatshazwa kwe-insulin20,21.I-Vitamin D yenza indima yayo enokwenzeka ngokusebenzisana ne-VDR kunye ne-vitamin D ye-metabolizing enzymes. Ezi zinokuthi zikhona kwiintlobo ezininzi zeeseli, kubandakanywa iiseli ze-pancreatic beta kunye neeseli eziphendula i-insulin ezifana ne-adipocytes.Nangona indlela echanekileyo phakathi kwe-vitamin D kunye nokuxhatshazwa kwe-insulin ihlala ingaqinisekanga, kuye kwacetyiswa ukuba izicubu ze-adipose zingabandakanyeka kwindlela yayo. ivenkile ephambili ye-vitamin D emzimbeni izicubu ze-adipose.Ikwasebenza njengomthombo obalulekileyo we-adipokines kunye ne-cytokines kwaye ibandakanyeka ekuveliseni ukuvuvukala kwenkqubo.Ubungqina obukhoyo bubonisa ukuba i-vitamin D ilawula iziganeko ezinxulumene nokukhuselwa kwe-insulin kwiiseli ze-pancreatic beta.
Ukunikezelwa kobu bungqina, ukuxhaswa kwe-vitamin D ekuphuculeni ukunganyangeki kwe-insulin kwizigulane ze-NAFLD kunengqiqo. Uhlalutyo lwemeta nguGuo et al.Ukuvavanya isiphumo sevithamin D ekuxhathiseni kwe-insulin kunika ubungqina obuninzi bokuba ivithamin D inokuba nefuthe eliluncedo kwi-insulin sensitivity.Bafumene ukuncipha kwe-HOMA-IR ye--1.32;I-95% CI - 2.30, - 0.34.Izifundo ezibandakanyiweyo ukuvavanya i-HOMA-IR yayizizifundo ezintandathu14. Nangona kunjalo, ubungqina obuphikisanayo bukhona.Uphononongo olucwangcisiweyo kunye nohlalutyo lwemeta olubandakanya i-18 RCTs nguPramono et al ukuvavanya umphumo we-vitamin D supplementation. uvakalelo lwe-insulin kwizifundo ezinokumelana ne-insulin okanye umngcipheko wokuxhatshazwa kwe-insulin ubonise ukuba i-vitamin D eyongezelelweyo i-insulin sensitivity ayinayo impembelelo, i-standard standard difference -0.01, 95% CI -0.12, 0.10;p = 0.87, I2 = 0% 15. Nangona kunjalo, kufuneka kuqatshelwe ukuba abantu abavavanywayo kwi-meta-analysis babeyizifundo okanye ezisengozini yokuxhatshazwa kwe-insulin (ubunzima, ukukhuluphala, i-prediabetes, i-polycystic ovary syndrome [PCOS] kunye nohlobo olunzima. I-2 yeswekile), kunokuba izigulane ze-NAFLD15.Olunye uhlalutyo lwe-meta ngu-Wei et al. Iziphumo ezifanayo nazo zafunyanwa.Kuvavanyo lwe-vitamin D yokuncedisa kwi-HOMA-IR, kubandakanywa nezifundo ezine, ukuxhaswa kwe-vitamin D akuzange kunciphise i-HOMA IR (WMD) = 0.380, 95% CI - 0.162, 0.923; p = 0.169) 16.Ukuthelekisa yonke idatha ekhoyo, ukuphononongwa okucwangcisiweyo kwangoku kunye nohlalutyo lwe-meta lubonelela ngeengxelo ezongezelelweyo ze-vitamin D zokuphucula ukuxhathisa kwe-insulin kwizigulane ze-NAFLD, ezifana ne-meta-analysis. nguGuo et al. Nangona uhlalutyo olufanayo lwe-meta luye lwaqhutywa, uhlalutyo lwe-meta lwangoku lubonelela ngoncwadi oluhlaziyiweyo olubandakanya izilingo ezilawulwa ngokungenamkhethe kwaye ngaloo ndlela zibonelela ngobungqina obunamandla bomphumela wokuxhaswa kwe-vitamin D kwi-insulin r.ukuchasa.
Umphumo we-vitamin D ekuxhathiseni kwe-insulin unokuchazwa ngendima yayo njengomlawuli onokuthi ube ngumlawuli we-insulin secretion kunye namanqanaba e-Ca2 +. I-Calcitriol inokubangela ngokuthe ngqo ukukhupha i-insulin ngenxa yokuba i-vitamin D impendulo element (VDRE) ikhona kwi-insulin umgqugquzeli wegene ehlala kwi-pancreatic. iiseli ze-beta.Akukuphela nje ukubhaliswa kwe-insulin gene, kodwa kwakhona i-VDRE iyaziwa ukuba ivuselele iindidi ezahlukahlukeneyo ezinxulumene nokubunjwa kwe-cytoskeleton, i-intracellular junctions, kunye nokukhula kweeseli ze-pancreatic cβ cells.I-Vitamin D nayo ibonakaliswe ukuchaphazela ukuxhathisa kwe-insulin ngokumodareyitha i-Ca2 + i-flux.Njengoko i-calcium ibalulekile kwiinkqubo ezininzi ze-insulin-mediated intracellular in muscle and adipose tissue, i-vitamin D inokubandakanyeka kwimpembelelo yayo kwi-insulin resistance.I-Optimal intracellular Ca2 + amazinga ayimfuneko kwisenzo se-insulin.Izifundo zifumene ukuba ukungabikho kwe-vitamin D kukhokelela ekubeni ukwanda kweCa2 +, okubangela ukunciphisa umsebenzi we-GLUT-4, ochaphazela ukuxhathisa kwe-insulin26,27.
Impembelelo yokuxhaswa kwe-vitamin D ekuphuculeni ukuxhathisa kwe-insulin yahlaziywa ngakumbi ukuze ibonise umphumo wayo ekusebenzeni kwesibindi, ebonakaliswe kwiinguqu ze-ALT kunye ne-AST. Ukunciphisa amanqanaba e-ALT, kodwa kungekhona amanqanaba e-AST, kwabonwa ngenxa ye-vitamin D eyongezelelweyo. ukuxhaswa.Uhlalutyo lwe-meta nguGuo et al.lubonise ukunciphisa umda kumanqanaba e-ALT, ngaphandle kwempembelelo kumanqanaba e-AST, afana nolu phando14.Olunye uphando lwe-meta-analysis ngu-Wei et al.2020 alufumananga mmahluko kwi-serum alanine aminotransferase kunye namanqanaba e-aspartate aminotransferase phakathi kokuxhaswa kwe-vitamin D kunye namaqela e-placebo.
Uphononongo lwangoku olucwangcisiweyo kunye nohlalutyo lweemeta luphinda luphikisana nemida.I-heterogeneity ye-meta-analysis yangoku inokuchaphazela iziphumo ezifunyenwe kulolu cwaningo.Iimbono zexesha elizayo kufuneka zijongane nenani lezifundo kunye nezifundo ezibandakanyekayo ekuvavanyeni i-vitamin D yokuxhaswa kwe-insulin, ngokukodwa kujoliswe kuluntu lwe-NAFLD, kunye ne-homogeneity yezifundo.Enye inkalo ekufuneka iqwalaselwe kukufunda ezinye iiparitha kwi-NAFLD, njengomphumo wokuxhaswa kwe-vitamin D kwizigulane ze-NAFLD kwiiparamitha ezivuthayo, amanqaku omsebenzi we-NAFLD (NAS) kunye nokuqina kwesibindi. Ukuqukumbela, ukuxhaswa kwe-vitamin D kuphuculwe ukunyanzeliswa kwe-insulin kwizigulane ezine-NAFLD, uphawu oluncitshisiweyo lwe-HOMA-IR.
Iikhrayitheriya zokufaneleka zichongwa ngokuphumeza ingcamango ye-PICO.Isakhelo esichazwe kwiThebhile yesi-3.
Uphononongo olucwangcisiweyo lwangoku kunye nohlalutyo lwe-meta lubandakanya zonke izifundo ukuya kuthi ga ngo-Matshi 28, 2021, kwaye lubonelela ngombhalo opheleleyo, ukuvavanya ulawulo olongezelelweyo lwevithamini D kwizigulane ezine-NAFLD.Amanqaku aneengxelo zengxelo, izifundo ezisemgangathweni kunye nezoqoqosho, ukuphononongwa, i-cadavers kunye neentlobo ze-anatomy. ayengabandakanywanga kwisifundo samanje.Amanqaku onke angazange abonelele ngedatha efunekayo ukuqhuba uhlalutyo lwe-meta yangoku nawo ayengabandakanywanga.Ukuthintela ukuphindaphinda kwesampuli, iisampuli zavandlakanywa kumanqaku abhalwe ngumbhali ofanayo ngaphakathi kwiziko elifanayo.
Uphononongo lubandakanya izifundo zabantu abadala be-NAFLD abafumana i-vitamin D. Ukuxhatshazwa kwe-insulin kwavavanywa kusetyenziswa i-Homeostasis Model Assessment ye-Insulin Resistance (HOMA-IR).
Ungenelelo oluphantsi koqwalaselo lulawulo lwe-vitamin D.Sibandakanya izifundo apho i-vitamin D ilawulwa kuyo nayiphi na idosi, nayiphi na indlela yokulawula, kunye naluphi na ixesha.Nangona kunjalo, sibhale umthamo kunye nobude be-vitamin D elawulwa kwisifundo ngasinye. .
Isiphumo esiphambili esiphandwayo kuhlaziyo olucwangcisiweyo lwangoku kunye nohlalutyo lwe-meta luxhathiso lwe-insulin.Kulo mba, sasebenzisa i-HOMA-IR ukumisela ukunganyangeki kwe-insulin kwizigulane.Iziphumo zesibini ziquka amanqanaba e-serum vitamin D (ng / mL), i-alanine aminotransferase (ALT). ) (IU / l) kunye ne-aspartate aminotransferase (AST) (IU / l) amanqanaba.
Khipha iikhrayitheriya zokufaneleka (i-PICO) kumagama angundoqo usebenzisa abaqhubi be-Boolean (umzekelo OKANYE, KUNYE, HAYI) kunye nazo zonke iindawo okanye i-MeSH (iSihloko seSifundo sezoNyango) amagama.Kulu cwaningo, sasebenzisa i-database ye-PubMed, i-Google Scholar, i-COCHRANE kunye neSayensi eNgqongileyo njengokukhangela. iinjini zokufumana iijenali ezifanelekileyo.
Inkqubo yokukhetha isifundo yenziwa ngababhali abathathu (DAS, IKM, GS) ukunciphisa ithuba lokususa izifundo ezinokuthi zifaneleke.Xa kuvela ukungavisisani, izigqibo zombhali wokuqala, owesibini nowesithathu ziqwalaselwa.Ukhetho lokufunda luqala ngokusingatha ikopi ephindwe kabini. iirekhodi.Isihloko kunye nokuhlolwa kwe-abstract kwenziwa ukuba kungabandakanyi izifundo ezingabalulekanga.Emva koko, izifundo eziphumelele uvavanyo lokuqala zaphinda zavavanywa ukuze zihlole ukuba ngaba zidibene neendlela zokubandakanywa kunye nokukhutshwa kolu hlaziyo.Zonke izifundo ezibandakanyiweyo ziye zavavanywa ngokucokisekileyo umgangatho ngaphambi kokufakwa kokugqibela.
Bonke ababhali basebenzisa iifom zokuqokelela idatha ye-elektroniki ukuqokelela idatha efunekayo kwinqaku ngalinye.Idatha yahlanganiswa kwaye ilawulwa kusetyenziswa i-software Review Manager 5.4.
Izinto zedatha zaziyigama lombhali, unyaka wokupapashwa, uhlobo lokufunda, inani labantu, umthamo we-vitamin D, ixesha lolawulo lwe-vitamin D, ubungakanani besampula, ubudala, isiseko se-HOMA-IR, kunye nesiseko se-vitamin D. Uhlalutyo lwe-meta-meta-analysis of the mean differences in I-HOMA-IR ngaphambi nangemva kokulawulwa kwe-vitamin D kwenziwa phakathi kwamaqela onyango kunye nokulawula.
Ukuqinisekisa umgangatho wawo onke amanqaku adibana nemigaqo yokufaneleka kolu hlaziyo, kusetyenziswe isixhobo sokuhlola esibalulekileyo esisemgangathweni.Le nkqubo, eyenzelwe ukunciphisa amandla okukhetha ukukhethwa kwezifundo, yenziwa ngokuzimeleyo ngababhali ababini (DAS kunye ne-IKM).
Isixhobo esiphambili sovavanyo esisetyenzisiweyo kolu hlaziyo yayiyi-Cochrane Collaboration's risk of bias method.
Ukudibanisa kunye nokuhlalutya ukungafani kwentsingiselo kwi-HOMA-IR kunye nangaphandle kwe-vitamin D kwizigulane ezine-NAFLD.Ngokutsho kukaLuo et al., Ukuba idatha inikezelwa njenge-median okanye uluhlu lwe-Q1 kunye ne-Q3, sebenzisa i-calculator ukubala intsingiselo. kunye noWan et al.I-28,29 Ubungakanani beempembelelo zichazwe njengeeyantlukwano zentsingiselo kunye ne-95% yexesha lokuzithemba (CI) .Uhlalutyo lwenziwa ngokusebenzisa imodeli yemiphumo ehleliweyo okanye engahleliweyo.I-Heterogeneity yavavanywa ngokusebenzisa i-I2 statistic, ebonisa ukuba umlinganiselo wokuhluka kwimpembelelo ephawulweyo kwizifundo zonke. ngenxa yokwahluka kwisiphumo esiyinyani, kunye namaxabiso> 60% ebonisa i-heterogeneity ephawulekayo.Ukuba i-heterogeneity yayi> 60%, uhlalutyo olongezelelweyo lwenziwa kusetyenziswa i-meta-regression kunye nohlalutyo lobuthathaka.Uhlalutyo lwe-sensitivity lwenziwa ngokusebenzisa indlela yokushiya (isifundo esinye ngexesha sacinywa kwaye ukuhlalutya kwaphindwa kwakhona) i-p-values <0.05 ithathwa njengento ebalulekileyo.Uhlalutyo lwe-Meta lwenziwa kusetyenziswa uMphathi wokuHlola isoftware 5.4, uhlalutyo lweemvakalelo lwenziwa kusetyenziswa iphakheji yesoftware yezibalo (i-Stata 17.0 ye-Windows), kunye nohlengahlengiso lwe-meta lwenziwa kusetyenziswa i-Integrated Meta-Analysis Software Version 3.
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Ixesha lokuposa: May-30-2022