Ukumelana ne-insulin kudlala indima ebalulekile ku-pathogenesis yesifo sesibindi esinamafutha e-non-alcoholic (NAFLD) .Izifundo eziningana ziye zahlola ukuhlangana kwezifo zesibindi.uvithamini Dukwengezwa ngokumelana ne-insulin ezigulini ezine-NAFLD.Imiphumela etholiwe isaza nemiphumela ephikisanayo.Inhloso yalolu cwaningo kwakuwukuhlola umphumela wokwelashwa okwengeziwe kwe-vitamin D ekuthuthukiseni ukumelana ne-insulin ezigulini ezine-NAFLD.Izincwadi ezifanele zitholwe kwa-PubMed, Google Imininingo egciniwe yeScholar, i-COCHRANE kanye neSayensi Direct.Izifundo ezitholiwe zahlaziywa kusetshenziswa imithelela engaguquki noma amamodeli wemiphumela engahleliwe.Izifundo ezifanelekile eziyisikhombisa ezinenani eliphelele labahlanganyeli abangu-735.Ivithamini Dukwesekwa kuthuthukisa ukumelana ne-insulin ezigulini ezine-NAFLD, okumakwe ngokuncipha kwe-Homeostatic Model Assessment of Insulin Resistance (HOMA-IR), enomehluko ohlanganisiwe we- -1.06 (p = 0.0006; 95% CI -1.66 kuya -0.45). Ukwengezwa kwe-Vitamin D kwandise amazinga e-serum vitamin D ngomehluko omkhulu we-17.45 (p = 0.0002; 95% CI 8.33 kuya ku-26.56).Ivithamini Dukwesekwa kwehliselwe amazinga e-ALT ngesilinganiso esihlanganisiwe se--4.44 (p = 0.02; 95% CI -8.24 kuya ku-0.65) .Awukho umphumela obonwe kumazinga e-AST.Ukwengezwa kwe-Vitamin D kunemiphumela enenzuzo ekuthuthukiseni ukumelana ne-insulin ezigulini ze-NAFLD.Lokhu ukwesekwa kunganciphisa i-HOMA-IR ezigulini ezinjalo.Ingasetshenziswa njengendlela yokwelapha engase ibe i-adjuvant yeziguli ze-NAFLD.
Isifo sesibindi esinamafutha e-Nonalcoholic (NAFLD) yiqembu lezifo zesibindi ezihlobene namafutha1.Sibonakala ngokuqoqwa okuphezulu kwe-triglycerides ku-hepatocytes, ngokuvamile nge-necroinflammatory umsebenzi kanye ne-fibrosis (i-steatohepatitis) 2.Ingaqhubekela ku-nonalcoholic steatohepatitis (NASH), i-fibrosis kanye ne-cirrhosis.I-NAFLD ibhekwa njengembangela enkulu yesifo sesibindi esingapheli futhi ukwanda kwayo kuyanda, kulinganiselwa ku-25% kuya ku-30% yabantu abadala emazweni athuthukile3,4.Ukumelana ne-insulin, ukuvuvukala, nokucindezeleka okwenziwe nge-oxidative kucatshangwa ukuthi yizici ezinkulu ukuthuthukiswa kwe-NAFLD1.
I-pathogenesis ye-NAFLD ihlobene eduze nokumelana ne-insulin.Ngokusekelwe kumodeli "ye-hit-hit hypothesis" evame kakhulu, ukumelana ne-insulin kuhilelekile kwinqubo "yokuqala".Kule ndlela yokuqala, kuhilela ukuqoqwa kwe-lipids etholakala i-hepatocytes, lapho ukumelana ne-insulin kucatshangwa ukuthi kuyimbangela enkulu ekuthuthukisweni kwe-hepatic steatosis.I-"hit yokuqala" ikhulisa ubungozi besibindi ezintweni ezenza "i-hit yesibili".Kungaholela ekulimaleni kwesibindi, ukuvuvukala kanye ne-fibrosis.Ukukhiqizwa kwama-cytokines e-proinflammatory, ukungasebenzi kahle kwe-mitochondrial, ukucindezeleka kwe-oxidative, kanye ne-lipid peroxidation nakho kuyizici ezingase zibe nomthelela ekuthuthukiseni ukulimala kwesibindi, okwakhiwa yi-adipokines.
I-Vitamin D iyivithamini e-fat-soluble elawula i-homeostasis yamathambo.Indima yayo iye yahlolisiswa kabanzi ezimweni zempilo ezingezona zamathambo ezifana nesifo se-metabolic, ukumelana ne-insulin, ukukhuluphala, uhlobo lwe-2 yesifo sikashukela kanye nezifo ezihlobene nenhliziyo. umzimba omkhulu wobufakazi besayensi uye wahlola ubuhlobo phakathi kwe-vitamin D ne-NAFLD.I-Vitamin D iyaziwa ngokulawula ukumelana ne-insulin, ukuvuvukala okungapheli kanye ne-fibrosis.Ngakho-ke, i-vitamin D ingasiza ekuvimbeleni ukuqhubeka kwe-NAFLD6.
Izilingo eziningana ezilawulwa ngokungahleliwe (RCTs) ziye zahlola umphumela wokwengezwa kwe-vitamin D ekumelaneni ne-insulin.Nokho, imiphumela etholakele isahluka;noma ikhombisa umphumela onenzuzo ekumelaneni ne-insulin noma ingabonisi noma iyiphi inzuzo7,8,9,10,11,12,13.Naphezu kwemiphumela engqubuzanayo, ukuhlaziya imeta kuyadingeka ukuze kuhlolwe umphumela ophelele wokwengezwa kwe-vitamin D.Ukuhlaziywa kwemeta eminingana kwenziwe ngaphambilini14,15,16.Ukuhlaziywa kwemeta kaGuo et al.Kuhlanganisa nezifundo eziyisithupha ezihlola umphumela wevithamini D ekuphikisweni kwe-insulin kunikeza ubufakazi obuningi bokuthi uvithamini D ungaba nomthelela onenzuzo ekuzweleni kwe-insulin14.Nokho, enye i-meta- ukuhlaziywa kwaveza imiphumela ehlukene.U-Pramono et al15 wathola ukuthi ukwelashwa okwengeziwe kwe-vitamin D kwakungenayo umthelela ekuzweleni kwe-insulini.Isibalo sabantu esifakwe ocwaningweni sasiyizifundo noma ezisengozini yokumelana ne-insulin, hhayi lezo ezihloselwe ngokukhethekile i-NAFLD.Olunye ucwaningo olwenziwe ngu-Wei et al. ., okuhlanganisa nezifundo ezine, okutholakele okufanayo.Ukwengezwa kwe-Vitamin D akuzange kunciphise i-HOMA IR16.Kucatshangelwa konke ukuhlaziya kwe-meta yangaphambili mayelana nokusetshenziswa kwezithako ze-vitamin D zokumelana ne-insulin, i-updai-ted meta-analysis iyadingeka kanye nezincwadi ezengeziwe ezibuyekeziwe.Inhloso yalolu cwaningo kwakuwukuhlola umphumela wokwengezwa kwe-vitamin D ekumelaneni ne-insulin.
Ngokusebenzisa isu eliphezulu lokusesha, sithole isamba sezifundo ezingu-207, futhi ngemva kokuphindaphinda, sathola ama-athikili angu-199. Sikhiphe ama-athikili angu-182 ngokuhlola izihloko nezifinyezo, okushiya isamba sezifundo ezingu-17 ezifanele.Izifundo ezingazange zinikeze lonke ulwazi. okudingekayo kulokhu kuhlaziywa kwe-meta noma umbhalo ogcwele owawungatholakali wawungafakwanga.Ngemva kokuhlolwa nokuhlolwa kwekhwalithi, sithole ama-athikili ayisikhombisa okubuyekezwa okuhlelekile kwamanje nokuhlaziywa kwemeta.Ishadi lokugeleza locwaningo lwe-PRISMA liboniswa kuMfanekiso 1 .
Sifake ama-athikili anombhalo ogcwele wezilingo eziyisikhombisa ezilawulwa ngokungahleliwe (RCTs).Iminyaka yokushicilelwa yalezi zihloko isukela ku-2012 kuya ku-2020, nesamba samasampuli angu-423 eqenjini lokungenelela kanye ne-312 eqenjini le-placebo.Iqembu lokuhlola lithole okuhlukile imithamo nobude bezithako ze-vitamin D, kuyilapho iqembu lokulawula lithole i-placebo. Isifinyezo semiphumela yocwaningo nezici zocwaningo zethulwe kuThebula loku-1.
Ingozi yokuchema yahlaziywa kusetshenziswa indlela yokuchema ye-Cochrane Collaboration.Zonke izindatshana eziyisikhombisa ezifakwe kulolu cwaningo ziphumelele ukuhlolwa kwekhwalithi.Imiphumela egcwele yengozi yokuchema yazo zonke izindatshana ezifakiwe ibonisiwe kuMfanekiso 2.
Ukwengezwa kwe-Vitamin D kuthuthukisa ukumelana ne-insulin ezigulini ezine-NAFLD, ezibonakala ngokuncipha kwe-HOMA-IR.Ngokusekelwe kumodeli wemiphumela engahleliwe (I2 = 67%; χ2 = 18.46; p = 0.005), umehluko ohlanganisiwe wesilinganiso phakathi kokwengezwa kwe-vitamin D futhi akukho vitamin Ukwengezwa kuka-D kwaba -1.06 (p = 0.0006; 95% CI -1.66 kuya ku-0.45) (isithombe 3).
Ngokusekelwe kumodeli yemiphumela engahleliwe (Umfanekiso 4), umehluko wesilinganiso ohlanganisiwe ku-vitamin D serum ngemva kokwengezwa kwe-vitamin D kwaba ngu-17.45 (p = 0.0002; 95% CI 8.33 kuya ku-26.56) . Izinga le-serum vitamin D ngo-17.5 ng/mL.Ngaleso sikhathi, umphumela wokwengezwa kwe-vitamin D kuma-enzyme esibindi i-ALT ne-AST ibonise imiphumela ehlukene.Ukwengezwa kwe-Vitamin D kwehlise amazinga e-ALT ngesilinganiso esihlanganisiwe se--4.44 (p = 0.02; 95% CI -8.24 kuye ku -0.65) (Umfanekiso 5). Nokho, awukho umthelela obonwe kumazinga e-AST, ngomehluko wesilinganiso ohlanganisiwe ongu- -5.28 (p = 0.14; 95% CI - 12.34 kuya ku-1.79) ngokusekelwe kumodeli yemiphumela engahleliwe ( Umfanekiso 6).
Izinguquko ku-HOMA-IR ngemva kokwengezwa kwe-vitamin D zibonise ukuhlukahluka okukhulu (I2 = 67%). Ukuhlaziywa kwe-meta-regression yomzila wokuphatha (ngomlomo noma nge-intramuscular), ukudla (nsuku zonke noma okungezona nsuku zonke), noma ubude besikhathi sokwengezwa kwe-vitamin D (≤ Amaviki angu-12 kanye namaviki angu->12) aphakamisa ukuthi imvamisa yokusetshenziswa ingase ichaze i-heterogeneity (Ithebula 2) .Konke kodwa isifundo esisodwa sika-Sakpal et al.I-11 isebenzise umzila womlomo wokuphatha.Ukudla kwansuku zonke kwezithako ze-vitamin D ezisetshenziswa ezifundweni ezintathu7,8,13.Ukuhlaziywa okuqhubekayo kokuzwela ngokuhlaziywa kwekhefu elilodwa lezinguquko ku-HOMA-IR ngemva kokwengezwa kwe-vitamin D kubonise ukuthi akukho cwaningo olwalubophezelekile i-heterogeneity yezinguquko ku-HOMA-IR (Fig. 7).
Imiphumela ehlanganisiwe yokuhlaziywa kwe-meta yamanje ithole ukuthi ukwelashwa okwengeziwe kwe-vitamin D kungase kuthuthukise ukumelana ne-insulin, uphawu lwazo oluncishisiwe lwe-HOMA-IR ezigulini ezine-NAFLD.Umzila wokuphatha uvithamini D ungase uhluke, ngomjovo we-intramuscular noma ngomlomo. .Ukuhlaziywa okwengeziwe komphumela walo ekuthuthukiseni ukumelana ne-insulin ukuze kuqondwe izinguquko ku-serum ALT kanye namazinga e-AST.Ukuncipha kwamazinga e-ALT, kodwa hhayi amazinga e-AST, kwabonwa ngenxa yokwengezwa kwe-vitamin D eyengeziwe.
Ukwenzeka kwe-NAFLD kuhlobene eduze nokumelana ne-insulin.Ukwenyuka kwamafutha acids mahhala (FFA), ukuvuvukala kwezicubu ze-adipose, nokuncipha kwe-adiponectin kunesibopho sokuthuthukiswa kokumelana ne-insulin ku-NAFLD17.I-FFA ye-Serum iphakeme kakhulu ezigulini ze-NAFLD, eziguqulwa kamuva. kuma-triacylglycerols ngendlela ye-glycerol-3-phosphate.Omunye umkhiqizo wale ndlela i-ceramide ne-diacylglycerol (DAG).I-DAG yaziwa ngokuba nesandla ekusebenziseni i-protein kinase C (PKC), engase ivimbele i-insulin receptor threonine 1160, okuhlotshaniswa nokunciphisa ukumelana ne-insulin.Ukuvuvukala kwezicubu ze-adipose nokwanda kwe-proinflammatory cytokines njenge-interleukin-6 (IL-6) kanye ne-tumor necrosis factor alpha (TNF-alpha) nayo inomthelela ekuphikiseni kwe-insulin.Ngokuqondene ne-adiponectin, ingakhuthaza ukuvinjelwa kwe-fatty acid beta-oxidation (FAO), ukusetshenziswa kwe-glucose kanye ne-fatty acid synthesis.Amazinga ayo ayancipha ezigulini ze-NAFLD, ngaleyo ndlela akhuthazeI-lopment of insulin resistance.Ihlobene ne-vitamin D, i-vitamin D receptor (VDR) ikhona kumaseli esibindi futhi iye yathinteka ekunciphiseni izinqubo zokuvuvukala ezifweni ezingapheli zesibindi.Umsebenzi we-VDR wandisa ukuzwela kwe-insulin ngokumodela i-FFA.Ngaphezu kwalokho, i-vitamin I-D inezindawo zokulwa nokuvuvukala kanye ne-anti-fibrotic esibindini19.
Ubufakazi bamanje bubonisa ukuthi ukuntula kwe-vitamin D kungase kuhileleke ku-pathogenesis yezifo eziningana.Lo mqondo uqinisekisa ukuxhumana phakathi kokuntuleka kwe-vitamin D nokumelana ne-insulin20,21.I-Vitamin D yenza indima yayo engaba khona ngokusebenzisana ne-VDR kanye ne-vitamin D ye-metabolizing enzymes. Lezi zingase zibe khona ezinhlotsheni eziningana zamangqamuzana, kuhlanganise namaseli e-beta e-pancreatic kanye namaseli asabela ku-insulin njenge-adipocytes.Nakuba indlela eqondile phakathi kwe-vitamin D nokumelana ne-insulin ihlala ingaqiniseki, kuye kwaphakanyiswa ukuthi izicubu ze-adipose zingase zihileleke endleleni yayo. isitolo esiyinhloko se-vitamin D emzimbeni izicubu ze-adipose.Iphinde isebenze njengomthombo obalulekile we-adipokines nama-cytokines futhi ihileleke ekukhiqizeni ukuvuvukala kwesistimu.Ubufakazi bamanje bubonisa ukuthi i-vitamin D ilawula izenzakalo ezihlobene nokukhishwa kwe-insulin kumaseli we-beta we-pancreatic.
Njengoba kunikezwe lobu bufakazi, ukuxhaswa kwe-vitamin D ukuthuthukisa ukumelana ne-insulin ezigulini ze-NAFLD kunengqondo.Imibiko yakamuva ikhomba umphumela onenzuzo wokwengezwa kwe-vitamin D ekuthuthukiseni ukumelana ne-insulin.Ama-RCT amaningana anikeze imiphumela engqubuzanayo, edinga ukuhlolwa okwengeziwe ngokuhlaziywa kwe-meta.Akamuva ukuhlaziywa kwemeta kaGuo et al.Ukuhlola umphumela kavithamini D ekumelaneni ne-insulin kunikeza ubufakazi obuningi bokuthi uvithamini D angase abe nomthelela onenzuzo ekuzweleni kwe-insulin.Bathole ukuncipha kwe-HOMA-IR kokungu- - 1.32;I-95% CI - 2.30, - 0.34.Izifundo ezifakiwe ukuhlola i-HOMA-IR kwakuyizifundo eziyisithupha14.Nokho, ubufakazi obuphikisanayo bukhona.Ukubuyekezwa okuhlelekile nokuhlaziywa kwemeta okubandakanya i-18 RCTs ngu-Pramono et al ehlola umphumela wokwengezwa kwe-vitamin D ukuzwela kwe-insulin ezifundweni ezinokumelana ne-insulin noma ingozi yokumelana ne-insulin kubonise ukuthi i-vitamin D eyengeziwe ukuzwela kwe-insulin ayinawo umphumela, umehluko ojwayelekile ojwayelekile -0.01, 95% CI -0.12, 0.10;p = 0.87, I2 = 0% 15.Nokho, kufanele kuqashelwe ukuthi abantu abahlolwa ekuhlaziyweni kwe-meta babeyizikhonzi ezine-insulin noma ezisengozini yokumelana ne-insulin (ukukhuluphala ngokweqile, ukukhuluphala, i-prediabetes, i-polycystic ovary syndrome [PCOS] kanye nohlobo olunzima. I-2 yesifo sikashukela), kuneziguli ze-NAFLD15.Okunye ukuhlaziywa kwe-meta ngu-Wei et al.Okutholakele okufanayo nakho kwatholwa.Ekuhlolweni kokuxhaswa kwe-vitamin D ku-HOMA-IR, kuhlanganise nezifundo ezine, ukuxhaswa kwe-vitamin D akuzange kunciphise i-HOMA IR (WMD = 0.380, 95% CI - 0.162, 0.923; p = 0.169) 16.Ukuqhathanisa yonke idatha etholakalayo, ukubuyekezwa okuhlelekile kwamanje kanye nokuhlaziywa kwe-meta kunikeza imibiko eyengeziwe yokwengezwa kwe-vitamin D ukuthuthukisa ukumelana ne-insulin ezigulini ze-NAFLD, ezifana nokuhlaziywa kwe-meta nguGuo et al.Nakuba ukuhlaziya okufanayo kuye kwenziwa, ukuhlaziywa kwemeta kwamanje kunikeza izincwadi ezibuyekeziwe ezibandakanya ukuhlolwa okulawulwa ngokungahleliwe futhi ngaleyo ndlela kunikeza ubufakazi obunamandla bomphumela wokwengezwa kwevithamini D ku-insulin r.ukuphikisa.
Umthelela we-vitamin D ekuphikiseni i-insulin ungachazwa ngendima yayo njengomlawuli ongase ube khona wokukhiqizwa kwe-insulin kanye namazinga e-Ca2 +. I-Calcitriol ingase ibangele ngokuqondile ukukhishwa kwe-insulin ngoba isici sokuphendula se-vitamin D (VDRE) sikhona kumgqugquzeli wofuzo lwe-insulin etholakala ku-pancreatic. amaseli we-beta.Akuyona nje ukubhaliswa kwesakhi sofuzo se-insulin, kodwa futhi i-VDRE iyaziwa ngokuvuselela izakhi zofuzo ezihlukahlukene ezihlobene nokwakheka kwe-cytoskeleton, i-intracellular junctions, nokukhula kwamangqamuzana e-pancreatic cβ cells.I-Vitamin D nayo iboniswe ukuthi ithinta ukumelana ne-insulin ngokumodulating i-Ca2 + i-flux.Njengoba i-calcium ibalulekile ezinqubweni eziningana ze-insulin-mediated intracellular ku-muscle nezicubu ze-adipose, i-vitamin D ingase ihileleke emphumeleni wayo ekuphikisweni kwe-insulin.Amazinga aphezulu e-Ca2 + e-intracellular adingekayo ukuze enze i-insulin. ukwanda kwe-Ca2 +, okuholela ekunciphiseni komsebenzi we-GLUT-4, okuthinta ukumelana ne-insulin26,27.
Umphumela wokwengezwa kwe-vitamin D ekuthuthukiseni ukumelana ne-insulin wabuye wahlaziywa ukuze ubonise umphumela wawo ekusebenzeni kwesibindi, okubonakala ekushintsheni kwamazinga e-ALT ne-AST.Ukwehla kwamazinga e-ALT, kodwa hhayi amazinga e-AST, kwabonwa ngenxa yokwengezwa kwevithamini D. ukwesekwa.Ukuhlaziywa kwe-meta ka-Guo et al.kubonise ukuncishiswa komngcele kumazinga e-ALT, okungenamthelela kumazinga e-AST, afana nalolu cwaningo14.Olunye ucwaningo lwe-meta-analysis olwenziwa ngu-Wei et al.2020 futhi alutholanga umehluko ku-serum alanine aminotransferase kanye namazinga e-aspartate aminotransferase phakathi kokwengezwa kwe-vitamin D namaqembu e-placebo.
Ukubuyekezwa kwamanje okuhlelekile nokuhlaziywa kwe-meta nakho kuphikisana nokulinganiselwa.I-heterogeneity ye-meta-analysis yamanje ingase ibe nomthelela emiphumeleni etholwe kulolu cwaningo.Imibono yesikhathi esizayo kufanele ibhekane nenani lezifundo nezihloko ezihilelekile ekuhloleni ukwesekwa kwe-vitamin D ukuze kutholakale ukumelana ne-insulin, ikakhulukazi eqondise inani labantu be-NAFLD, kanye ne-homogeneity yezifundo.Esinye isici okufanele sicatshangelwe ukutadisha ezinye imingcele ku-NAFLD, njengomphumela wokwengezwa kwe-vitamin D ezigulini ze-NAFLD ngemingcele yokuvuvukala, isikolo somsebenzi we-NAFLD (NAS) nokuqina kwesibindi. Ekuphetheni, ukuxhaswa kwe-vitamin D kwathuthukisa ukumelana ne-insulin ezigulini ezine-NAFLD, uphawu oluncishisiwe lwe-HOMA-IR.Ingasetshenziswa njengendlela yokwelapha engaba khona yeziguli ze-NAFLD.
Imibandela yokufaneleka inqunywa ngokusebenzisa umqondo we-PICO.Uhlaka oluchazwe kuThebula lesi-3.
Ukubuyekezwa okuhlelekile kwamanje kanye nokuhlaziywa kwe-meta kufaka phakathi zonke izifundo kuze kufike ku-March 28, 2021, futhi inikeza umbhalo ogcwele, ukuhlola ukuphathwa kwe-vitamin D eyengeziwe ezigulini ezine-NAFLD.Izihloko ezinemibiko yamacala, izifundo zekhwalithi nezomnotho, ukubuyekezwa, ama-cadavers kanye nezinhlobo ze-anatomy. azibandakanyi esifundweni samanje.Zonke izihloko ezingazange zinikeze idatha edingekayo ukuze kuqhutshwe ukuhlaziywa kwe-meta yamanje nazo azifakiwe.Ukuvimbela ukuphindaphinda kwesampula, amasampuli ahlolwe izihloko ezibhalwe ngumlobi ofanayo ngaphakathi kwesikhungo esifanayo.
Ukubuyekezwa kwakuhlanganisa izifundo zeziguli ezindala ze-NAFLD ezithola ukuphathwa kwe-vitamin D. Ukuphikiswa kwe-insulin kwahlolwa kusetshenziswa i-Homeostasis Model Assessment ye-Insulin Resistance (HOMA-IR).
Ukungenelela okubuyekezwayo kwakuwukuphathwa kwe-vitamin D.Sifake izifundo lapho i-vitamin D ilawulwa nganoma yisiphi isithako, nganoma iyiphi indlela yokuphatha, nanoma yisiphi isikhathi.Nokho, siqophe umthamo kanye nobude be-vitamin D obulawulwa esifundweni ngasinye. .
Umphumela oyinhloko ophenywe ekubuyekezweni okuhlelekile kwamanje kanye nokuhlaziywa kwemeta kwakuwukumelana ne-insulin.Kulokhu, sasebenzisa i-HOMA-IR ukuze sinqume ukumelana ne-insulin ezigulini.Imiphumela yesibili yayihlanganisa amazinga e-serum vitamin D (ng/mL), i-alanine aminotransferase (ALT). ) (IU/l) kanye namazinga e-aspartate aminotransferase (AST) (IU/l).
Khipha Imibandela Yokufaneleka (PICO) ibe ngamagama angukhiye usebenzisa ama-opharetha e-Boolean (isb. NOMA, KANYE, CHA) nazo zonke izinkambu noma imigomo ye-MeSH (Isihloko Sesihloko Sezokwelapha).Kulolu cwaningo, sisebenzise imininingo egciniwe ye-PubMed, i-Google Scholar, i-COCHRANE kanye neSayensi Direct njengokusesha. izinjini zokuthola amajenali afanelekile.
Inqubo yokukhetha isifundo yenziwa ababhali abathathu (DAS, IKM, GS) ukuze kuncishiswe amathuba okukhipha izifundo ezingase zifaneleke.Lapho kuvela ukungezwani, izinqumo zombhali wokuqala, owesibili nowesithathu ziyabhekwa.Ukukhetha isifundo kuqala ngokuphatha impinda. amarekhodi.Ukuhlolwa kwesihloko kanye nokuhlolwa okungabonakali kwenziwa ukuze kukhishwe izifundo ezingabalulekile.Kamuva, izifundo eziphumelele ukuhlolwa kokuqala zabuye zahlolwa ukuze kuhlolwe ukuthi ziyahlangabezana yini nemibandela yokufakwa nokukhishwa kwalokhu kubuyekezwa.Zonke izifundo ezifakiwe zahlolwa kahle ngekhwalithi ngaphambi kokufakwa kokugcina.
Bonke ababhali basebenzise amafomu okuqoqwa kwedatha ye-elekthronikhi ukuze baqoqe idatha edingekayo esihlokweni ngasinye.Idatha yabe isihlanganiswa futhi yaphathwa kusetshenziswa i-software Review Manager 5.4.
Izinto zedatha kwakuyigama lombhali, unyaka wokushicilelwa, uhlobo locwaningo, inani labantu, umthamo wevithamini D, ubude besikhathi sokuphathwa kwevithamini D, usayizi wesampula, ubudala, isisekelo se-HOMA-IR, kanye namazinga ayisisekelo kavithamini D. Ukuhlaziywa kwemeta kokuhluka kwenani I-HOMA-IR ngaphambi nangemva kokuphathwa kwe-vitamin D kwenziwa phakathi kwamaqembu okwelapha nokulawula.
Ukuqinisekisa ikhwalithi yazo zonke izindatshana ezihlangabezana nemibandela yokufaneleka yalokhu kubuyekezwa, kwasetshenziswa ithuluzi lokuhlola elibalulekile elimisiwe.Le nqubo, eklanyelwe ukunciphisa amandla okuchema ekukhethweni kocwaningo, yenziwa ngokuzimela ababhali ababili (i-DAS kanye ne-IKM).
Ithuluzi lokuhlola eliyinhloko elisetshenziswe kulokhu kubuyekezwa kwakuyingozi ye-Cochrane Collaboration yendlela yokuchema.
Ukuhlanganisa nokuhlaziywa komehluko omaphakathi ku-HOMA-IR enevithamini D noma engenawo ezigulini ezine-NAFLD.Ngokusho kuka-Luo et al., uma idatha yethulwa njengemaphakathi noma ububanzi be-Q1 ne-Q3, sebenzisa umshini wokubala ukuze ubale incazelo. kanye noWan et al.28,29 Osayizi bomphumela babikwa njengomehluko obalulekile ngezikhawu zokuzethemba ezingu-95% (CI).Ukuhlaziya kwenziwa kusetshenziswa amamodeli wemiphumela engaguquki noma engahleliwe.I-Heterogeneity yahlolwa kusetshenziswa izibalo ze-I2, okubonisa ukuthi ingxenye yokuhluka komphumela obhekiwe kuzo zonke izifundo ngenxa yokuhlukahluka komphumela wangempela, amanani>>60% akhombisa ukuhluka okubalulekile.Uma i-heterogeneity ibingu->60%, ukuhlaziya okwengeziwe kwenziwa kusetshenziswa ukuhlaziya i-meta-regression kanye nokuhlaziya ukuzwela.Ukuhlaziywa kokuzwela kwenziwa kusetshenziswa indlela yokushiya-one-out. (ucwaningo olulodwa ngesikhathi lwasuswa futhi ukuhlaziya kwaphindwa). p-values < 0.05 abhekwa njengokubalulekile. Ukuhlaziywa kwe-Meta kwenziwa kusetshenziswa i-software Review Manager 5.4, ukuhlaziya ukuzwela kwenziwa kusetshenziswa iphakheji yesofthiwe yezibalo (i-Stata 17.0 ye-Windows), kanye nokuhlehla kwe-meta kwenziwa kusetshenziswa inguqulo yesi-3 ye-Integrated Meta-Analysis Software.
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Isikhathi sokuthumela: May-30-2022