今天,微信朋友圈里被天津醫(yī)院的一個微信宣傳稿刷屏了。 標題駭人聽聞:《國際頂級醫(yī)學期刊JAMA(IF=44.405)發(fā)表天津醫(yī)院趙嘉國和曾憲鐵團隊論文,徹底顛覆骨質疏松防治理念》。宣傳稿的內容將原文章的標題進行刪改為《鈣劑/維生素D補充和社區(qū)居住的老年人骨折發(fā)生的相關性》。并在整個內容報到中,用盡極其溢美夸大之詞,誤導讀者以為該文章的作者研究了5萬余名患者,進行了調查研究。當我讀到此處的時候,我就相信,這個報導是假的。因為在中國,完成5萬人的臨床對照研究是不可能的。沒有那個學者能做到這一點。
然后該報導被丁香園、骨科在線、醫(yī)學界等等醫(yī)學媒體轉載,各醫(yī)學同行微信朋友圈廣為轉發(fā),刷屏。 都用了“顛覆”二字。 腦子是個好東西,一定要珍惜著用。
然后就查閱原始文章。標題為:《Association Between Calcium orVitamin D Supplementation and Fracture Incidence in Community-Dwelling Older AdultsA Systematic Reviewand Meta-analysis》 找到原始文章后大吃一驚,該篇文章只不過是一篇Meta分析,也就是把別人的已發(fā)表的文章拿過來分析分析,然后綜合捏把捏把出個結論來,還不一定是客觀正確的,所有的綜述和Meta分析文章都有一定的作者偏倚性的,作為循證指南的制定來說,一般不建議使用綜述和Meta分析文章作為證據(jù)文獻的。而天津醫(yī)院的微信公號報道卻把題目進行刪改,讓讀者誤以為是這些數(shù)據(jù)是天津醫(yī)院骨科趙嘉國和曽憲鐵醫(yī)生團隊做的調查研究。
下面是原始文章的英文摘要:
Abstract Importance The increased social and economic burdens for osteoporosis-relatedfractures worldwide make the prevention of such injuries a major public healthgoal. Previous studies have reached mixed conclusions regarding the associationbetween calcium, vitamin D, or combined calcium and vitamin D supplements andfracture incidence in older adults.
Objective To investigate whether calcium, vitamin D, or combined calcium andvitamin D supplements are associated with a lower fracture incidence incommunity-dwelling older adults.
Data Sources The PubMed, Cochrane library, and EMBASEdatabases were systematically searched from the inception dates to December 24,2016, using the keywords calcium, vitamin D, and fracture to identifysystematic reviews or meta-analyses. The primary randomized clinical trialsincluded in systematic reviews or meta-analyses were identified, and anadditional search for recently published randomized trials was performed fromJuly 16, 2012, to July 16, 2017.
Study Selection Randomized clinical trials comparing calcium,vitamin D, or combined calcium and vitamin D supplements with a placebo or notreatment for fracture incidence in community-dwelling adults older than 50years.
Data Extraction and Synthesis Two independent reviewers performed the dataextraction and assessed study quality. A meta-analysis was performed tocalculate risk ratios (RRs), absolute risk differences (ARDs), and 95% CIsusing random-effects models.
Main Outcomes and Measures Hip fracture was defined as the primaryoutcome. Secondary outcomes were nonvertebral fracture, vertebral fracture, andtotal fracture.
Results A total of 33 randomized trials involving 51?145participants fulfilled the inclusion criteria. There was no significantassociation of calcium or vitamin D with risk of hip fracture compared withplacebo or no treatment (calcium: RR, 1.53 [95% CI, 0.97 to 2.42]; ARD, 0.01[95% CI, 0.00 to 0.01]; vitamin D: RR, 1.21 [95% CI, 0.99 to 1.47]; ARD, 0.00[95% CI, ?0.00 to 0.01]. There was no significantassociation of combined calcium and vitamin D with hip fracture compared withplacebo or no treatment (RR, 1.09 [95% CI, 0.85 to 1.39]; ARD, 0.00 [95% CI, ?0.00 to 0.00]). No significant associations were found betweencalcium, vitamin D, or combined calcium and vitamin D supplements and theincidence of nonvertebral, vertebral, or total fractures. Subgroup analysesshowed that these results were generally consistent regardless of the calciumor vitamin D dose, sex, fracture history, dietary calcium intake, and baselineserum 25-hydroxyvitamin D concentration.
Conclusions and Relevance In this meta-analysis of randomized clinicaltrials, the use of supplements that included calcium, vitamin D, or bothcompared with placebo or no treatment was not associated with a lower risk offractures among community-dwelling older adults. These findings do not supportthe routine use of these supplements in community-dwelling older people.
該文章摘要的中文翻譯:
題目: 社區(qū)居住老年人群中,鈣劑或維生素D攝入對骨折發(fā)病率的關系:系統(tǒng)綜述與Meta分析
問題:攝入維生素D或鈣劑或合用是否能夠降低社區(qū)居住老年人的骨折發(fā)生率?
發(fā)現(xiàn):本Meta分析納入33個RCT研究,包含51145例樣本。與安慰劑對照組或空白對照組比較,無論攝入補充劑包括鈣劑、維生素D、或鈣加維生素D都不能顯著降低髖關節(jié)骨折,三種治療方案的RR分別為1.53,1.21,1.09
意義:本文的發(fā)現(xiàn)并不支持在社區(qū)居住的老年人給予常規(guī)鈣劑補充
Abstract: 意義:由于骨質疏松導致的骨折在全世界范圍內帶來巨大的社會與經濟負擔,對此類骨折的預防是一個重要的公共健康課題。前期研究關于補充鈣劑、維生素D對預防老年人骨折發(fā)病率的研究結果混雜不一(mixed conclusion)
目的:探究補充鈣劑維生素D或兩者聯(lián)用是否能夠降低社區(qū)老年人骨折發(fā)生率。
數(shù)據(jù)來源:在PubMed,Cochranelibrary, 與EMBASE中系統(tǒng)性搜索系統(tǒng)綜述或Meta分析,截止日為2016年12月24日。關鍵詞為calcium, vitamin D, 與fracture。首次搜索納入了系統(tǒng)綜述與Meta分析,并加入了在2012年7月16日至2017年7月16日的隨機臨床試驗。
研究選擇:比較鈣劑、維生素D或兩者聯(lián)用VS 安慰劑或空白對照在社區(qū)居住的大于50歲以上老人中是否能夠降低骨折發(fā)生率的隨機臨床試驗。
數(shù)據(jù)提取與合成:兩位獨立的審閱人分別進行了數(shù)據(jù)提取與研究質量評估,META分析使用隨機效應模型計算RR ARD,95%CI。
結局與指標:定義髖關節(jié)骨折為原發(fā)結局,繼發(fā)結局為非椎體骨折,椎體骨折與其他所有骨折
結果:33個RCT研究納入51145個符合標準的樣本,沒有發(fā)現(xiàn)使用鈣劑、維生素D相比安慰劑治療或空白對照顯著降低髖關節(jié)骨折發(fā)病率。(calcium: RR, 1.53 [95% CI, 0.97 to 2.42]; ARD, 0.01 [95% CI, 0.00to 0.01]; vitamin D: RR, 1.21 [95% CI, 0.99 to 1.47]; ARD, 0.00 [95% CI, ?0.00 to 0.01]。也沒有發(fā)現(xiàn)鈣劑與維生素D合用相比安慰劑治療或空白對照顯著降低髖關節(jié)骨折發(fā)病率(RR, 1.09 [95% CI, 0.85 to 1.39]; ARD, 0.00 [95% CI, ?0.00 to 0.00])。更沒有發(fā)現(xiàn)鈣劑、維生素D、或兩者合用相比安慰劑治療或空白對照顯著降低非椎體骨折、椎體骨折、所有骨折(total fracture)發(fā)病率。亞組分析進一步確認,無論鈣劑或維生素D劑量或人群性別,骨折既往史,每日鈣劑攝入、血清25-羥化維生素D含基線水平,以上結論依然正確。 結論與推論:本文的發(fā)現(xiàn)不支持在社區(qū)居住的老年人日常攝入鈣劑或維生素D預防骨折。
下面是原始文章的部分頁面截圖。 邀請有識之士對該文章進行分析,看看還有其他問題沒有。
這是該英文文章前兩頁的截圖。 JMMA網(wǎng)站上該文章的全文地址如下: https:///journals/jama/fullarticle/2667071?utm_campaign=articlePDF&utm_medium=articlePDFlink&utm_source=articlePDF&utm_content=jama.2017.19344 |
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來自: 漸近故鄉(xiāng)時 > 《待分類》