Objective: To explore the relationship between serum 25-hydroxy-vitamin D [25(OH)D] and diabetic retinopathy (DR), and provide evidence regarding the cause and the prevention of DR. Methods: In this meta-analysis study, a systematic literature search was conducted for articles cited up to May 2016 in PubMed, Embase, the Cochrane Library, VIP Database, and WanFang Data. The Newcastle-Ottawa Scale was used to assess the quality of the included trials. Data excerpted from the trials were subjected to meta-analyses using Review Manager 5.2. Heterogeneity between studies was assessed by the I 2 statistic.Subgroup analysis was performed based on age, continent, and measurement method for 25(OH)D. A funnel plot and a statistical test for asymmetry were used to assess the potential for publication bias. Results: Six studies were included with 634 patients in the DR group and 683 patients in the "no diabetic retinopathy"(NDR) group. The mean serum concentration of 25(OH)D was significantly lower in the DR group than in the NDR group [Standard Mean Difference (SMD)=-0.41, 95%CI (-0.63, -0.18), P =0.0004]. Subgroup analysis could not determine the origin of heterogeneity. After excluding a study with high heterogeneity,we used fixed-effects sensibility analysis. The results showed that the SMD between the DR and NDR groups for 25(OH)D [SMD=-0.33, 95%CI (-0.45, -0.21), P <0.01] was significant. Conclusions: Patients with DR have a lower concentration of 25(OH)D than NDRs do. Measuring serum 25(OH)D levels may be used as a clinical monitoring indicator of DR.
涂瑞雪,黄莹莹,宋奔昊,温岱宗,李琦,王勤美,黄锦海. 糖尿病视网膜病变与血清25-羟基维生素D浓度相关性的Meta分析[J]. 中华眼视光学与视觉科学杂志, 2017, 19(12): 741-747.
Ruixue Tu,Yingying Huang,Benhao Song,Daizong Wen,Qi Li,Qinmei Wang,Jinhai Huang. Meta-analysis of the Relationship between Serum 25-Hydroxy-Vitamin D Levels and Diabetic Retinopathy. Chinese Journal of Optometry Ophthalmology and Visual science, 2017, 19(12): 741-747. DOI: 10.3760/cma.j.issn.1674-845X.2017.12.007
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Alcubierre N, Valls J, Rubinat E, et al. Vitamin D Deficiency Is Associated with the Presence and Severity of Diabetic Retinopathy in Type 2 Diabetes Mellitus. J Diabetes Res, 2015,2015: 374178. DOI: 10.1155/2015/374178.
[9]
Bonakdaran S, Shoeibi N. Is there any correlation between vitamin D insufficiency and diabetic retinopathy? Int J Ophthalmol, 2015, 8(2): 326-331. DOI: 10.3980/j.issn.2222-3959.2015.02.20.
[10]
Shehab D, Al-Jarallah K, Mojiminiyi OA, et al. Does Vitamin D deficiency play a role in peripheral neuropathy in Type 2 diabetes? Diabet Med, 2012, 29(1): 43-49. DOI: 10.1111/j.1464-5491.2011.03510.x.
[11]
Wilkinson CP, Ferris FL, Klein RE, et al. Proposed international clinical diabetic retinopathy and diabetic macular edema disease severity scales. Ophthalmology, 2003, 110(9): 1677-1682. DOI:10.1016/S0161-6420(03)00475-5.
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Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in metaanalyses.Eur J Epidemiol, 2010, 25(9): 603-605. DOI: 10.1007/s10654-010-9491-z.
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Higgins JP, Thompson SG, Deeks JJ, et al. Measuring inconsistency in meta-analyses. BMJ, 2003, 327(7414): 557-560. DOI: 10.1136/bmj.327.7414.557.
Egger M, Smith GD. Bias in location and selection of studies.BMJ, 1998, 316(7124): 61-66.
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Reddy GB, Sivaprasad M, Shalini T, et al. Plasma vitamin D status in patients with type 2 diabetes with and without retinopathy. Nutrition, 2015, 31(7-8): 959-963. DOI: 10.1016/
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Cantorna MT, Zhu Y, Froicu M, et al. Vitamin D status,1, 25-dihydroxyvitamin D3, and the immune system. Am J Clin Nutr, 2004, 80(6 Suppl): 1717S-20S.
Suzuki T, Sano Y, Kinoshita S. Effects of 1 alpha,25-dihydroxyvitamin D-3 on langerhans cell migration and corneal neovascularization in mice. Invest Ophthalmol Vis Sci,2000, 41(1): 154-158.
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Taverna MJ, Sola A, Guyot-Argenton C, et al. Taq I polymorphism of the vitamin D receptor and risk of severe diabetic retinopathy. Diabetologia, 2002, 45(3): 436-442. DOI:10.1007/s00125-001-0769-2.
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Payne JF, Ray R, Watson DG, et al. Vitamin D insufficiency in diabetic retinopathy. Endocr Pract, 2012, 18(2): 185-193. DOI:10.4158/EP11147.OR.
[29]
Kaur H, Donaghue KC, Chan AK, et al. Vitamin D deficiency is associated with retinopathy in children and adolescents with type 1 diabetes. Diabetes Care, 2011, 34(6): 1400-1402. DOI:10.2337/dc11-0103.
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