维生素A补充与变应性疾病相关性的Meta分析

doi:10.11852/zgetbjzz2019-0612

摘要/Abstract

摘要： 目的系统评价维生素A补充对变应性疾病的临床作用。方法检索万方、维普、中国知网、Medline、PubMed、EBSCO等数据库,查找维生素A补充与哮喘、喘息、过敏、湿疹、肺功能等变应性疾病相关的临床随机对照试验,检索时限为建库至2018年9月30日。2位评价者按标准独立进行文献筛选、质量评价和数据提取,采用Revman 5.3软件进行Meta分析。结果维生素A补充可增加女童过敏反应发病率(P<0.05)及成人迟发型过敏反应阳性率(P<0.05),维生素A补充与儿童喘息、湿疹发病无明显相关性(P>0.05)。结论维生素A补充可能增加过敏风险,但对儿童喘息、湿疹的影响尚待明确。

关键词: 维生素A, 哮喘, 过敏, 变应性, Meta分析

Abstract: Objective To assess the evidence of therapeutic effects of vitamin A on allergic disease. Methods Databases were searched for collecting the randomized controlled trials (RCTs) of the effects of vitamin A supplementation on allergic disease in human models from inception to September 30th,2018.Studies were critically appraised,and meta-analyses were then performed using RevMan5.3 software. Result Supplementationof vitamin A increased the risk of girls′atopy (P<0.05) and the responses of delayed-hypersensitivity (P<0.05),while significant differences were not found in wheeze or eczema between the experimental group and control group (P>0.05). Conclusion Vitamin A supplementation may increase the risk of allergy,its effect on wheeze and eczema is controversial.

Key words: vitamin A, asthma, allergy, allergic, meta-analysis

中图分类号:

R725.9

陈沁竹, 徐王国. 维生素A补充与变应性疾病相关性的Meta分析[J]. 中国儿童保健杂志, 2020, 28(2): 172-177.

CHEN Qin-zhu, XU Wang-guo. Effect of Vitamin A supplementation on allergic disease:systematic review and meta-analysis[J]. journal1, 2020, 28(2): 172-177.

参考文献

[1] Nurmatov U,Devereux G,and Sheikh A.Nutrients and foods for the primary prevention of asthma and allergy:systematic review and meta-analysis[J].J Allergy Clin Immunol,2011,127(3):724-733.e1-30.
[2] Stelmach I,Grzelewski T,Bobrowska-Korzeniowska M,et al.The role of zinc,copper,plasma glutathione peroxidase enzyme,and vitamins in the development of allergic diseases in early childhood:the Polish mother and child cohort study[J].Allergy Asthma Proc,2014,35(3748):227-232.
[3] Peroni DG,Bonomo B,Casarotto S.How changes in nutrition have influenced the development of allergic diseases in childhood[J].Ital J Pediatr,2012,38:22.e1-7.
[4] Global Burden of Disease 2015 Disability-Adjusted Life-Ye ars(DALYs) and Healthy Life Expectancy (HALE) Collaborators.Global,regional,and national disability-adjusted life-years (DALYs) for 315 diseases and injuries and healthy life expectancy (HALE),1990-2015:a systematic analysis for the Global Burden of Disease Study 2015[J].Lancet,2016,388(10053):1603-1658.
[5] Patel S,Murray CS,Woodcock A,et al.Dietary antioxidant intake,allergic sensitization and allergic diseases in young children[J].Allergy,2009,64(12):1766-1772.
[6] Ober C,Yao TC.The genetics of asthma and allergic disease:a 21st century perspective[J].Immunol Rev,2011,242(1):10-30.
[7] Allen S,Britton JR,Leonardi-Bee JA.Association between antioxidant vitamins and asthma outcome measures:systematic review and meta-analysis[J].Thorax,2009,64(7):610-619.
[8] Andino D,Moy J,Gaynes BI.Serum vitamin A,zinc and visual function in children with moderate to severe persistent asthma[J].J Asthma,2019,56(11):1196-1203.
[9] Luo ZX,Liu EM,Luo J,et al.Vitamin A deficiency and wheezing[J].World J Pediatr,2010,6(1):81-84.
[10] Wu J,Zhang Y,Liu Q,et al.All-trans retinoic acid attenuates airway inflammationby inhibiting Th2 and Th17 response in experimental allergic asthma[J].BMC Immunol,2013,14:28.
[11] Hufnagl K,Jensen-Jarolim E.Vitamin A and D in allergy:from experimental animal models and cellular studies to human disease[J].Allergo J Int,2018,27(3):72-78.
[12] Kraus LF,Scheurmann N,Frenzel DF,et al.9-cis-Retinoic acid induces a distinct regulatory dendritic cell phenotype that modulates murine delayed-type allergy[J].Contact Dermatitis,2018,78(1):41-54.
[13] Chen F,Hector M,Youn-Kyung K,et al.Effect of a retinoid X receptor partial agonist on airway inflammation and hyperresponsiveness in a murine model of asthma[J].Respir Res,2017,18(1):23.
[14] Dao DQ,Ngo TC,Thong NM,et al.Is vitamin A an antioxidant or a pro-oxidant? [J].JPhys Chem B,2017,121(40):9348-9357.
[15] Pavert SA,Ferreira M,Domingues RG,et al.Maternal retinoids control type 3 innate lymphoid cells and set the offspring immunity[J].Nature,2014,508(7494):123-127.
[16] Kiraly N,Balde A,Lisse IM,et al.Vitamin A supplementation and risk of atopy:long-term follow-up of a randomized trial of vitamin A supplementation at six and nine months of age[J].BMC Pediatr,2013,13:190.
[17] Kiraly N,Benn CS,Biering-Sørensen S,et al.Vitamin A supplementation and BCG vaccination at birth may affect atopy in childhood:long-term follow-up of a randomized controlled trial[J].Allergy,2013,68(9):1168-1176.
[18] Aage S,Kiraly N,Da Costa K,et al.Neonatal vitamin A supplementation associated with increased atopy in girls[J].Allergy,2015,70(8):985-994.
[19] Bogden JD,Bendich A,Kemp FW,et al.Daily micronutrient supplements enhance delayed-hypersensivity skin test responses in older people[J].Am J Clin Nutr,1994,60:437-447.
[20] Fuller CJ,Faulkner H,Bendich A,et al.Effect of β-carotene supplementation on photosuppression of delayed-type hypersensitivity in normal young men[J].Am J Clin Nutr,1992,56:684-690.
[21] Herraiz LA,Hsieh WC,Parker RS,et al.Effect of UV exposure and β-carotene supplementation on delayed-type hypersensitivity response in healthy older men[J].J Am Coll Nutr,1998,17(6):617-624.
[22] Wolvers D-AW,Herpen-Broekmans W-MR-V,Logman M-HGM,et al.Effect of a mixture of micronutrients,but not of bovine colostrum concentrate,on immune function parameters in healthy volunteers:a randomized placebo-controlled study[J].Nutr J,2006,5:28.
[23] Checkley W,West KP,Wise RA,et al.Supplementation with vitamin A early in life and subsequent risk of asthma[J].Eur Respir J,2011,38(6):1310-1319.
[24] Checkley W,West KP,Wise RA,et al.Maternal vitamin A supplementation and lung function in offspring[J].N Engl J Med,2010,362(19):1784-1794.
[25] Neuman I,Nahum H,Ben-Amotz A.Prevention of exercise-induced asthma by a natural isomer mixture of β-carotene[J].Ann Allergy Asthma Immunol,1999,82(6):549-553.
[26] Reifen R,Berkovich Z,Mandelberg A.Vitamin A supplementation via aerosol spray in asthmatic children[J].Pediatric Allergy and Immunol,2015,26(6):578-594.
[27] Ruhl R.Non-pro-vitamin A and pro-vitamin A carotenoids in atopy development[J].Int Arch Allergy Immunol,2013,161:99-115.
[28] Kiraly N,Aage S,Benn CS.Disparity between vitamin A-induced Th1-dependent oral tolerance in newborn mice and vitamin A-induced atopic sensitization in Guinean girls[J].Mucosal Immunol,2016,9(2):564.
[29] Schuster GU,Kenyon NJ,Stephensen CB.Vitamin A deficiency decreases and high dietary vitamin A increases disease severity in the mouse model of asthma[J].J Immunol,2008,180(3):1834 -1842.
[30] Matheu V,Berggård K,Barrios Y,et al.Impact on allergic immune response after treatment with vitamin A[J].Nutr Metab (Lond),2009,6(1):44.
[31] Ferreira M,Veiga-Fernandes H.Pre-birth world and the development of the immune system:mum′s diet affects our adult health:new insight on how the diet during pregnancy permanently influences offspring health and immune fitness [J].Bioessays,2014,36(12):1213-1220.
[32] Cruz S,Pereira da Cruz S,Ramalho A.Impact of vitamin A supplementation on pregnant women and on women who have just given birth:a systematic review[J].J Am Coll Nutr,2018,37(3):243-250.
[33] Stern A,Wold AE,Ostman S.Neonatal mucosal immune stimulation by microbial superantigen improves the tolerogenic capacity of CD103⁺ dendritic cells[J].PLoS One,2013,8(9):e75594.
[34] Hämäläinen N,Nwaru BI,Erlund I,et al.Serum carotenoid and tocopherol concentrations and risk of asthma in childhood:a nested case-control study[J].Clin Exp Allergy,2017,47(3):401-409.
[35] Litonjua AA.Fat-soluble vitamins and atopic disease:what is the evidence?[J].Proc Nutr Soc,2012,71(1):67-74.
[36] Barrera-Mendoza CC,Ayala-Mata F,Cortés-Rojo C,et al.Antioxidant vitamins in asthma[J].Rev Alerg Mex,2018,65(1):61-77.
[37] Pontes MV,Ribeiro TCM,Ribeiro H,et al.Cow′s milk-based beverage consumption in 1-to 4-year-olds and allergic manifestations:an RCT[J].Nutr J,2016,15:19.
[38] Maslova E,Hansen S,Strøm M,et al.Maternal intake of vitamins A,E and K in pregnancy and child allergic disease:a longitudinal study from the Danish National Birth Cohort[J].Br J Nutr,2014,111(6):1096-1108.
[39] Parr CL,Magnus MC,Holvik K,et al.Vitamin A and D intake in pregnancy,infant supplementation,and asthma development:the Norwegian Mother and Child Cohort[J].Am J Clin Nutr,2018,107(5):789-798.
[40] Mai XM,Langhammer A,Chen Y,et al.Cod liver oil intake and incidence of asthma in Norwegian adults-the hunt study[J].Thorax,2013,68(1):25-30.
[41] Torres-Borrego J,Moreno-Solís G,Molina-Terán AB.Diet for the prevention of asthma and allergies in early childhood:much ado about something?[J].Allergol Immunopathol (Madr),2012,40(4):244-252.
[42] Lee SY,Kim BS,Kwon SO,et al.Modification of additive effect between vitamins and ETS on childhood asthma risk according toGSTP1 polymorphism:a cross -sectional study[J].BMC Pulm Med,2015,15:125.
[43] Wood LG,Garg ML,Smart JM,et al.Manipulating antioxidant intake in asthma:a randomized controlled trial[J].Am J Clin Nutr,2012,96(3):534-543.
[44] Patelarou E,Giourgouli G,Lykeridou A,et al.Association between biomarker-quantified antioxidant status during pregnancy and infancy and allergic disease during early childhood:a systematic review[J].Nutr Rev,2011,69(11):627-641.
[45] Guo CH,Liu PJ,Lin KP,et al.Nutritional supplement therapy improves oxidative stress,immune response,pulmonary function,and quality of life in allergic asthma patients:an open-label pilot study[J].Altern Med Rev,2012,17(1):42-56.
[46] Chen F,Hector M,Youn-Kyung K,et al.Prenatal retinoid deficiency leads to airway hyperresponsiveness in adult mice[J].J Clin Invest,2014,124(2):801-811.
[47] Chen F,Shao F,Hinds A,et al.Retinoic acid signaling is essential for airway smooth musclehomeostasis[J].Jci Insight,2018,3(16).pii:120398.
[48] Marquez HA,Cardoso WV.Vitamin A-retinoid signaling in pulmonary development anddisease[J].Mol Cell Pediatr,2016,3(1):28.
[49] Murray JS,White J.Vitamin A supplementation in infants andchildren[J].J Spec Pediatr Nurs,2016,21(4):212-217.