Kurwanya insuline bigira uruhare runini mu gutera indwara y’umwijima idafite inzoga (NAFLD) .Ubushakashatsi bwakozwe bwasuzumye ishyirahamwe ryavitamine D.inyongera hamwe no kurwanya insuline kubarwayi barwaye NAFLD.Ibisubizo byabonetse biracyazana ibisubizo bivuguruzanya. Intego yubu bushakashatsi kwari ugusuzuma ingaruka zo kuvura vitamine D ziyongera ku kunoza insuline ku barwayi bafite NAFLD.Ibyanditswe byabonetse kuri PubMed, Google Intiti, COCHRANE na Science Direct base base.Ubushakashatsi bwabonetse bwasesenguwe hakoreshejwe ingero zifatika cyangwa ingero zidasanzwe.Ubushakashatsi bujuje ibisabwa hamwe nabitabiriye 735 bose hamwe.Vitamine D.inyongera yazamuye insuline irwanya abarwayi bafite NAFLD, irangwa no kugabanuka kwa Homeostatic Model Assessment of Insulin Resistance (HOMA-IR), hamwe nibitandukanya -1.06 (p = 0.0006; 95% CI -1.66 kugeza -0.45). Kwiyongera kwa Vitamine D byongereye vitamine D ya serumu itandukanye hagati ya 17.45 (p = 0.0002; 95% CI 8.33 kugeza 26.56).Vitamine D.inyongera yagabanije urwego rwa ALT hamwe nibisobanuro bihuriweho -4.44 (p = 0.02; 95% CI -8.24 kugeza -0.65) .Nta ngaruka byagaragaye kurwego rwa AST. Inyongera ya vitamine D igira ingaruka nziza mukuzamura insuline kubarwayi ba NAFLD.Ibi inyongera irashobora kugabanya HOMA-IR mubarwayi nkabo.Bishobora gukoreshwa nkubuvuzi bushobora kuvura abarwayi ba NAFLD.
Indwara yumwijima idafite ubukana (NAFLD) nitsinda ryindwara ziterwa numwijima1.Birangwa no kwirundanya kwinshi kwa triglyceride muri hepatocytes, akenshi hamwe nibikorwa bya necroinflammatory na fibrosis (steatohepatitis) 2.Bishobora gutera imbere kuri steatohepatite idafite inzoga (NASH), fibrosis na cirrhose. iterambere rya NAFLD1.
Indwara ya NAFLD ifitanye isano rya bugufi no kurwanya insuline. Dushingiye ku buryo bwa “hyp-hypothesis” ikunze kugaragara, kurwanya insuline bigira uruhare muri “hit-hit”. Muri ubu buryo bwambere, burimo kwirundanya kwa lipide iherereye hepatocytes, aho insuline irwanya insuline itekereza ko ari ikintu gikomeye gitera indwara ya hepatike ya “hepatike”. gutwika na fibrosis.Kubyara protokine ya cytokine, imikorere mibi ya mitochondrial, stress oxydeide, na lipide peroxidation nayo ni ibintu bishobora kugira uruhare mu mikurire yimitsi yumwijima, igizwe na adipokine.
Vitamine D ni vitamine ikuramo ibinure igenga amagufwa ya homeostasis.Uruhare rwayo rwashakishijwe cyane mubuzima butandukanye butari skeletale nka syndrome de metabolike, kurwanya insuline, umubyibuho ukabije, diyabete yo mu bwoko bwa 2 n'indwara zifitanye isano n'umutima. Vuba aha, a umubiri munini wibimenyetso bya siyansi wakoze ubushakashatsi ku isano iri hagati ya vitamine D na NAFLD.Vitamine D izwiho kugenzura insuline irwanya insuline, gutwika indwara zidakira na fibrosis. Kubera iyo mpamvu, vitamine D ishobora gufasha kwirinda iterambere rya NAFLD6.
Ibigeragezo byinshi byateganijwe (RCTs) byasuzumye ingaruka ziterwa na vitamine D ku kurwanya insuline.Nyamara, ibisubizo byabonetse biratandukanye;haba kwerekana ingaruka nziza mukurwanya insuline cyangwa kutagaragaza inyungu 7,8,9,10,11,12,13. Nubwo ibisubizo bivuguruzanya, hakenewe meta-gusesengura kugirango harebwe ingaruka rusange ziterwa na vitamine D.Ibisesengura meta-isesengura byakozwe mbere14,15,16.Isesengura ryakozwe na Guo et al. Harimo ubushakashatsi butandatu bwerekana ingaruka za vitamine D ku kurwanya insuline bitanga ibimenyetso bifatika byerekana ko vitamine D ishobora kugira ingaruka nziza kuri sensibilité ya insuline14.Nyamara, ubundi meta- isesengura ryatanze ibisubizo bitandukanye.Pramono et al15 yasanze ubundi buryo bwo kuvura vitamine D butagize ingaruka ku myumvire ya insuline. Abaturage bashyizwe mu bushakashatsi bari bafite ibibazo cyangwa bafite ibyago byo kurwanya insuline, ntabwo ari byo byibasiye NAFLD.Ubundi bushakashatsi bwakozwe na Wei et al. ., harimo ubushakashatsi bune, bwakoze ubushakashatsi busa.Inyongera ya Vitamine D ntabwo yagabanije HOMA IR16. Urebye meta-analyse zose zabanjirije gukoresha ikoreshwa rya vitamine D mu kurwanya insuline, updated meta-gusesengura irakenewe hamwe nibindi bitabo byavuguruwe. Intego yubu bushakashatsi kwari ugusuzuma ingaruka zinyongera vitamine D ku kurwanya insuline.
Mugukoresha ingamba zo hejuru zo gushakisha, twabonye ubushakashatsi 207, hanyuma nyuma yo kugabanywa, twabonye ingingo 199.Twakuyemo ingingo 182 mugusuzuma imitwe hamwe nibisobanuro, dusigaranye ubushakashatsi 17 bwingirakamaro.Abanyeshuri batatanze amakuru yose bisabwa kuri iri sesengura cyangwa inyandiko yuzuye itabonetse yarashizwemo.Nyuma yo gusuzuma no gusuzuma ubuziranenge, twabonye ingingo zirindwi zo gusuzuma buri gihe na meta-gusesengura. Imbonerahamwe yerekana ubushakashatsi bwa PRISMA irerekanwa ku gishushanyo 1 .
Twashyizemo inyandiko-yuzuye yuzuye y'ibigeragezo birindwi byateganijwe (RCTs) .Imyaka yo gusohora izi ngingo yatangiye kuva 2012 kugeza 2020, hamwe na 423 by'icyitegererezo mumatsinda yitabiriwe na 312 mumatsinda ya placebo. Itsinda ryubushakashatsi ryakiriye bitandukanye ingano n'ibihe byinyongera bya vitamine D, mugihe itsinda rishinzwe kugenzura ryakiriye umwanya.Incamake y'ibyavuye mu bushakashatsi n'ibiranga ubushakashatsi bigaragara mu mbonerahamwe ya 1.
Ingaruka zo kubogama zasesenguwe hifashishijwe ingaruka za Cochrane Ubufatanye bwo kubogama.Ingingo zirindwi zose zashyizwe muri ubu bushakashatsi zatsinze isuzuma ryiza. Ibisubizo byuzuye byugarije kubogama kubintu byose birimo byerekanwe mubishusho 2.
Inyongera ya Vitamine D itezimbere insuline ku barwayi barwaye NAFLD, irangwa no kugabanuka kwa HOMA-IR.Bishingiye ku ngero zidasanzwe (I2 = 67%; χ2 = 18.46; p = 0.005), ihuriro risobanura itandukaniro riri hagati yo kongera vitamine D kandi nta vitamine. D inyongera yari -1.06 (p = 0.0006; 95% CI -1.66 kugeza -0.45) (ishusho 3).
Ukurikije icyitegererezo kidasanzwe (Isanamu 4), ihuriweho risobanura itandukaniro rya serumu ya vitamine D nyuma yo kongerwamo vitamine D yari 17.45 (p = 0.0002; 95% CI 8.33 kugeza 26.56) .Dukurikije isesengura, inyongera ya vitamine D irashobora kongera vitamine D ya serumu kuri 17.5 ng / mL. Hagati aho, ingaruka zo kongera vitamine D kuri enzymes yumwijima ALT na AST zerekanye ibisubizo bitandukanye. Kwiyongera kwa Vitamine D byagabanutse kurwego rwa ALT hamwe no gutandukanya -4.44 (p = 0.02; 95% CI -8.24 kugeza -0.65) (Igicapo 5) .Nyamara, nta ngaruka zagaragaye kurwego rwa AST, hamwe no gutandukanya itandukaniro rya -5.28 (p = 0.14; 95% CI - 12.34 kugeza 1.79) hashingiwe ku ngero zidasanzwe (( Igicapo 6).
Impinduka muri HOMA-IR nyuma yo kongerwamo vitamine D yerekanaga ubutunzi butandukanye (I2 = 67%) Ibyumweru 12 na> ibyumweru 12) byerekana ko inshuro zikoreshwa zishobora gusobanura ubutumburuke (Imbonerahamwe 2) .Byose ariko ubushakashatsi bwakozwe na Sakpal nibindi.11 yakoresheje inzira yo munwa yubuyobozi.Gufata buri munsi inyongera ya vitamine D ikoreshwa mubushakashatsi butatu 7.8,13.Ubundi gusesengura ibyiyumvo ukoresheje isesengura rimwe-rimwe ryerekana impinduka zabaye muri HOMA-IR nyuma yo kongera vitamine D byagaragaje ko nta bushakashatsi bwabigizemo uruhare itandukanyirizo ryimpinduka muri HOMA-IR (Ishusho 7).
Ibisubizo byahurijwe hamwe na meta-isesengura ryakozwe byerekanye ko kuvura vitamine D byongera imbaraga zo kurwanya insuline, ikimenyetso cyayo kikaba cyaragabanutse HOMA-IR ku barwayi barwaye NAFLD.Inzira yo kuyobora vitamine D irashobora gutandukana, bitewe no gutera inshinge cyangwa umunwa. .Ubundi gusesengura ingaruka zabyo mugutezimbere insuline kugirango wumve impinduka za serumu ALT na AST. Kugabanuka kurwego rwa ALT, ariko ntabwo ari AST, byagaragaye kubera inyongera ya vitamine D.
Kubaho kwa NAFLD bifitanye isano rya bugufi no kurwanya insuline.Kongera aside irike yubusa (FFA), adipose tissue inflammation, hamwe na adiponectine yagabanutse bifite uruhare runini mu iterambere rya insuline muri NAFLD17.Serum FFA yazamutse cyane mubarwayi ba NAFLD, hanyuma igahinduka nyuma. kuri triacylglycerol ukoresheje inzira ya glycerol-3-fosifate.Ikindi gicuruzwa cyiyi nzira ni ceramide na diacylglycerol (DAG) .DAG izwiho kugira uruhare mugukora protein kinase C (PKC), ishobora kubuza insuline reseptor threonine 1160, ibyo bikaba bifitanye isano no kugabanya insuline irwanya.Gutwika tissue ya adipose kandi ikiyongera muri cytokine ya proinflammatory nka interleukin-6 (IL-6) hamwe na tumorosi ya nekrosis alpha (TNF-alpha) nayo igira uruhare mukurwanya insuline.Nkuko kuri adiponectine, irashobora guteza imbere kubuza aside irike beta-okiside (FAO), gukoresha glucose hamwe na synthesis ya fatty.Ibipimo byayo bigabanuka kubarwayi ba NAFLD, bityo bikazamura development yo kurwanya insuline. Bifitanye isano na vitamine D, reseptor ya vitamine D (VDR) iboneka mu ngirangingo z'umwijima kandi yagize uruhare mu kugabanya uburyo bwo gutwika indwara zidakira. Igikorwa cya VDR cyongera insuline mu guhindura FFA. Byongeye kandi, vitamine D ifite anti-inflammatory na anti-fibrotic mumwijima19.
Ibimenyetso bigezweho byerekana ko ibura rya vitamine D rishobora kugira uruhare mu gutera indwara nyinshi.Iki gitekerezo gifatika ku isano iri hagati yo kubura vitamine D no kurwanya insuline 20.21. Izi zishobora kuba mubwoko butandukanye, harimo pancreatic beta selile na insuline-yitabira insuline nka adipocytes.Nubwo uburyo nyabwo buri hagati ya vitamine D hamwe no kurwanya insuline bikomeje kutamenyekana, byavuzwe ko tissue ya adipose ishobora kugira uruhare muburyo bwayo. ububiko nyamukuru bwa vitamine D mu mubiri ni adipose tissue.Bikora kandi nkisoko yingenzi ya adipokine na cytokine kandi igira uruhare mukubyara umuriro wa sisitemu. Ibimenyetso bihari byerekana ko vitamine D igenga ibintu bijyanye no gusohora kwa insuline biva mu ngirabuzimafatizo za beta.
Urebye ibi bimenyetso, inyongera ya vitamine D kugirango irusheho kurwanya insuline ku barwayi ba NAFLD irashyize mu gaciro. Raporo ziheruka zerekana ingaruka nziza z’inyongera ya vitamine D mu kunoza imiti irwanya insuline. meta-gusesengura na Guo n'abandi Gusuzuma ingaruka za vitamine D ku kurwanya insuline bitanga ibimenyetso bifatika byerekana ko vitamine D ishobora kugira ingaruka nziza ku myumvire ya insuline. Basanze igabanuka rya HOMA-IR ya - 1.32;95% CI - 2.30, - 0.34.Ubushakashatsi burimo gusuzuma HOMA-IR bwari ubushakashatsi butandatu14.Nyamara, ibimenyetso bivuguruzanya birahari.Isuzuma rifatika hamwe na meta-isesengura ririmo RCTs 18 na Pramono nabandi basuzuma ingaruka ziterwa na vitamine D kuri ibyiyumvo bya insuline mubintu bifite insuline irwanya insuline cyangwa ibyago byo kurwanya insuline byerekanaga ko vitamine D yongeyeho ibyiyumvo bya insuline nta ngaruka byagize, itandukaniro risobanura itandukaniro -0.01, 95% CI -0.12, 0.10;p = 0.87, I2 = 0.% Diyabete 2), aho kuba abarwayi ba NAFLD15.Ubundi meta-isesengura ryakozwe na Wei et al.Ubushakashatsi busa nabwo bwabonetse.Mu isuzuma ry’inyongera ya vitamine D muri HOMA-IR, harimo ubushakashatsi bune, inyongera ya vitamine D ntabwo yagabanije HOMA IR (WMD) = 0.380, 95% CI - 0.162, 0.923; p = 0.169) 16.Gereranije namakuru yose aboneka, isuzuma rya sisitemu iriho hamwe na meta-isesengura ritanga raporo nyinshi ziyongera kuri vitamine D zongera imbaraga zo kurwanya insuline kubarwayi ba NAFLD, bisa na meta-gusesengura na Guo nabandi.Nubwo meta-isesengura nkiryo ryakozwe, meta-isesengura ryubu ritanga ubuvanganzo bugezweho burimo ibigeragezo byateganijwe bityo bigatanga ibimenyetso bifatika byerekana ingaruka zinyongera vitamine D kuri insuline rkurwanira.
Ingaruka za vitamine D ku kurwanya insuline zishobora gusobanurwa n’uruhare rwayo nk'urwego rushobora kugenzura imisemburo ya insuline ndetse n'urwego rwa Ca2 +. selile beta.Ntabwo ari transcription ya insuline gusa, ariko kandi VDRE izwiho gukangura ingirabuzimafatizo zitandukanye zijyanye no gukora cytoskeleton, guhuza ingirabuzimafatizo, no gukura kw'ingirabuzimafatizo ya cβ selile. Vitamine D nayo yerekanwe ko igira ingaruka ku kurwanya insuline ihindura Ca2 + flux.Kubera ko calcium ari ngombwa muburyo butandukanye bwa insuline-yunganiwe mu mitsi no mu ngingo za adipose, vitamine D irashobora kugira uruhare mu ngaruka zayo zo kurwanya insuline. kwiyongera kwa Ca2 +, bigatuma ibikorwa bya GLUT-4 bigabanuka, bigira ingaruka kuri insuline 26,27.
Ingaruka zo kongera vitamine D mu kunoza ubukana bwa insuline zongeye gusesengurwa kugira ngo zigaragaze ingaruka zabyo ku mikorere y’umwijima, ibyo bikaba byaragaragaye mu mpinduka zabaye mu rwego rwa ALT na AST. Kugabanuka kurwego rwa ALT, ariko ntabwo ari AST, byagaragaye kubera vitamine D yiyongereye. inyongera. Meta-isesengura ryakozwe na Guo nabandi.yerekanye ko kugabanya imipaka kurwego rwa ALT, nta ngaruka bigira kurwego rwa AST, bisa nubu bushakashatsi14.Ubundi bushakashatsi bwakozwe na meta bwakozwe na Wei et al.2020 nabwo bwasanze nta tandukaniro riri muri serumu alanine aminotransferase na aspartate aminotransferase urwego hagati yinyongera ya vitamine D hamwe nitsinda rya placebo.
Isubiramo rya sisitemu hamwe na meta-isesengura nabyo bivuguruza imbogamizi.Uburinganire bwa meta-isesengura ryubu bushobora kuba bwaragize ingaruka ku bisubizo byatanzwe muri ubu bushakashatsi. Ibitekerezo bizaza bigomba gukemura umubare w’inyigisho hamwe n’amasomo agira uruhare mu gusuzuma inyongera ya vitamine D yo kurwanya insuline, byumwihariko kwibasira abaturage ba NAFLD, hamwe nuburinganire bwubushakashatsi. Ikindi kintu ugomba gusuzuma ni ukwiga ibindi bipimo muri NAFLD, nkingaruka zo kongera vitamine D kubarwayi ba NAFLD kubipimo byerekana umuriro, amanota y'ibikorwa bya NAFLD (NAS) no gukomera k'umwijima. Mu gusoza, inyongera ya vitamine D yongereye imbaraga zo kurwanya insuline ku barwayi barwaye NAFLD, ikimenyetso cyayo kikaba cyaragabanutse HOMA-IR.Bishobora gukoreshwa nk'ubuvuzi bushobora kuvura abarwayi ba NAFLD.
Ibipimo byujuje ibisabwa bigenwa no gushyira mu bikorwa igitekerezo cya PICO. Urwego rwasobanuwe mu mbonerahamwe ya 3.
Isubiramo rya sisitemu hamwe na meta-isesengura ririmo ubushakashatsi bwose kugeza ku ya 28 Werurwe 2021, kandi butanga inyandiko yuzuye, gusuzuma ubundi buryo bwa vitamine D ku barwayi bafite NAFLD. ntibakuwe mubushakashatsi bugezweho.Ingingo zose zitatanze amakuru asabwa kugirango ikore meta-isesengura ryubu nazo zaraciwe.Kurinda kwigana icyitegererezo, ingero zasuzumwe kubintu byanditswe numwanditsi umwe mubigo bimwe.
Muri iryo suzuma harimo ubushakashatsi bwakozwe n’abarwayi bakuze ba NAFLD bakira ubuyobozi bwa vitamine D
Ibikorwa byasuzumwe ni ubuyobozi bwa vitamine D.Twashyizemo ubushakashatsi aho vitamine D yatangwaga ku kigero icyo ari cyo cyose, uburyo ubwo ari bwo bwose bwo kuyobora, ndetse no mu gihe icyo ari cyo cyose.Nyamara, twanditse urugero hamwe na vitamine D yatanzwe muri buri bushakashatsi. .
Ibisubizo nyamukuru byakorewe iperereza mubisubiramo bya sisitemu na meta-isesengura byari ukurwanya insuline.Mu bijyanye, twakoresheje HOMA-IR kugirango tumenye abarwayi ba insuline ku barwayi.Icyiciro cya kabiri cyarimo vitamine D ya serumu (ng / mL), alanine aminotransferase (ALT ) (IU / l) hamwe na aminotransferase (AST) (IU / l) urwego.
Kuramo Ibipimo Byujuje ibisabwa (PICO) mumagambo yingenzi ukoresheje abakoresha Boolean (urugero OR, NA, OYA) hamwe nimirima yose cyangwa amagambo ya MeSH (Ubuvuzi bwubuvuzi) moteri kugirango ibone ibinyamakuru byujuje ibisabwa.
Gahunda yo gutoranya ubushakashatsi yakozwe nabanditsi batatu (DAS, IKM, GS) kugirango bagabanye amahirwe yo gukuraho ubushakashatsi bushobora kuba bwiza.Iyo havutse ubwumvikane buke, harebwa ibyemezo byabanditsi ba mbere, aba kabiri nuwa gatatu. Guhitamo abanyeshuri bitangirana no gukora duplicate. inyandiko.Isuzuma ryitiriwe na abstract ryakozwe kugirango hirindwe ubushakashatsi budafite akamaro. Nyuma yaho, ubushakashatsi bwatsinze isuzuma ryambere bwarasuzumwe kugirango harebwe niba bwujuje ibisabwa byo gushyiramo no guhezwa muri iri suzuma. Byose birimo ubushakashatsi bwakorewe isuzuma ryujuje ubuziranenge mbere yo kubishyiramo bwa nyuma.
Abanditsi bose bakoresheje impapuro zo gukusanya amakuru ya elegitoronike kugirango bakusanye amakuru asabwa muri buri ngingo.Amakuru yahise akusanywa kandi acungwa hifashishijwe software isubiramo 5.4.
Ibintu byamakuru byari izina ryumwanditsi, umwaka watangarijwe, ubwoko bwubushakashatsi, abaturage, urugero rwa vitamine D, igihe cyo kuyobora vitamine D, ingano yicyitegererezo, imyaka, ibyingenzi HOMA-IR, hamwe na vitamine D yibanze. Meta-gusesengura itandukaniro riri hagati muri HOMA-IR mbere na nyuma yubuyobozi bwa vitamine D bwakozwe hagati yo kuvura no kugenzura amatsinda.
Kugirango hamenyekane ubuziranenge bwingingo zose zujuje ibyangombwa bisabwa kugira ngo dusubiremo, hakoreshejwe igikoresho gisanzwe cyo gusuzuma. Iyi nzira, igamije kugabanya ubushobozi bwo kubogama mu guhitamo ubushakashatsi, yakozwe mu bwigenge n’abanditsi babiri (DAS na IKM).
Igikoresho cyingenzi cyo gusuzuma cyakoreshejwe muri iri suzuma ni Cochrane Ubufatanye bwikibazo cyo kubogama.
Kuzuza no gusesengura itandukaniro riri hagati ya HOMA-IR hamwe na vitamine D idafite abarwayi ba NAFLD. Nkuko Luo nabandi babivuga, niba amakuru yatanzwe nkumuhuza cyangwa intera ya Q1 na Q3, koresha calculatrice kugirango ubare ikigereranyo. na Wan n'abandi.28,29 Ingano yingaruka ivugwa nkibisobanuro bitandukanya intera 95% (CI) .Isesengura ryakozwe hakoreshejwe ingero zifatika cyangwa zidasanzwe.Heterogeneité yasuzumwe hifashishijwe imibare ya I2, byerekana ko igipimo cyo gutandukana mubikorwa byagaragaye mubushakashatsi cyari bitewe no guhinduka mubikorwa nyabyo, hamwe nagaciro> 60% byerekana ubudasa bukomeye.Niba itandukanyirizo ryabaye> 60%, isesengura ryinyongera ryakozwe hakoreshejwe meta-regression hamwe na analyse ya sensitivite.Isesengura ryibyiyumvo ryakozwe hakoreshejwe uburyo bwo kuruhuka . kuri Windows), na meta-regressions byakozwe hakoreshejwe Integrated Meta-Analysis Software Version 3.
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Igihe cyo kohereza: Gicurasi-30-2022