Impact Of Vitamin D Supplementation On The Outcome Of Pulmonary Tuberculosis Treatment:A Meta-analysis Of Randomized Controlled Trials

Background: Vitamin D participates in the host's immune response to Mycobacterium tuberculosis by regulating the vitamin D receptor on the cell membrane and nucleus,and acts to kill Mycobacterium tuberculosis in cells.However,different trials on the effects of vitamin D supplementation on the time of sputum tuberculosis and the negative rate of tuberculosis,tuberculosis score,BMI,serum vitamin D concentration,serum calcium concentration and serious adverse events in tuberculosis patients.The conclusion is controversial.Therefore,we conducted a meta-analysis by searching and collecting the literature of relevant clinical trials to study the effect of vitamin D on the negative conversion rate and mean time of sputum tuberculosis in the treatment of tuberculosis.Methods : By extracting keywords and constructing search expressions,we systematically searched the electronic database published before August 1,2018,including Pubmed,Medline,Embase,Cochrane Central Register,Web of Science,CBM,CNKI,and Wan-fang Data.According to the inclusion and exclusion criteria,9 clinical trial research literatures were selected by browsing the title,abstract and even the full text.A total of 2017 patients with tuberculosis were included.The main research indicators were sputum smear or culture mean conversion time?conversion rate? basic clinical characteristics of patients with vitamin D supplementation and adverse events and other indicators.The Review Manager software was used to evaluate the risk of bias using a random or fixed-effects model and the final synthesis and analysis of the completed data using the Cochrane Risk Bias Evaluation Tool.Results: Nine of the included literatures are in English and were randomized controlled trials in which the intervention was the use of vitamin D preparations.A total of 2017 patients received anti-tuberculosis treatment then get different courses of treatment and dose vitamin D or placebo control.The study showed that there was a statistically significant difference in the rate of sputum smear or culture conversion between patients with vitamin D(OR 1.18,95% CI 1.03~ 1.34,z=2.45,P = 0.01),but for the mean conversion time was not statistically significant.(MD-2.66,95% CI-8.25~2.93,z=0.93,P=0.35).Analysis of clinical indicators the serum vitamin D concentration and serum calcium ion concentration in the vitamin D group were higher than those in the control group(MD 110.69,95% CI 85.60~ 135.78,P < 0.00001,SMD 0.03 95% CI 0.01~0.06,P=0.02).There were no statistically significant differences between the two groups in the TB scores?BMI,?and serious adverse events.Conclusion: Meta-analysis showed that vitamin D supplementation can increase the conversion rate of sputum in tuberculosis patients,but it has no effect in shortening the conversion time of sputum smear or culture sputum in patients with tuberculosis.