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Article(id=1322590111959728213, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1322589954702688372, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202409228, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1726243200000, receivedDateStr=2024-09-14, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1793259655226, onlineDateStr=2026-10-29, pubDate=1736438400000, pubDateStr=2025-01-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793259655226, onlineIssueDateStr=2026-10-29, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793259655226, creator=13701087609, updateTime=1793259655226, updator=13701087609, issue=Issue{id=1322589954702688372, tenantId=1146029695717560320, journalId=1227665162245664772, year='2025', volume='52', issue='1', pageStart='1', pageEnd='192', issueExtLink='null', onlineDate='null', pubDate='1736438400000', pubDateStr='2025-01-10', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1793259617734, creator='13701087609', updateTime=1793260023378, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext={EN=IssueExt(id=1322591656147276425, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1322589954702688372, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1322591656147276426, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1322589954702688372, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null, downloadFileDto=null}, startPage=180, endPage=187, ext={EN=ArticleExt(id=1322590112152666198, articleId=1322590111959728213, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Systematic review and meta-analysis of the relationship between vitamin D and common ocular diseases, columnId=1228016569138213037, journalTitle=Modern Preventive Medicine, columnName=Clinical Medicine and Prevention, runingTitle=null, highlight=null, articleAbstract=
Objective

To summarize the levels of vitamin D in patients with common ocular diseases and explore the relationship between low vitamin D levels and the occurrence of ocular diseases.

Methods

A search was conducted in the PubMed, Web of Science, Embase, and Cochrane databases up to May 25, 2024, to collect meta-analysis studies assessing the relationship between vitamin D and ocular diseases. Additionally, observational studies not included in existing meta-analyses were collected, and the effect size and 95% confidence interval (CI) were calculated using the random effects weighted mean difference (WMD). The results of the studies were included in the meta-analysis, culminating in an umbrella review.

Results

This study included 13 meta-analyses and 15 observational studies (11 case-control studies and 4 cross-sectional studies). The meta-analysis indicated that the overall weighted mean difference (WMD) for vitamin D and ocular diseases was -2.17 (95%CI: -2.50 to -1.84; P=0.282, I2=18.7%). The overall odds ratio (OR) for vitamin D in ocular diseases was 0.96 (95%CI: 0.92 to 0.99; P<0.001, I2=87.1%). The robustness of the conclusions was verified through trial sequential analysis (TSA).

Conclusion

Higher vitamin D levels are significantly associated with a reduced risk of developing glaucoma and myopia, yet showing an association with an increased risk of non-infectious uveitis (NIU).

, authors=Pei-yuan HE, Yu-ping LIU, Ping SHUAI, Xue XIE, authorsList=Pei-yuan HE, Yu-ping LIU, Ping SHUAI, Xue XIE, authorCompany=null, correspAuthors=Xue XIE, authorNote=null, correspAuthorsNote=null, copyrightStatement=null, copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1322590116380524646, articleId=1322590111959728213, tenantId=1146029695717560320, journalId=1227665162245664772, language=CN, title=维生素D与常见眼部疾病关系的系统综述与荟萃分析, columnId=1228016570119680182, journalTitle=现代预防医学, columnName=临床与预防, runingTitle=null, highlight=null, articleAbstract=
目的

本研究旨在总结常见眼部疾病患者的维生素D水平，探讨低维生素D水平与眼部疾病发生之间的关系。

方法

检索了截至2024年5月25日的PubMed、Web of Science、Embase和Cochrane数据库，收集荟萃分析研究以评估维生素D与眼部疾病的关系。此外，收集了未包含在现有荟萃分析中的观察性研究，使用随机效应加权均数差（WMD）计算效应值及95%置信区间（CI）。研究结果纳入荟萃分析，最终进行伞状综述。

结果

本研究纳入了13项荟萃分析和15项观察性研究（11项病例对照研究和4项横断面研究）。荟萃分析显示，维生素D与眼部疾病研究的综合加权均数差（WMD）= -2.17（95%CI：-2.50--1.84；P=0.282，I2=18.7%）。维生素D在眼部疾病中的总体比值比（OR）=0.96（95%CI：0.92-0.99；P<0.001，I2=87.1%）。并通过试验序贯分析（TSA），验证了本研究结论的稳健性。

结论

研究发现较高的维生素D水平与青光眼和近视的发病风险显著降低相关，但与非感染性葡萄膜炎（NIU）的发病风险增加相关。

, authors=何沛原, 刘玉萍, 帅平, 谢雪, authorsList=何沛原, 刘玉萍, 帅平, 谢雪, authorCompany=null, correspAuthors=谢雪, authorNote=

何沛原（1984—），女，硕士，医师，研究方向：健康管理

, correspAuthorsNote=
谢雪，E-mail:
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A cross-sectional study from South Korea, refAbstract=null), Reference(id=1322590134386671825, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322590111959728213, doi=null, pmid=null, pmcid=null, year=2021, volume=18, issue=1, pageStart=206, pageEnd=null, url=null, language=null, rfNumber=[51], rfOrder=53, authorNames=Lazzara F, Amato R, Platania CBM, journalName=Journal of Neuroinflammation, refType=null, unstructuredReference=Lazzara F, Amato R, Platania CBM, et al. 1α,25-dihydroxyvitamin D3 protects retinal ganglion cells in glaucomatous mice[J]. Journal of Neuroinflammation, 2021, 18(1): 206., articleTitle=1α,25-dihydroxyvitamin D3 protects retinal ganglion cells in glaucomatous mice, refAbstract=null), Reference(id=1322590134462169298, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322590111959728213, doi=null, pmid=null, pmcid=null, year=2023, volume=15, issue=2, pageStart=423, pageEnd=null, url=null, language=null, rfNumber=[52], rfOrder=54, authorNames=Lee JH, Kwon YJ, Lee HS, journalName=Nutrients, refType=null, unstructuredReference=Lee JH, Kwon YJ, Lee HS, et al. Inverse relationship between serum 25-hydroxyvitamin D and elevated intraocular pressure[J]. Nutrients, 2023, 15(2): 423., articleTitle=Inverse relationship between serum 25-hydroxyvitamin D and elevated intraocular pressure, refAbstract=null), Reference(id=1322590134554443987, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322590111959728213, doi=null, pmid=null, pmcid=null, year=2023, volume=23, issue=4, pageStart=1089, pageEnd=1106, url=null, language=null, rfNumber=[53], rfOrder=55, authorNames=Wu X, Tao MY, Zhu L, journalName=Clinical and Experimental Medicine, refType=null, unstructuredReference=Wu X, Tao MY, Zhu L, et al. Pathogenesis and current therapies for non-infectious uveitis[J]. Clinical and Experimental Medicine, 2023, 23(4): 1089-1106., articleTitle=Pathogenesis and current therapies for non-infectious uveitis, refAbstract=null), Reference(id=1322590134617358548, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322590111959728213, doi=null, pmid=null, pmcid=null, year=2024, volume=32, issue=5, pageStart=628, pageEnd=635, url=null, language=null, rfNumber=[54], rfOrder=56, authorNames=Koller K, Matos TFK, Areco KN, journalName=Ocular Immunology and Inflammation, refType=null, unstructuredReference=Koller K, Matos TFK, Areco KN, et al. Serum vitamin D levels as biomarkers in patients with autoimmune uveitis and their possible correlation with disease activity[J]. Ocular Immunology and Inflammation, 2024, 32(5): 628-635., articleTitle=Serum vitamin D levels as biomarkers in patients with autoimmune uveitis and their possible correlation with disease activity, refAbstract=null), Reference(id=1322590134684467413, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322590111959728213, doi=null, pmid=null, pmcid=null, year=2020, volume=127, issue=2, pageStart=230, pageEnd=237, url=null, language=null, rfNumber=[55], rfOrder=57, authorNames=Chiu ZK, Lim LL, Rogers SL, journalName=Ophthalmology, refType=null, unstructuredReference=Chiu ZK, Lim LL, Rogers SL, et al. Patterns of vitamin D levels and exposures in active and inactive noninfectious uveitis patients[J]. Ophthalmology, 2020, 127(2): 230-237., articleTitle=Patterns of vitamin D levels and exposures in active and inactive noninfectious uveitis patients, refAbstract=null), Reference(id=1322590134780936406, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322590111959728213, doi=null, pmid=null, pmcid=null, year=2014, volume=55, issue=7, pageStart=4552, pageEnd=4559, url=null, language=null, rfNumber=[56], rfOrder=58, authorNames=Yazar S, Hewitt AW, Black LJ, journalName=Invest Ophthalmol Vis Sci, refType=null, unstructuredReference=Yazar S, Hewitt AW, Black LJ, et al. Myopia is associated with lower vitamin D status in young adults[J]. Invest Ophthalmol Vis Sci, 2014, 55(7): 4552-4559., articleTitle=Myopia is associated with lower vitamin D status in young adults, refAbstract=null)], funds=[Fund(id=1322590122822975641, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322590111959728213, awardId=2022YFS0600, language=CN, fundingSource=四川省科技厅重点研发计划项目(2022YFS0600), fundOrder=null, country=null), Fund(id=1322590122965581978, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322590111959728213, awardId=2021LY15, language=CN, fundingSource=院级临床研究及转化基金(2021LY15), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1322590116648960103, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322590111959728213, xref=null, ext=[AuthorCompanyExt(id=1322590116653154408, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322590111959728213, companyId=1322590116648960103, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=Health Management Center (Health Management Research Institute), Sichuan Academy of Medical Sciences/Sichuan Provincial People’s Hospital (Affiliated Hospital of University of Electronic Science and Technology of China), Chengdu, Sichuan 610072,China), AuthorCompanyExt(id=1322590116661543017, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322590111959728213, companyId=1322590116648960103, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=四川省医学科学院·四川省人民医院(电子科技大学附属医院)，健康管理中心(健康管理研究所)，四川 成都 610072)])], figs=[ArticleFig(id=1322590118574145672, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322590111959728213, language=EN, label=Figure 1, caption=Flow chart of literature search and research selection, figureFileSmall=kRqpmBkLn1V7mp/JCL7Muw==, figureFileBig=l9velGfjniieUXwYMN0CLg==, tableContent=null), ArticleFig(id=1322590118641254537, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322590111959728213, language=CN, label=图1, caption=文献检索和研究选择流程图, figureFileSmall=kRqpmBkLn1V7mp/JCL7Muw==, figureFileBig=l9velGfjniieUXwYMN0CLg==, tableContent=null), ArticleFig(id=1322590118825803914, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322590111959728213, language=EN, label=Figure 2, caption=Forest map of vitamin D levels and common ocular diseases (excluding original meta-analysis), figureFileSmall=myx+70TooHhRms0jppYV3Q==, figureFileBig=+L5BhE6wO1o4IplKReFSOA==, tableContent=null), ArticleFig(id=1322590120495136907, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322590111959728213, language=CN, label=图2, caption=维生素D水平与常见眼病的森林图（不包括原始荟萃分析）, figureFileSmall=myx+70TooHhRms0jppYV3Q==, figureFileBig=+L5BhE6wO1o4IplKReFSOA==, tableContent=null), ArticleFig(id=1322590120587411596, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322590111959728213, language=EN, label=Figure 3, caption=Forest plot of total WMD and OR effect values of vitamin D levels on ocular disease outcomes, figureFileSmall=lvIsy8qP8m7PXQ9lTRXp1w==, figureFileBig=NuDrAHlTP1Qd1z80vQshjA==, tableContent=null), ArticleFig(id=1322590120721629326, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322590111959728213, language=CN, label=图3, caption=维生素D水平对眼病结果的总体WMD和OR效应值的森林图

注：WMD为加权均数差；OR为比值比。

, figureFileSmall=lvIsy8qP8m7PXQ9lTRXp1w==, figureFileBig=NuDrAHlTP1Qd1z80vQshjA==, tableContent=null), ArticleFig(id=1322590120780349583, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322590111959728213, language=EN, label=Figure 4, caption=Funnel plot and sensitivity analysis of non-meta-analysis studies on vitamin D levels and ocular disease outcomes, figureFileSmall=9M/COlZo4Cz2rofeQSmdxg==, figureFileBig=4Qh3e6TRdWC4pFJ8NXFz9A==, tableContent=null), ArticleFig(id=1322590120834875536, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322590111959728213, language=CN, label=图4, caption=维生素D水平与眼病结果的非荟萃分析研究的漏斗图与敏感性分析, figureFileSmall=9M/COlZo4Cz2rofeQSmdxg==, figureFileBig=4Qh3e6TRdWC4pFJ8NXFz9A==, tableContent=null), ArticleFig(id=1322590121145254033, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322590111959728213, language=EN, label=Figure 5, caption=Funnel plot and sensitivity analysis of odds ratio (OR) analysis between vitamin D levels and ocular disease outcomes, figureFileSmall=s6lkP6/PjMKXuoBYmzwM5Q==, figureFileBig=UceyzY7vo1X33irbqk4Y8A==, tableContent=null), ArticleFig(id=1322590121237528722, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322590111959728213, language=CN, label=图5, caption=维生素D水平与眼病结果的OR分析的漏斗图与敏感性分析, figureFileSmall=s6lkP6/PjMKXuoBYmzwM5Q==, figureFileBig=UceyzY7vo1X33irbqk4Y8A==, tableContent=null), ArticleFig(id=1322590121589850259, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322590111959728213, language=EN, label=Figure 6, caption=Vitamin D levels and ocular disease outcomes were trial sequential analyses of odds ratio (OR) studies, figureFileSmall=HGfgXB+Zgli8qFf0ICJNHA==, figureFileBig=D1rzwT8RjvKfomEBVN6HAA==, tableContent=null), ArticleFig(id=1322590121677930644, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322590111959728213, language=CN, label=图6, caption=维生素D水平与眼病结果为OR研究的试验序贯分析, figureFileSmall=HGfgXB+Zgli8qFf0ICJNHA==, figureFileBig=D1rzwT8RjvKfomEBVN6HAA==, tableContent=null), ArticleFig(id=1322590121988309141, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322590111959728213, language=EN, label=Table 1, caption=

Features of included meta-analyses

, figureFileSmall=null, figureFileBig=null, tableContent=
作者/年份纳入研究(项)结局研究类型例数/总数模式效应值
（OR/SMD/WMD）		95%CI（OR/SMD/WMD）效应值类型I2 (OR/WMD)发表偏倚
Annweiler,2016[21]9AMDCs, Crs1 440/17 054FM0.830.71 ~ 0.97OR78.4NR
Wu,2016[22]8AMDCs, Crs, CCNR/57 643RM0.910.69 ~ 1.22OR79.7NR
Ferreira,2021[23]16AMDCs, Crs, CC9 736/75 294RM1.81.00 ~ 3.24OR70NR
Han,2022[24]8GLACs, CC77/584FM0.90.45 ~ 1.35OR29NR
Ulhaq,2020[25]9GLACC476/130 676RM-1.16-1.56 ~ -0.76SMD98NR
Li,2017[26]13GLARCT,CC513/5 629RM2.488-5.12 ~ 10.09WMD87.20.41
Liu,2020[27]10DEDCrs2 526/16 330RM-3.99-6.58 ~ 1.4WMD97NR
Askari,2020[28]11DEDCrs, CCNR/44 343RM-1.7-2.61 ~ -0.79WMD94.60.46
Rojas-Carabali,2024[29]11NIUCs, Crs, CC357/5 728RM2.041.55～2.68OR79NR
Tang,2019[30]7MyopiaCs, Crs, CC8 244/25 008FM0.920.88～0.96OR450.44
Luo,2017[31]15DRCs, Crs, CC3 455/17 664RM2.031.07～3.86OR80NR
Xiong,2022[32]34DRCrs159/517RM1.00/-3.060.58～1.73/5.15～-0.96OR/WMDNRNR
Zhang,2017[33]12DRCs, Crs, CCNR/10 007RM1.27/-1.321.17～1.37/2.50～-0.15OR/WMD80/890.22
), ArticleFig(id=1322590122063806614, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322590111959728213, language=CN, label=表1, caption=

纳入研究的荟萃分析研究特征

, figureFileSmall=null, figureFileBig=null, tableContent=
作者/年份纳入研究(项)结局研究类型例数/总数模式效应值
（OR/SMD/WMD）		95%CI（OR/SMD/WMD）效应值类型I2 (OR/WMD)发表偏倚
Annweiler,2016[21]9AMDCs, Crs1 440/17 054FM0.830.71 ~ 0.97OR78.4NR
Wu,2016[22]8AMDCs, Crs, CCNR/57 643RM0.910.69 ~ 1.22OR79.7NR
Ferreira,2021[23]16AMDCs, Crs, CC9 736/75 294RM1.81.00 ~ 3.24OR70NR
Han,2022[24]8GLACs, CC77/584FM0.90.45 ~ 1.35OR29NR
Ulhaq,2020[25]9GLACC476/130 676RM-1.16-1.56 ~ -0.76SMD98NR
Li,2017[26]13GLARCT,CC513/5 629RM2.488-5.12 ~ 10.09WMD87.20.41
Liu,2020[27]10DEDCrs2 526/16 330RM-3.99-6.58 ~ 1.4WMD97NR
Askari,2020[28]11DEDCrs, CCNR/44 343RM-1.7-2.61 ~ -0.79WMD94.60.46
Rojas-Carabali,2024[29]11NIUCs, Crs, CC357/5 728RM2.041.55～2.68OR79NR
Tang,2019[30]7MyopiaCs, Crs, CC8 244/25 008FM0.920.88～0.96OR450.44
Luo,2017[31]15DRCs, Crs, CC3 455/17 664RM2.031.07～3.86OR80NR
Xiong,2022[32]34DRCrs159/517RM1.00/-3.060.58～1.73/5.15～-0.96OR/WMDNRNR
Zhang,2017[33]12DRCs, Crs, CCNR/10 007RM1.27/-1.321.17～1.37/2.50～-0.15OR/WMD80/890.22
), ArticleFig(id=1322590122172858519, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322590111959728213, language=EN, label=Table 2, caption=

Characteristics of included non-meta-analysis studies

, figureFileSmall=null, figureFileBig=null, tableContent=
作者结局国家研究设计参与者维生素 D［ （），（ng/mL）］
患者组正常组总人数患者组正常组
Abdellah,2019[34]白内障埃及病例对照研究3253857107.6±5.518.5±9.6
Atalay,2020[35]白内障土耳其病例对照研究26537917.31±13.3013.34±7.87
ktem,2021[36]白内障土耳其病例对照研究3753905.6±8.420.8±7.1
Alswailmi,2021[37]结膜炎沙特阿拉伯病例对照研究26265238.96±11.3729.47±11.73
Bozkurt,2018[38]结膜炎土耳其病例对照研究29629111.02±5.1615.99±7.36
Dadaci,2014[39]结膜炎土耳其病例对照研究4944938.19 ±4.3411.66 ±5.93
Goksugur,2015[40]结膜炎土耳其病例对照研究22315334.1±12.721.8±11.3
Sorkhabi,2021[41]结膜炎伊朗病例对照研究39327127.64±8.5035.96±11.34
Kara,2017[42]翼状胬肉土耳其病例对照研究635812136.3±18.937.5±16.8
Bilak,2021[43]翼状胬肉土耳其病例对照研究1189421212.06±7.0720.04±7.96
rnek,2021[44]翼状胬肉土耳其病例对照研究35256056.24±16.6059.11±13.38
Chun,2018[45]翼状胬肉韩国横断面研究86911 38912 25817.4±0.219.7±0.3
Jee,2016[46]翼状胬肉韩国横断面研究1 54817 63019 17818.5±0.120.4±0.2
Jung,2020[48]近视韩国横断面研究12 14713 05225 19917.0 + 0.118.7±0.1
Kabatas,,2017[47]视网膜疾病土耳其横断面研究7126977.1±5.211.9±6.5
), ArticleFig(id=1322590122470654104, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322590111959728213, language=CN, label=表2, caption=

纳入研究的非荟萃分析研究特征

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作者结局国家研究设计参与者维生素 D［ （），（ng/mL）］
患者组正常组总人数患者组正常组
Abdellah,2019[34]白内障埃及病例对照研究3253857107.6±5.518.5±9.6
Atalay,2020[35]白内障土耳其病例对照研究26537917.31±13.3013.34±7.87
ktem,2021[36]白内障土耳其病例对照研究3753905.6±8.420.8±7.1
Alswailmi,2021[37]结膜炎沙特阿拉伯病例对照研究26265238.96±11.3729.47±11.73
Bozkurt,2018[38]结膜炎土耳其病例对照研究29629111.02±5.1615.99±7.36
Dadaci,2014[39]结膜炎土耳其病例对照研究4944938.19 ±4.3411.66 ±5.93
Goksugur,2015[40]结膜炎土耳其病例对照研究22315334.1±12.721.8±11.3
Sorkhabi,2021[41]结膜炎伊朗病例对照研究39327127.64±8.5035.96±11.34
Kara,2017[42]翼状胬肉土耳其病例对照研究635812136.3±18.937.5±16.8
Bilak,2021[43]翼状胬肉土耳其病例对照研究1189421212.06±7.0720.04±7.96
rnek,2021[44]翼状胬肉土耳其病例对照研究35256056.24±16.6059.11±13.38
Chun,2018[45]翼状胬肉韩国横断面研究86911 38912 25817.4±0.219.7±0.3
Jee,2016[46]翼状胬肉韩国横断面研究1 54817 63019 17818.5±0.120.4±0.2
Jung,2020[48]近视韩国横断面研究12 14713 05225 19917.0 + 0.118.7±0.1
Kabatas,,2017[47]视网膜疾病土耳其横断面研究7126977.1±5.211.9±6.5
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维生素D与常见眼部疾病关系的系统综述与荟萃分析
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何沛原 , 刘玉萍 , 帅平 , 谢雪
现代预防医学 | 临床与预防 2025,52(1): 180-187
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现代预防医学 |临床与预防 2025 , 52 (1) : 180 -187
维生素D与常见眼部疾病关系的系统综述与荟萃分析
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何沛原, 刘玉萍, 帅平, 谢雪
作者信息
  • 四川省医学科学院·四川省人民医院(电子科技大学附属医院)，健康管理中心(健康管理研究所)，四川 成都 610072
通讯作者:
谢雪，E-mail:
作者简介:

何沛原（1984—），女，硕士，医师，研究方向：健康管理

Systematic review and meta-analysis of the relationship between vitamin D and common ocular diseases
Pei-yuan HE, Yu-ping LIU, Ping SHUAI, Xue XIE
Affiliations
  • Health Management Center (Health Management Research Institute), Sichuan Academy of Medical Sciences/Sichuan Provincial People’s Hospital (Affiliated Hospital of University of Electronic Science and Technology of China), Chengdu, Sichuan 610072,China
出版时间: 2025-01-10 doi: 10.20043/j.cnki.MPM.202409228
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摘要
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目的

本研究旨在总结常见眼部疾病患者的维生素D水平，探讨低维生素D水平与眼部疾病发生之间的关系。

方法

检索了截至2024年5月25日的PubMed、Web of Science、Embase和Cochrane数据库，收集荟萃分析研究以评估维生素D与眼部疾病的关系。此外，收集了未包含在现有荟萃分析中的观察性研究，使用随机效应加权均数差（WMD）计算效应值及95%置信区间（CI）。研究结果纳入荟萃分析，最终进行伞状综述。

结果

本研究纳入了13项荟萃分析和15项观察性研究（11项病例对照研究和4项横断面研究）。荟萃分析显示，维生素D与眼部疾病研究的综合加权均数差（WMD）= -2.17（95%CI：-2.50--1.84；P=0.282，I2=18.7%）。维生素D在眼部疾病中的总体比值比（OR）=0.96（95%CI：0.92-0.99；P<0.001，I2=87.1%）。并通过试验序贯分析（TSA），验证了本研究结论的稳健性。

结论

研究发现较高的维生素D水平与青光眼和近视的发病风险显著降低相关，但与非感染性葡萄膜炎（NIU）的发病风险增加相关。

维生素D  /  眼部疾病  /  伞状综述  /  荟萃分析  /  观察性研究
Objective

To summarize the levels of vitamin D in patients with common ocular diseases and explore the relationship between low vitamin D levels and the occurrence of ocular diseases.

Methods

A search was conducted in the PubMed, Web of Science, Embase, and Cochrane databases up to May 25, 2024, to collect meta-analysis studies assessing the relationship between vitamin D and ocular diseases. Additionally, observational studies not included in existing meta-analyses were collected, and the effect size and 95% confidence interval (CI) were calculated using the random effects weighted mean difference (WMD). The results of the studies were included in the meta-analysis, culminating in an umbrella review.

Results

This study included 13 meta-analyses and 15 observational studies (11 case-control studies and 4 cross-sectional studies). The meta-analysis indicated that the overall weighted mean difference (WMD) for vitamin D and ocular diseases was -2.17 (95%CI: -2.50 to -1.84; P=0.282, I2=18.7%). The overall odds ratio (OR) for vitamin D in ocular diseases was 0.96 (95%CI: 0.92 to 0.99; P<0.001, I2=87.1%). The robustness of the conclusions was verified through trial sequential analysis (TSA).

Conclusion

Higher vitamin D levels are significantly associated with a reduced risk of developing glaucoma and myopia, yet showing an association with an increased risk of non-infectious uveitis (NIU).

Vitamin D  /  Ocular diseases  /  Umbrella review  /  Meta-analysis  /  Observational studies
何沛原, 刘玉萍, 帅平, 谢雪. 维生素D与常见眼部疾病关系的系统综述与荟萃分析. 现代预防医学, 2025 , 52 (1) : 180 -187 . DOI: 10.20043/j.cnki.MPM.202409228
Pei-yuan HE, Yu-ping LIU, Ping SHUAI, Xue XIE. Systematic review and meta-analysis of the relationship between vitamin D and common ocular diseases[J]. Modern Preventive Medicine, 2025 , 52 (1) : 180 -187 . DOI: 10.20043/j.cnki.MPM.202409228
正文
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维生素D不仅在维持骨骼健康中发挥关键作用，还通过其抗氧化和抗炎特性参与调节多个生理系统，包括眼部健康[1-2]。研究显示，维生素D代谢产物在角膜上皮、睫状体和视网膜色素上皮细胞中表达[3-5]，并存在于泪液、房水和玻璃体中[6]。植物来源的维生素D2（麦角钙化醇）和动物来源的维生素D3（胆钙化醇）通过酶促反应转化为其活性形式1,25-二羟维生素D（骨化三醇），在眼部发挥生物功能[7]。维生素D受体（VDR）在神经节细胞层、内核层及视网膜色素上皮等多个眼部组织中被观察到[8]。
随着全球老龄化，白内障、黄斑变性和青光眼等眼部疾病发病率显著上升，导致视力下降、甚至丧失[9]，严重影响生活质量。尽管已有研究表明维生素D代谢与眼部疾病（如角膜疾病和黄斑变性）相关[10-11]，但血清维生素D水平与多种眼部疾病的系统性证据仍有限。
研究发现，低维生素D水平可能与眼轴延长及近视风险增加相关[12]，同时也可能影响泪液功能，增加干眼症的患病风险[13]。然而，维生素D在不同眼部疾病中具体机制的理解尚不清楚，目前多为单一疾病的观察性研究，缺乏对维生素D与多种眼部疾病关系的全面综述。
因此，本研究旨在通过荟萃分析和伞状综述，系统总结维生素D水平与常见眼部疾病之间的关联，为临床预防和治疗提供更加全面的证据。此外，尽管初步研究表明维生素D可能在眼部疾病的预防和治疗中发挥潜在作用，但关于不同疾病类型和维生素D水平之间的具体关系尚不明确。因此，本研究将填补这一研究空白，为临床应用提供更强的科学依据。
1　资料与方法
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1.1　协议和注册
研究方案在PROSPERO（CRD42024550922）上进行了前瞻性注册。伞状综述遵循了PRISMA[14]框架中的指导原则进行。预先注册的协议没有变化。
1.2　纳入、排除标准
纳入标准为：（1）英文发表的荟萃分析和系统评价；（2）研究维生素D与眼部疾病的关系；（3）报告了效应值及95%置信区间（CI）。排除动物研究、基础研究及重复研究。非荟萃研究包括观察性研究，排除非人体研究、综述文章及摘要。不同意见均通过三人以上讨论解决。
1.3　检索策略及研究筛选和纳入流程
我们检索了截至2024年5月25日的PubMed、Web of Science、Embase和Cochrane四个数据库，并手动补充相关会议论文，导入EndNote 20首次排重。软件排除重复文章后，由两名独立的评价者根据标题和摘要对检索到的所有文献按照标准进行筛选，以第三方为基准调解任何分歧。全文筛选采用STROBE清单[15]。筛选流程见图1。
1.4　数据提取
纳入的研究由第一作者标准化提取数据。由通信作者进行验证，提取的信息包括研究类型、样本量、效应类型、加权均数差（WMD）值、标准化均数差（SMD）值和比值比（OR）值及其相应的95%CI、异质性、发表偏倚以及血清维生素D含量等。Meta研究及非meta研究分别见表1、2。
1.5　质量评价
由两位作者根据AMSTAR2工具[16]独立评价meta分析的质量。另外，按照纽卡斯尔-渥太华量表(NOS)[17]和美国卫生保健研究与质量机构（AHRQ）[18]评价病例对照和横断面研究的质量。
1.6　统计分析
伞状评价的目的在于全面评估现有荟萃分析，而非重复检索原始文章进行新的荟萃分析[19]。本研究非荟萃分析观察性研究的维生素D结局数据，采用DerSimonian和Laird随机效应模型计算WMD及其95%CI。通过Cochran Q检验评估异质性，P<0.05且I2≥50%表示显著异质性。通过敏感性分析评估研究剔除的影响，并对WMD和OR进行荟萃分析，其中OR值经过对数转换。Egger检验用于评估发表偏倚，以P<0.05表示存在偏倚。以上所有分析使用STATA 16.0，P<0.05视为有统计学意义。最后采用TSA0.9.5.10Beta软件，绘制试验序贯分析（TSA）界值图，评估累积荟萃分析的效应显著性，并设定最佳期望样本量（RIS）以避免随机误差[20]。
2　结果
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2.1　研究选择及特征
在进行了全面检索及筛选后，最终本研究纳入了13项meta分析，涵盖6个结局指标：年龄相关性黄斑变性[21-23]、糖尿病视网膜病变[31-33]、干眼病[27-28]、青光眼[24-26]、非感染性葡萄膜炎[29]和近视[30]。此外，还回顾了15项非meta观察性研究，研究内容包括相关性白内障[34-36]、翼状胬肉[42-46]、结膜炎[37-41]、早产儿视网膜病变[47]和补充近视研究[48]。
2.2　偏倚风险评估
大多数meta分析研究质量较高，但引用不足和缺乏注册信息的问题普遍存在。非meta研究中，病例对照研究得分为6～9分（满分9分），横断面研究得分为8～10分（满分11分）。
2.3　综合效应大小
采用随机效应模型对非meta观察性研究进行了分析，结果显示，白内障(WMD:-4.49; 95%CI: -11.85～2.87; P<0.001, I2=94.3%)、结膜炎(WMD: 0.30; 95%CI: -5.20～5.81; P<0.001, I2=90.7%)、翼状胬肉(WMD: -2.29; 95%CI: -2.68～-1.91;P<0.001, I2=99.8%)患者的维生素D水平显著低于对照组。见图2。纳入meta分析研究综合评价，得到合并WMD=-2.17 (95%CI:-2.50 ～1.84; P=0.282, I2=18.7%)。合并OR=0.96 (95%CI: 0.92～0.99; P<0.001,I2=87.1%)，结果提示维生素D水平与青光眼和近视负相关，与葡萄膜炎正相关。见图3。
2.4　敏感性及偏倚分析
非meta研究的漏斗图显示，翼状胬肉、白内障和结膜炎的研究数据较为对称，未见明显发表偏倚。同时，敏感性分析结果表明，各单项研究对总体结果的影响较小，Egger检验结果翼状胬肉（P=0.545）、白内障（P=0.082）和结膜炎（P=0.224）均较稳定，见图4。
取OR值的meta研究漏斗图显示，研究无明显偏倚，且敏感性分析表明剔除任一研究后，结果均保持一致。Egger检验结果P=0.352，进一步支持结果的稳健性。见图5。
2.5　试验序贯分析
在试验序贯分析中，除无样本量的两项研究外，其余研究的累积Z值依次跨越传统界值线（Z=1.96）和TSA界限值，并在达到最佳期望样本量（RIS=49 453）前趋于稳定，表明结果稳健且进一步增加样本量可能不会显著改变结论。见图6。
3　讨论
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本研究通过系统综述和荟萃分析整合了104项研究数据，分析了维生素D水平与多种眼部疾病之间的关联。通过TSA结果显示，累积Z值超过传统界值线、TSA界限值及RIS线，表明meta分析的统计检验结果具有较高的可信度，现有样本量足以支撑本研究结论的可靠性。
青光眼是一种与眼压升高和视神经损伤相关的慢性眼病[49]。维生素D通过其抗炎和抗氧化特性，可能对青光眼的发病机制产生影响。炎症和氧化应激是青光眼发病中的两个关键因素[50]。维生素D能够通过减少促炎因子的释放，抑制视神经损伤，从而可能延缓青光眼的进展[51]。此外，维生素D可能通过调节钙离子通道影响眼压调节系统[52]。
非感染性葡萄膜炎是一种由免疫介导的眼部炎症性疾病，可能导致视力丧失甚至失明[53]。维生素D在调节免疫系统中扮演着重要角色，尤其是在抑制过度的炎症反应方面。之前的研究量化了25(OH) D水平，表明每增加1单位，葡萄膜炎的发生率降低6%[54]。维生素D补充剂和阳光照射也被建议用于预防葡萄膜炎的复发[55]。
近视的发生与发展受到遗传和环境因素的共同影响。维生素D可能通过调节眼部细胞的生长和发育，影响眼球形态，从而在户外活动中发挥保护作用[30]。25(OH)D3作为眼部阳光照射的生物标志物，既往研究显示，在不同人群中，其浓度降低与近视风险增加之间可能存在生物学关联[56]。因此，维生素D在近视发生中的作用可能涉及光照暴露、免疫调节和眼球生长等多个机制。增加维生素D的摄入可能有助于缓解近视的发展。
本研究揭示了维生素D在眼部疾病中的潜在保护机制，特别是在青光眼、葡萄膜炎和近视等慢性病的防治中展现出较大潜力。然而，目前的研究多为观察性研究，因果关系尚未得到确立。未来的研究应明确维生素D在这些疾病中的生物机制，并通过大规模随机对照试验验证维生素D补充的临床疗效。此外，针对不同人群的维生素D补充剂量和方式也需深入研究，以指导精准的预防和治疗策略。
基金
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  • 四川省科技厅重点研发计划项目(2022YFS0600)
  • 院级临床研究及转化基金(2021LY15)
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2025年第52卷第1期
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doi: 10.20043/j.cnki.MPM.202409228
  • 接收时间：2024-09-14
  • 首发时间：2026-10-29
  • 出版时间：2025-01-10
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  • 收稿日期：2024-09-14
基金
四川省科技厅重点研发计划项目(2022YFS0600)
院级临床研究及转化基金(2021LY15)
作者信息
    四川省医学科学院·四川省人民医院(电子科技大学附属医院)，健康管理中心(健康管理研究所)，四川 成都 610072

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2种不同金属材料的力学参数
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Family		 属数
Number of
genus		 种数
Number of
species		 占总种数比例
Percentage of
total species (%)		 属
Genus		 种数
Number of
species		 占总种数比例
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鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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