xov xwm

Cov ntshav siab thaum cev xeeb tub tuaj yeem ua rau eclampsia thiab yug ntxov ntxov thiab yog ib qho tseem ceeb ua rau niam thiab menyuam mos thiab tuag taus. Raws li kev ntsuas kev noj qab haus huv tseem ceeb, Lub Koom Haum Saib Xyuas Kev Noj Qab Haus Huv Ntiaj Teb (WHO) pom zoo tias cov poj niam cev xeeb tub uas tsis txaus noj calcium ntxiv ntxiv 1000 txog 1500 mg ntawm calcium txhua hnub. Txawm li cas los xij, vim muaj cov calcium ntxiv uas tsis tshua muaj siab, kev ua raws li cov lus pom zoo no tsis txaus siab.

Randomized tswj kev sim ua nyob rau hauv Is Nrias teb thiab Tanzania los ntawm xibfwb Wafie Fawzi ntawm Harvard Tsev Kawm Ntawv Kev Noj Qab Haus Huv Hauv Tebchaws Meskas tau pom tias kev noj cov calcium uas qis thaum cev xeeb tub tsis yog qhov phem tshaj li cov calcium ntxiv hauv kev txo cov kev pheej hmoo ntawm pre-eclampsia. Hais txog kev txo qis kev pheej hmoo ntawm kev yug ntxov ntxov, Indian thiab Tanzanian kev sim siab tau ua tsis tiav.

Ob qhov kev sim no suav nrog 11,000 tus neeg koom nrog hnub nyoog ≥18 xyoo, lub hnub nyoog gestational < txij lub Kaum Ib Hlis 2018 txog Lub Ob Hlis 2022 (Is Nrias teb) thiab Lub Peb Hlis 2019 txog Lub Peb Hlis 2022 (Tanzania). Cov niam txiv thawj zaug ntawm 20 lub lis piam uas xav tias yuav nyob hauv thaj chaw sim mus txog 6 lub lis piam tom qab yug me nyuam tau muab 1: 1 rau cov khoom noj uas tsis muaj calcium ntxiv (500 mg txhua hnub + 2 cov tshuaj placebo) lossis cov tshuaj calcium ntxiv (1500 mg txhua hnub) kom txog rau thaum yug. Cov ntsiab lus tseem ceeb yog preeclampsia thiab yug ntxov ntxov (dual endpoints). Cov ntsiab lus thib ob suav nrog kev kub siab ntawm cev xeeb tub, preeclampsia nrog qhov tshwm sim hnyav, kev tuag ntawm cev xeeb tub, tseem yug menyuam, yug menyuam tsis taus, me me rau lub hnub nyoog gestational, thiab kev tuag tsis pub dhau 42 hnub. Cov ntsiab lus ntawm kev nyab xeeb suav nrog kev mus pw hauv tsev kho mob ntawm cov poj niam cev xeeb tub (rau cov laj thawj uas tsis yog kev yug menyuam) thiab mob ntshav qab zib hnyav hauv peb lub hlis thib peb. Tsis yog-inferiority margins yog cov kev pheej hmoo ntawm 1.54 (preeclampsia) thiab 1.16 (preterm yug), feem.

Rau preeclampsia, qhov tshwm sim ntawm 500 mg piv rau 1500 mg pawg hauv Indian sim yog 3.0% thiab 3.6%, feem (RR, 0.84; 95% CI, 0.68 ~ 1.03); Hauv kev sim Tanzanian, qhov tshwm sim yog 3.0% thiab 2.7%, feem (RR, 1.10; 95% CI, 0.88 ~ 1.36). Ob qhov kev sim tau pom tias qhov kev pheej hmoo ntawm preeclampsia tsis yog phem dua nyob rau hauv pawg 500 mg dua li ntawm 1500 mg pawg.

Rau kev yug ntxov ntxov, hauv kev sim Indian, qhov tshwm sim ntawm 500 mg piv rau 1500 mg pawg yog 11.4% thiab 12.8%, ntsig txog (RR, 0.89; 95% CI, 0.80 ~ 0.98), qhov tsis muaj qis dua tau tsim nyob rau hauv tus nqi pib ntawm 1.54; Hauv kev sim Tanzanian, tus menyuam yug ntxov ntxov yog 10.4% thiab 9.7%, feem (RR, 1.07; 95% CI, 0.95 ~ 1.21), tshaj qhov tsis muaj qhov tsis zoo ntawm qhov pib ntawm 1.16, thiab qhov tsis muaj qhov qis dua tsis tau lees paub.

Hauv cov ntsiab lus thib ob thiab kev nyab xeeb, tsis muaj pov thawj tias pawg 1500 mg zoo dua li 500 mg pawg. Ib qho kev tshuaj ntsuam meta-kev soj ntsuam ntawm cov txiaj ntsig ntawm ob qhov kev sim pom tsis muaj qhov sib txawv ntawm 500 mg thiab 1500 mg pawg hauv preeclampsia, kev pheej hmoo yug ntxov ntxov, thiab cov txiaj ntsig thib ob thiab kev nyab xeeb.

Txoj kev tshawb no tsom mus rau cov teeb meem tseem ceeb ntawm kev noj qab haus huv pej xeem ntawm calcium supplementation rau cov poj niam cev xeeb tub rau kev tiv thaiv ntawm preeclampsia, thiab ua ib tug loj randomized tswj mus sib hais nyob rau hauv ob lub teb chaws ib txhij los teb cov lus nug tseem ceeb tab sis tseem tsis paub meej scientific lo lus nug ntawm qhov pom zoo koob tshuaj calcium supplementation. Txoj kev tshawb no muaj ib tug nruj tsim, loj qauv loj, ob-dig muag placebo, tsis yog-inferiority hypothesis, thiab ob tug tseem ceeb soj ntsuam tshwm sim ntawm preeclampsia thiab yug ntxov ntxov raws li ob lub endpoints, ua raws li 42 hnub tom qab yug me nyuam. Nyob rau tib lub sijhawm, qhov ua tau zoo ntawm kev ua tiav yog siab, tus nqi poob ntawm kev ua raws li qis heev (99.5% kev soj ntsuam tom qab cev xeeb tub, Is Nrias teb, 97.7% Tanzania), thiab kev ua raws cai yog siab heev: qhov nruab nrab feem pua ​​​​ntawm kev ua raws cai yog 97.7% (India, 93.2-99.3%), interquartile (2.9%). 82.7-97.1 interquartile ntu).

Calcium yog ib qho khoom noj tsim nyog rau kev loj hlob ntawm tus menyuam hauv plab thiab kev loj hlob, thiab qhov kev thov calcium hauv cov poj niam cev xeeb tub nce ntxiv nrog rau cov pej xeem, tshwj xeeb tshaj yog thaum cev xeeb tub thaum lub fetus loj hlob sai thiab cov pob txha pob txha pob txha pob txha yuav tsum tau ntxiv calcium ntxiv. Calcium supplementation tuaj yeem txo qhov tso tawm ntawm parathyroid hormone thiab intracellular calcium concentration nyob rau hauv cov poj niam cev xeeb tub, thiab txo qhov contraction ntawm cov hlab ntsha thiab uterine smooth nqaij. Kev sim tshuaj placebo tau qhia tias kev noj tshuaj calcium ntau ntxiv thaum cev xeeb tub (> 1000 mg) txo qhov kev pheej hmoo ntawm preeclampsia ntau dua 50% thiab kev pheej hmoo ntawm kev yug ntxov ntxov los ntawm 24%, thiab qhov txo qis tau tshwm sim ntau dua rau cov neeg uas muaj calcium tsawg. Yog li ntawd, nyob rau hauv "Cov Lus Pom Zoo Pom Zoo rau Calcium Supplementation Thaum Cev Xeeb Tub los Tiv Thaiv Preeclampsia thiab Nws Cov Teeb Meem" tau tshaj tawm los ntawm World Health Organization (WHO) thaum Lub Kaum Ib Hlis 2018, nws tau pom zoo tias cov neeg uas muaj calcium tsawg yuav tsum ntxiv calcium nrog 1500 txog 2000 mg txhua hnub, muab faib ua peb koob tshuaj, thiab ob peb teev ntawm kev noj cov hlau. Tuam Tshoj tus kws tshaj lij pom zoo rau Calcium Supplementation rau cov poj niam cev xeeb tub, tshaj tawm thaum lub Tsib Hlis 2021, pom zoo tias cov poj niam cev xeeb tub uas tsis tshua muaj calcium ntxiv calcium 1000 ~ 1500 mg txhua hnub kom txog thaum yug.

Tam sim no, tsuas yog ob peb lub teb chaws thiab cheeb tsam tau ua raws li niaj hnub siv tshuaj calcium ntau ntxiv thaum cev xeeb tub, cov laj thawj suav nrog qhov ntim loj ntawm calcium ntau npaum li cas, nyuaj rau nqos, txoj kev tswj hwm txoj haujlwm (peb zaug hauv ib hnub, thiab yuav tsum tau sib cais los ntawm cov hlau), thiab kev ua raws li cov tshuaj txo qis; Hauv qee thaj chaw, vim muaj cov peev txheej tsawg thiab cov nqi siab, calcium tsis yooj yim kom tau, yog li qhov ua tau ntawm cov tshuaj calcium ntxiv tau cuam tshuam. Hauv kev sim tshuaj ntsuam xyuas cov tshuaj calcium uas tsis muaj tshuaj ntxiv thaum cev xeeb tub (feem ntau 500 mg txhua hnub), txawm hais tias piv nrog cov placebo, qhov kev pheej hmoo ntawm preeclampsia raug txo qis hauv pawg calcium supplementation (RR, 0.38; 95% CI, 0.28 ~ 0.52), tab sis nws yuav tsum tau paub txog qhov muaj kev pheej hmoo ntawm kev tshawb fawb. Hauv tsuas yog ib qho kev sim me me piv rau cov tshuaj calcium uas tsis tshua muaj thiab cov tshuaj calcium ntau ntxiv, qhov kev pheej hmoo ntawm preeclampsia tshwm sim txo qis hauv cov koob tshuaj ntau dua piv rau cov pab pawg tsawg (RR, 0.42; 95% CI, 0.18 ~ 0.96); Tsis muaj qhov sib txawv ntawm qhov kev pheej hmoo ntawm kev yug ntxov ntxov (RR, 0.31; 95% CI, 0.09 ~ 1.08)