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中西药联用治疗原发性骨质疏松症疗效和安全性的Meta分析     被引量:2

Meta-Analysis of the Efficacy and Safety of Combined Chinese and Western Medicine in the Treatment of Primary Osteoporosis

文献类型:期刊文献

中文题名:中西药联用治疗原发性骨质疏松症疗效和安全性的Meta分析

英文题名:Meta-Analysis of the Efficacy and Safety of Combined Chinese and Western Medicine in the Treatment of Primary Osteoporosis

作者:田雨[1];李喜香[2];王宝才[2];李翔[1]

第一作者:田雨

机构:[1]甘肃中医药大学药学院,甘肃兰州730000;[2]甘肃省中医院药学部,甘肃兰州730000

第一机构:甘肃中医药大学药学院(西北中藏药协同创新中心办公室)

年份:2020

卷号:15

期号:10

起止页码:1790

中文期刊名:世界中西医结合杂志

外文期刊名:World Journal of Integrated Traditional and Western Medicine

收录:CSTPCD

基金:兰州市人才创新创业项目(2017-RC-44)。

语种:中文

中文关键词:原发性骨质疏松症;系统评价;中西药联用;Meta分析

外文关键词:Primary Osteoporosis;Systematic Review;Integrative Medicine;Meta Analysis

摘要:目的评价中西药联合干预治疗原发性骨质疏松症的疗效与安全性。方法检索中国期刊全文数据库(CNKI)、中文科技期刊全文数据库(VIP)、中国生物医学数据库(CBM)、万方数据、Cochrane图书馆、Pub Med、EMbase、Web of Science数据库,检索时限截至2020年2月。纳入中西药联合干预治疗原发性骨质疏松症的随机对照实验(RCT)。由两名研究人员根据纳入与排除标准,独立进行文献筛选、数据提取、质量评价,并交叉核对结果,采用Rev Man 5.3软件进行Meta分析。结果共纳入23个RCT,共2359例原发性骨质疏松症患者。Meta分析结果显示,中西药联用组与对照组比较,有效率升高[RR=1.20,95%CI(1.15,1.25),P<0.000 01],两组VAS评分[WMD=-1.81,95%CI(-2.04,-1.59),P<0.000 01]、腰椎骨密度[WMD=0.53,95%CI(0.34,0.71),P<0.000 01]、股骨颈骨密度[WMD=0.49,95%CI(0.34,0.64),P<0.000 01]、其他部位骨密度[WMD=0.95,95%CI(0.78,1.11),P<0.000 01]、骨钙素[WMD=0.42,95%CI(0.18,0.66),P=0.000 5]、血钙[WMD=0.43,95%CI(0.05,0.80),P=0.03]、证候积分[WMD=-2.75,95%CI(-3.58,-1.92),P<0.000 01]比较差异有统计学学意义;两组骨特异性碱性磷酸酶(B-ALP)[WMD=0.13,95%CI(-0.62,0.88),P=0.74]、血磷[WMD=-0.11,95%CI(-0.39,0.18),P=0.45]比较差异无统计学意义。23篇纳入文献中,有10篇文献提及不良反应,有6篇文献报道了不良反应发生率,仅有2篇文献中西药联用组不良反应发生率低于对照组(P<0.05),差异均有统计学意义;另4篇文献中西药联用组不良反应发生率高于对照组(P>0.05),差异无统计学意义;其余13篇文献未提及安全性和不良反应。结论基于当前临床证据初步得出,中西药联用治疗原发性骨质疏松症可能优于单纯西药治疗。但纳入的研究存在潜在偏倚,仍需要进一步高质量的RCT进行论证。
Objective To assess the effeicacy and safety of combined Chinese and western medicine in the treatment of primary osteoporosis.Methods CNKI,VIP,CBM,wanfang,Cochrane library,Pub Med,EMbase,and Web of Science databases were searched,and the retrieval time was up to February 2020.A randomized controlled trial(RCTs) of combined Chinese and western medicine in the treatment of primary osteoporosis was included.According to inclusion and exclusion criteria,2 researchers independently conducted literature screening,data extraction and quality evaluation,and cross-checked the results.Meta analysis was performed using Rev Man5.3 software.Results A total of 23 RCTs were included,including 2359 patients with primary osteoporosis.Meta-analysis results showed that compared with the control group,the combination group of Chinese and Western medicines had an increased effective rate[RR = 1.20,95% CI(1.15,1.25),P<0.000 01],compared with VAS[WMD =-1.81,95% CI(-2.04,-1.59),P<0.000 01],lumbar bone mineral density[WMD = 0.53,95% CI(0.34,0.71),P<0.000 01],femoral neck bone mineral density[WMD = 0.49,95% CI(0.34,0.64),P<0.000 01],bone mineral density of other parts[WMD = 0.95,95% CI(0.78,1.11),P<0.000 01],osteocalcin[WMD = 0.42,95% CI(0.18,0.66),P = 0.000 5],blood calcium[WMD = 0.43,95% CI(0.05,0.80),P =0.03],syndrome score[WMD =-2.75,95% CI(-3.58,-1.92),P<0.000 01,WMD = 0.13,95% CI(-0.62,0.88),P = 0.74],blood phosphorus[WMD =-0.11,95% CI(-0.39,0.18),P = 0.45],the difference was not statistically significant.Among the 23 included literatures,10 literatures mentioned adverse reactions,and 6 of them reported the incidence of adverse reactions.Only 2 of the literatures reported that the incidence of adverse reactions in the combined western medicine group was lower than that in the control group,and the differences were statistically significant.Scientific significance(P<0.05);the incidence of adverse reactions in the combined western medicine group in the other 4 literatures was higher than that in the control group,and the difference was not statistically significant(P>0.05);the remaining 13 literatures did not mention safety and adverse reactions.Conclusion Based on the current clinical evidence,it is concluded that the combination of Chinese and western medicine in the treatment of primary osteoporosis is batter than western medicine alone.However,the included study has potential bias,which still needs to be demonstrated by further high-quality RCTS.

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