补肾活血法治疗骨质疏松症对骨密度、骨代谢疗效的Meta分析
The Meta-analysis of the therapeutic effects of tonifying the kidney and promoting blood circulation method on bone density and bone metabolism in the treatment of osteoporosis
熊浪 1唐芳 2马武开 2兰维娅 2蒋总 2蔡珊珊 1陈学勇1
作者信息
- 1. 贵州中医药大学,贵州 贵阳 550002
- 2. 贵州中医药大学第二附属医院,贵州 贵阳 550003
- 折叠
摘要
目的 系统评价补肾活血法治疗骨质疏松症(osteoporosis,OP)对骨密度(bone mineral density,BMD)与骨代谢标志物的疗效.方法 检索的中文数据库为知网、维普、万方,英文数据库为PubMed、Embase、Web of Science、Cochrane,检索运用补肾活血法的中药制剂或联合常规疗法治疗OP的BMD与骨代谢标志物的随机对照试验.对纳入文献进行Cochrane推荐的改良Jadad评分量表与随机对照试验偏倚风险工具的质量评价,采用RevMan5.3 软件进行Meta统计分析.结果 共纳入 16 篇文献,共 1 851 例患者.分析结果:①补肾活血法中药制剂联合常规疗法治疗OP,与对照组相比,有以下优势临床效果:中医证候积分[MD=-2.99,95%CI:-4.11～-1.86,P<0.000 01]、腰椎BMD[MD=0.06,95%CI:0.04～0.08,P<0.000 01]、股骨颈BMD[MD=0.04,95%CI:0.03～0.06,P<0.000 01]、骨钙素(BGP)[MD=1.41,95%CI:0.68～2.14,P=0.000 1]及I型胶原羧基端肽β特殊序列(β-CTX)[MD=-0.28,95%CI:-0.42～-0.14,P=0.000 1];同时,治疗OP后的Ward三角BMD、骨源性碱性磷酸酶(BALP)、I型原胶原N-端前肽(PINP)及抗酒石酸性磷酸酶(TRACP-5B)与对照组相比无明显差异;②亚组结果:补肾活血法中药制剂联合常规疗法治疗三种类型OP的腰椎BMD、BGP的疗效明显优于对照组,且治疗老年骨质疏松症(senile osteoporosis,SOP)和原发性骨质疏松症(primary osteoporosis,POP)的BGP 疗效明显优于绝经后骨质疏松症(postmenopausal osteoporosis,PMOP).结论 ①补肾活血法中药制剂联合常规疗法在治疗OP 方面,对中医证候、BMD(腰椎、股骨颈)、BGP、β-CTX的疗效更为显著;②补肾活血法中药制剂联合常规疗法在治疗3 种类型OP腰椎BMD、BGP的疗效明显优于对照组,且治疗SOP、POP的BGP疗效明显优于PMOP;③对于这两种结果,需进行统一性、规范性、高标准和高质量的大样本、多中心试验研究进行分析和评估.
Abstract
Objective To systematically evaluate the efficacy of kidney-tonifying and blood-activating therapy on bone mineral density(BMD)and bone metabolism markers in the treatment of osteoporosis(OP).Methods Chinese databases(CNKI,VIP,and Wanfang)and English databases(PubMed,Embase,Web of Science,and Cochrane)were screened.Randomized controlled trials that used kidney-tonifying and blood-activating therapy in combination with traditional Chinese medicine preparations or conventional therapy to treat BMD and bone metabolism markers in OP were included.The quality of the included literature was evaluated using the modified Jadad rating scale recommended by Cochrane and the risk of bias tool for randomized controlled trials.Meta-statistical analysis was performed using RevMan5.3 software.Results A total of 16 articles including 1851 patients were included.①The result of the analysis indicated the following advantages of combining traditional Chinese medicine preparations with conventional therapy for the treatment of OP compared to the control group,including Traditional Chinese Medicine Syndrome Score[MD=-2.99,95%CI(-4.11～-1.86),P<0.00001],lumbar spine BMD[MD=0.06,95%CI(0.04-0.08),P<0.00001],femoral neck BMD[MD=0.04,95%CI(0.03-0.06),P<0.000 01],bone glaprotein(BGP)[MD=1.41,95%CI(0.68-2.14),P=0.000 1],and type I collagen carboxy terminal peptide β special sequence(β-CTX)[MD=-0.28,95%CI(-0.42--0.14),P=0.0001].Additionally,there were no significant differences observed in Wards triangle BMD after OP,bone specific alkaline phosphatase(BALP),N-terminal propeptide of type I procollagen(PINP),and tartrate-resistant acid phosphatase 5B(TRACP-5B)when compared to those in the control group.②Subgroup analysis revealed that the combination of traditional Chinese medicine preparations with conventional therapy was significantly more effective than the control group in treating lumbar spine BMD and BGP for all three types of OP.Additionally,it demonstrated greater efficacy in treating senile osteoporosis(SOP)and primary osteoporosis(POP)than in postmenopausal osteoporosis(PMOP)in terms of BGP.Conclusion ①In the treatment of osteoporosis,the combination of traditional Chinese medicine preparations using the method of tonifying the kidney and promoting blood circulation,along with conventional therapy,has shown more significant efficacy in terms of traditional Chinese medicine syndrome differentiation,bone mineral density(lumbar spine and femoral neck),BGP and β-CTX.②Furthermore,the efficacy of traditional Chinese medicine preparations that tonify the kidney and activate blood circulation,in combination with conventional therapy,is significantly better than that of the control in treating lumbar spine BMD and BGP for all three types of OP.Additionally,it has been found to be more effective in treating SOP and POP compared to PMOP in terms of BGP.③ Further research should be conducted using unified,standardized,and high-quality large-sample studies to analyze and evaluate these result.
关键词
补肾活血/骨质疏松症/骨密度/骨代谢/Meta分析Key words
tonifying the kidney and promoting blood circulation/osteoporosis/bone mineral density/bone metabolism/meta-analysis引用本文复制引用
基金项目
国家自然科学基金(82160917)
贵州省教育厅青年科技人才成长项目(黔教合KY字2022262号)
贵州省科技计划项目(黔科合基础-ZK2023一般435)
贵州省中医风湿免疫病临床研究中心项目(黔科合平台人才20202202)
贵州省高等学校中西医结合防治疾病转化医学重点实验室(黔教技2023017号)
贵州中医药大学国家与省级科技创新人才团队培育项目(贵中医TD合字2022004号)
贵州中医药大学大学生创新创业训练计划项目(贵中医大创合字202157号)
出版年
2024
NETL
NSTL
万方数据