大豆异黄酮干预对妇女骨密度影响的META分析

META ANALYSIS FOR THE EFFECTS OF SOY ISOFLAVONE INTERVENTION ON BONE DENSITY IN WOMEN

目的采用meta分析方法评估大豆异黄酮干预对妇女骨密度作用的随机对照试验研究的合并效应。方法以"植物雌激素"、"异黄酮"、"大豆"、"金雀素黄酮"和"骨"为主题词和关键词,检索1990年1月至2007年10月Medline、Pubmed及CNKI数据库发表的有关文献。纳入文献限定于在成年妇女中进行大豆异黄酮随机对照试验,且有干预前后骨密度值或改变值及其标准差或可信区间者。结果共纳入16篇文献,含1304名妇女,约91%为停经女性。结果发现,平均每天补充73mg异黄酮者的腰椎和总股骨骨密度的年均变化值(95%CI)比对照人群分别增加了18.3(6.0～30.6)和3.3(0.5～6.1)mg/cm2,相当于对应部位骨密度值的2.0%和0.4%;但对股骨颈骨密度无显著效应。亚组分析显示,该效应在干预剂量≥80mg/d者略好于小于80mg/d者;干预时间<1年者略好于≥1年者;剔出非绝经对象可轻微增加合并效应。结论大豆异黄酮干预可有效改善妇女腰椎及总股骨骨密度。

Objective To evaluate the effects of soy isoflavones on bone density （BMD） in women in randomized clinical trials by meta-analysis. Method We searched the databases the Medline, Pubmed, and CNKI from January 1990 to October 2007 using the key words, phytoestrogen, isoflavone, soy, genistein in combination with bone. We only included the studies of randomized clinical trial, in which the data of BMDs at lumbar spine, total hip or femoral neck prior to and post isoflavone intervention or their relevant changes and their standard deviation or 95% CI in women were provided. Results Sixteen papers （1304 women, 91% postmenopausal） were included and a mean daily dose of 73 mg supplemental soy isoflavones resulted in weighted mean （%）（95%CI） difference in yearly BMD changes of 18.3 （2.0%, CI 6.0-30.6） and 3.3（0.40%, CI 0.5-6.1） mg/cm^2 at the lumber spine and total hip, respectively. Subgroup analyses showed that the effects were more pronounced in those with the isoflavone dose ≥ 80 mg/d than those of 〈80mg/d, and in those with a shorter intervention duration （〈1year） than those with longer duration （≥ 1year）. The pooled effects increased slightly when the studies were limited to postmenopausal women. Conclusion Isoflavone supplementation has a statistically beneficial effect on BMD changes at the lumber spine and total hip in women.