亚临床皮质醇增多症与骨质疏松症的关系：系统综述和meta分析

Relationship between subclinical hypercortisolism and osteoporosis： A systematic review and meta-analysis

目的探讨亚临床皮质醇增多症（SH）与骨质疏松症的关系。方法检索MEDLINE、B10SISPreviews、HighWire、维普数据库、万方数据库获取研究SH与骨质疏松的关系的文献。以骨密度、骨转换生化标志物、骨质疏松症患病率、骨折发病率为结局指标。仅限中英文文献。按照纳入和排除标准选择相关研究进行文献质量评价后，使用RevMan5软件进行meta分析。结果共纳入研究15个，回顾性研究6个，前瞻性研究6个，干预性研究3个。回顾性研究显示骨密度水平在亚临床皮质醇增多症组（SH＋组）明显低于非亚临床皮质醇增多症组（SH一组），前瞻性研究meta分析发现腰椎及股骨颈骨密度水平SH＋组显著低于SH一组（均P〈0．01），而回顾性研究和前瞻性研究均显示骨转换生化指标在两组问则无显著差异；干预性研究显示对SH的患者进行手术干预不能改善预后。结论SH可以降低腰椎及股骨颈骨密度．增加骨质疏松症患病率及骨折发病率．对并发骨质疏松症的SH的患者进行手术干预．不能明确回答患者是否获益，有待进一步研究。

Objective To explore the relationship between subclinical hypercortisolism （ SH ） and osteoprosis. Methods MEDLINE, BIOSIS Previews, High Wire Wanfang Database, and Vip Database were retrieved for articles about the relations of SH and osteoporosis. Searches were limited to Chinese/English-language publications. The clinical outcomes evaluated in this study included bone mineral density, biochemical markers of bone turnover, prevalence of osteoporosis, and incidence of fracture. Meta-analysis was carried out by RevMan5 among articles suitable for the inclusion and exclusion criteria. Results Fifteen studies were included, containing 6 retrospective studies, 6 prospective studies, and 3 intervention studies. Retrospective studies suggested that bone mineral density level in subclinical hypercortisolism group （ SH ＋ group ） was significantly lower than that in the nonsubclinical hypercortisolism group （ SH- group） , meta-analysis of prospective studies showed that the level of bone mineral density at lumbar spine and femoral neck was significantly lower in SH＋ group than that in the SH- group（ all P〈0.01 ）. Both retrospective studies and prospective studies showed no significant difference between the biochemical markers of bone turnover in both SH＋ and SH- groups. Data from intervention studies showed that the prognosis in SH patients with surgical intervention was not improved. Conclusions SH reduces bone mineral density at lumbar spine and femoral neck, and increases the prevalence of osteoporosis and incidence of fracture. Whether surgical intervention is beneficial in SH patients remains uncertain.