鲑降钙素治疗髋部骨折的系统评价

Evaluation of salmon calcitonin in the treatment of hip fractures

目的系统评价鲑降钙素对髋部骨折的疗效。方法计算机检索中国期刊全文数据库(1994-2014.5),中国生物医学文献数据库(1978-2014.5),中文科技期刊全文数据库(1989-2014.5),数字化期刊全文数据库(1997-2014.5),Pub Med(1966-2014.5),Cochrane library(2014年第2期),EMBASE(1990-2014.5),收集鲑降钙素治疗髋部骨折的随机对照实验(RCT),依据Cochrane评价手册5.1.0评价文献质量,并提取有效数据进行Meta分析。结果纳入11个RCT,共823名患者。Meta分析结果示:鲑降钙素可降低髋部骨折患者的再骨折率[RR=0.41,95%CI(0.04,0.47)]。可缓解髋部骨折后疼痛[SMD=2.27 95%CI(1.08,3.46),P=0.0002];不影响骨密度。对于骨代谢、髋关节功能及骨折愈合等指标,由于条件所限未能做Meta分析,只进行描述性分析。结论鲑降钙素可以降低髋部骨折患者的再骨折率,缓解疼痛,部分研究显示可能改善髋部活动功能及促进骨折愈合。因此可推荐鲑降钙素作为髋部骨折后的常规临床治疗方案。本结论尚需更多设计严谨、科学的临床试验进一步证实。

Objective To determine the efficacy of salmon calcitonin in the treatment of hip fractures. Methods The randomized clinical trials （RCTs） of salmon calcitonin treatment for hip fractures were searched from the CNKI （ 1994 -2014.5 ）, CBM （ 1978 - 2014.5 ） , VIP （989 - 2014.5 ） , Wanfang Data （ 1997 - 2014.5 ） , PubMed （ 1966 - 2014.5 ） , Cochrane library （issue 2, 2014）, and Embase （1990 -2014.5）. Data were extracted and Meta analysis was performed according to the Cochrane methods using RevMan 5.2.0 software. Results Eleven RCTs including 823 patients were eligible. Meta analysis showed that salmon calcitonin reduced the refracture rate in hip fracture patients ~ RR = 0. 41, 95% CI （0. 04, 0. 47 ） ~, relieved the pain after hip fracture [ SMD = 2.27, . 95% CI （1.08, 3.46）, P = 0. 0002 ], but did not affect bone mineral density. Since the indexes of bone metabolic markers, and the function of hip joint and fracture healing were not suitable for Meta analysis, we only made descriptive analysis. Conclusion Salmon calcitonin can reduce the refracture rate and release the pain of hip fracture patients. It also improves the hip function and promotes fracture healing. Therefore, we recommend salmon calcitonin as a routine treatment for hip fracture. But the results still need more rigorous, scientific clinical trials to confirm.